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1.
Acad Med ; 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34261864

RESUMO

PURPOSE: In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions. METHOD: For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0 - ≥15) per determination. These individual student-level data were de-identified and merged into a multischool database; Chi-squares tested the significance of associations between variables. RESULTS: The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or with evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (Chi-square P < .001) and, for 10/13 EPAs, WBAs availability was associated with making (vs. not making) entrustment decisions (each Chi-square P < .05). CONCLUSIONS: TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness for entrustment to perform this EPA with indirect supervision." More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.

2.
J Aging Phys Act ; : 1-7, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193627

RESUMO

The Physical Activity Guidelines for Americans, second edition recommends that older adults do multicomponent physical activity, which includes balance training in addition to aerobic and muscle-strengthening activities. The authors estimated the prevalence of U.S. older adults (age ≥65 years) who do balance activities and meet the aerobic and muscle-strengthening physical activity guidelines. The authors analyzed data on 1,012 respondents to the 2019 FallStyles survey, a nationwide web-based panel survey. Approximately four in 10 respondents (40.7%) reported doing balance activities on ≥1 day/week, 34.0% on ≥2 days/week, and 25.3% on ≥3 days/week. Prevalence differed by sex, education level, income level, census region, body mass index category, and meeting the aerobic and/or muscle-strengthening guidelines. The combined prevalence of participation in balance activities and meeting aerobic and muscle-strengthening guidelines ranged from 12.0% for ≥3 days/week to 15.8% for ≥1 day/week. Opportunities exist to introduce and increase participation in balance and multicomponent activities by older adults.

3.
Acad Med ; 96(7S): S14-S21, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183597

RESUMO

The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.


Assuntos
Competência Clínica , Educação Baseada em Competências , Educação de Graduação em Medicina , Internato e Residência , Comportamento Cooperativo , Diagnóstico Diferencial , Documentação , Medicina Baseada em Evidências , Humanos , Ciência da Implementação , Consentimento Livre e Esclarecido , Relações Interprofissionais , Anamnese , Transferência da Responsabilidade pelo Paciente , Segurança do Paciente , Exame Físico , Projetos Piloto , Gestão da Segurança
4.
J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120960

RESUMO

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.


Assuntos
COVID-19/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Populações Vulneráveis , Adolescente , Adulto , Idoso , Criança , Serviços de Saúde Comunitária , Informação de Saúde ao Consumidor , Feminino , Florida/epidemiologia , Assistência Alimentar , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Pandemias , Determinantes Sociais da Saúde , Adulto Jovem
6.
Int J Mol Sci ; 22(9)2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33922383

RESUMO

Ageing represents the single biggest risk factor for development of neurodegenerative disease. Despite being such long-lived cells, microglia have been relatively understudied for their role in the ageing process. Reliably identifying aged microglia has proven challenging, not least due to the diversity of cell populations, and the limitations of available models, further complicated by differences between human and rodent cells. Consequently, the literature contains multiple descriptions and categorisations of microglia with neurotoxic phenotypes, including senescence, without any unifying markers. The role of microglia in brain homeostasis, particularly iron storage and metabolism, may provide a key to reliable identification.


Assuntos
Envelhecimento/patologia , Senescência Celular , Microglia/patologia , Doenças Neurodegenerativas/patologia , Animais , Humanos , Doenças Neurodegenerativas/etiologia
7.
Urology ; 148: 77-82, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33290774

RESUMO

OBJECTIVE: To compare the health-related quality of life (HRQOL) of patients with residual fragments after surgical intervention for kidney stones to patients that are stone-free using the disease-specific Wisconsin stone quality of life (WISQOL) questionnaire. Kidney stones contribute to impaired HRQOL, which is increasingly recognized as an important healthcare outcome measurement. MATERIALS AND METHODS: With institutional review board approval, 313 adult patients who underwent surgical intervention for kidney stones at 4 sites completed a WISQOL questionnaire. We retrospectively collected surgical data including presence of residual fragments on post-operative imaging. We calculated standardized WISQOL total and domain scores (0-100), which included items related to social functioning (D1), emotional functioning (D2), stone-related impact (D3), and vitality (D4). Scores were compared between patients with residual fragments to those who were stone-free after surgical intervention. RESULTS: Demographics did not differ between groups, overall mean age 54.6 ± 13.5 and 55.4% female. There was no significant difference in total WISQOL score for patients with residual fragments (n = 124) compared to patients that were stone-free (n = 189), 110.5 ± 27.8 vs 115.4 ± 23.6 respectively, (P = .12). Interestingly, patients with residual fragments who underwent secondary surgery were found to have significantly lower total WISQOL score (88.4 ± 30.1 vs 116.6 ± 25.0, P <.0001). CONCLUSION: Stone-free status after surgical intervention is not associated with better HRQOL when compared with patients whose surgeries left residual fragments. Indeed, further surgical intervention on residual fragments to achieve stone-free status may actually result in worse HRQOL.

8.
Am J Prev Med ; 60(1): e27-e40, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33341185

RESUMO

CONTEXT: The number of children who bicycle or walk to school has steadily declined in the U.S. and other high-income countries. In response, several countries responded in recent years by funding infrastructure and noninfrastructure programs that improve the safety, convenience, and attractiveness of active travel to school. The objective of this study is to synthesize the economic evidence for the cost and benefit of these programs. EVIDENCE ACQUISITION: Literature from the inception of databases to July 2018 were searched, yielding 9 economic evaluation studies. All analyses were done in September 2018-May 2019. EVIDENCE SYNTHESIS: All the studies reported cost, 6 studies reported cost benefit, and 2 studies reported cost effectiveness. The cost-effectiveness estimates were excluded on the basis of quality assessment. Cost of interventions ranged widely, with higher cost reported for the infrastructure-heavy projects from the U.S. ($91,000-$179,000 per school) and United Kingdom ($227,000-$665,000 per project). Estimates of benefits differed in the inclusion of improved safety for bicyclists and pedestrians, improved health from increased physical activity, and reduced environmental impacts due to less automobile use. The evaluations in the U.S. focused primarily on safety. The overall median benefit‒cost ratio was 4.4:1.0 (IQR=2.2:1-6.0:1, 6 studies). The 2-year benefit-cost ratios for U.S. projects in California and New York City were 1.46:1 and 1.79:1, respectively. CONCLUSIONS: The evidence indicates that interventions that improve infrastructure and enhance the safety and ease of active travel to schools generate societal economic benefits that exceed the societal cost.


Assuntos
Instituições Acadêmicas , Criança , Análise Custo-Benefício , Humanos , Cidade de Nova Iorque , Reino Unido
9.
Clin Diabetes Endocrinol ; 6(1): 18, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33292727

RESUMO

BACKGROUND: While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone. METHODS: A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone. RESULTS: Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided. CONCLUSION: Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone.

10.
Prev Med ; 141: 106279, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33035548

RESUMO

Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months and can be one of the earliest symptoms of Alzheimer's disease. Regular physical activity can contribute to the primary, secondary, and tertiary prevention of cognitive decline. At the national level, prevalence estimates of SCD by physical activity level in the United States are currently unknown. The purpose of this study is to examine the prevalence of SCD and resulting functional limitations by physical activity level among US adults aged ≥45 years. Data from 33 states and the District of Columbia participating in the 2015 Behavioral Risk Factor Surveillance System (N = 128,925) were analyzed. We estimated the prevalence of SCD (a positive response to a question about worsening or more frequent confusion or memory loss within the previous 12 months) and resulting functional limitations overall and by self-reported physical activity level based on current guidelines (i.e., active, insufficiently active, and inactive). Odds ratios were estimated using logistic regression models adjusting for respondent characteristics. Overall, 11.3% of US adults aged ≥45 years reported SCD. Prevalence of SCD increased as physical activity level decreased (active: 8.8%; insufficiently active: 11.4%; inactive: 15.7%). Among those with SCD, the prevalence of functional limitations also increased as physical activity level decreased (active: 40.5%; insufficiently active: 50.0%; inactive: 57.4%). These differences largely remained after adjusting for respondent characteristics. Findings highlight the potential public health impact nationally of efforts to promote physical activity for cognitive health.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Adulto , Disfunção Cognitiva/epidemiologia , Estudos Transversais , District of Columbia , Exercício Físico , Humanos , Estados Unidos/epidemiologia
11.
Circulation ; 142(11): e160-e166, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32787451

RESUMO

Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.

12.
PLoS One ; 15(8): e0237325, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810134

RESUMO

Recent research has shown relationships between health outcomes and residence proximity to unconventional oil and natural gas development (UOGD). The challenge of connecting health outcomes to environmental stressors requires ongoing research with new methodological approaches. We investigated UOGD density and well emissions and their association with symptom reporting by residents of southwest Pennsylvania. A retrospective analysis was conducted on 104 unique, de-identified health assessments completed from 2012-2017 by residents living in proximity to UOGD. A novel approach to comparing estimates of exposure was taken. Generalized linear modeling was used to ascertain the relationship between symptom counts and estimated UOGD exposure, while Threshold Indicator Taxa Analysis (TITAN) was used to identify associations between individual symptoms and estimated UOGD exposure. We used three estimates of exposure: cumulative well density (CWD), inverse distance weighting (IDW) of wells, and annual emission concentrations (AEC) from wells within 5 km of respondents' homes. Taking well emissions reported to the Pennsylvania Department of Environmental Protection, an air dispersion and screening model was used to estimate an emissions concentration at residences. When controlling for age, sex, and smoker status, each exposure estimate predicted total number of reported symptoms (CWD, p<0.001; IDW, p<0.001; AEC, p<0.05). Akaike information criterion values revealed that CWD was the better predictor of adverse health symptoms in our sample. Two groups of symptoms (i.e., eyes, ears, nose, throat; neurological and muscular) constituted 50% of reported symptoms across exposures, suggesting these groupings of symptoms may be more likely reported by respondents when UOGD intensity increases. Our results do not confirm that UOGD was the direct cause of the reported symptoms but raise concern about the growing number of wells around residential areas. Our approach presents a novel method of quantifying exposures and relating them to reported health symptoms.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/efeitos adversos , Fraturamento Hidráulico , Gás Natural/efeitos adversos , Campos de Petróleo e Gás , Adulto , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pennsylvania , Estudos Retrospectivos , Níveis Máximos Permitidos
13.
Acad Med ; 95(1): 77-82, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31348064

RESUMO

PROBLEM: In 2014, medical students at the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) first drew attention to perceived gaps in the sexual health curriculum. The authors used Kern and colleagues' model for curriculum development to review and update the existing curriculum. APPROACH: To develop longitudinal sexual health curricular objectives for undergraduate medical education (UME), the authors reviewed existing specialty- and organization-specific objectives. Then, an iterative process guided by clear criteria was used to develop feasible objectives, which were refined through stakeholder feedback. As these objectives were being finalized in 2017, UME sexual health competencies were first published; the authors mapped their objectives to these, as possible. The medical school's course activities and assessments were mapped to the authors' sexual health objectives to identify curricular gaps and unplanned redundancies. OUTCOMES: This process resulted in 12 sexual health curricular objectives that are adaptable by other institutions. In mapping the FIU HWCOM curriculum to these objectives, specific gaps and assessment weaknesses emerged. With stakeholder support obtained through a strong curricular management structure, the work of modifying content to address gaps has begun. NEXT STEPS: New assessments specific to these sexual health objectives are needed, especially within the clinical curriculum. Assessment of these objectives may be strengthened through the development of new sexual-health-related entrustable professional activities (EPAs) nested within the broader Core EPAs for Entering Residency being piloted. When data on learning outcomes are available, the process of targeting curricular improvement will begin.


Assuntos
Educação Baseada em Competências/métodos , Currículo/normas , Educação de Graduação em Medicina/métodos , Saúde Sexual/normas , Currículo/tendências , Feminino , Florida/epidemiologia , Humanos , Internato e Residência/métodos , Aprendizagem/fisiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Faculdades de Medicina/organização & administração , Estudantes de Medicina/estatística & dados numéricos
14.
J Neurochem ; 151(6): 676-688, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31478208

RESUMO

The single largest risk factor for etiology of neurodegenerative diseases like Alzheimer's disease is increased age. Therefore, understanding the changes that occur as a result of aging is central to any possible prevention or cure for such conditions. Microglia, the resident brain glial population most associated with both protection of neurons in health and their destruction is disease, could be a significant player in age related changes. Microglia can adopt an aberrant phenotype sometimes referred to either as dystrophic or senescent. While aged microglia have been frequently identified in neurodegenerative diseases such as Alzheimer's disease, there is no conclusive evidence that proves a causal role. This has been hampered by a lack of models of aged microglia. We have recently generated a model of senescent microglia based on the observation that all dystrophic microglia show iron overload. Iron-overloading cultured microglia causes them to take on a senescent phenotype and can cause changes in models of neurodegeneration similar to those observed in patients. This review considers how this model could be used to determine the role of senescent microglia in neurodegenerative diseases.


Assuntos
Envelhecimento/metabolismo , Encéfalo/metabolismo , Senescência Celular/fisiologia , Microglia/metabolismo , Doenças Neurodegenerativas/metabolismo , Envelhecimento/patologia , Animais , Encéfalo/patologia , Humanos , Microglia/patologia , Doenças Neurodegenerativas/patologia , Neurônios/metabolismo , Neurônios/patologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31452436

RESUMO

Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.


Assuntos
Poluentes Atmosféricos/análise , Exposição Ambiental/análise , Monitoramento Ambiental/métodos , Gás Natural/análise , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Pennsylvania/epidemiologia , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/fisiopatologia , Vento
16.
Am J Health Promot ; 33(2): 191-198, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29860864

RESUMO

PURPOSE: The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. DESIGN: Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. SETTING: Nationally representative sample of US municipalities. PARTICIPANTS: Respondents are 2005 local officials. MEASURES: Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. ANALYSIS: Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. RESULTS: Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement. CONCLUSIONS: Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.


Assuntos
Planejamento de Cidades/organização & administração , Participação da Comunidade/métodos , Planejamento Ambiental , Exercício Físico , Promoção da Saúde/organização & administração , Estudos Transversais , Humanos , Políticas , Características de Residência , Fatores Socioeconômicos , Transportes , Estados Unidos
18.
PLoS One ; 13(8): e0202462, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30114206

RESUMO

Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close is too close?" for maintaining public health and safety. The goal of this Delphi study was to elicit expert consensus on appropriate setback distances for UOGD from human activity. Three rounds were used to identify and seek consensus on recommended setback distances. The 18 panelists were health care providers, public health practitioners, environmental advocates, and researchers/scientists. Consensus was defined as agreement of ≥70% of panelists. Content analysis of responses to Round 1 questions revealed four categories: recommend setback distances; do not recommend setback distances; recommend additional setback distances for vulnerable populations; do not recommend additional setback distances for vulnerable populations. In Round 2, panelists indicated their level of agreement with the statements in each category using a five-point Likert scale. Based on emerging consensus, statements within each category were collapsed into seven statements for Round 3: recommend set back distances of <» mile; »-½ mile; 1-1 » mile; and ≥ 2 mile; not feasible to recommend setback distances; recommend additional setbacks for vulnerable groups; not feasible to recommend additional setbacks for vulnerable groups. The panel reached consensus that setbacks of < » mile should not be recommended and additional setbacks for vulnerable populations should be recommended. The panel did not reach consensus on recommendations for setbacks between » and 2 miles. The results suggest that if setbacks are used the distances should be greater than » of a mile from human activity, and that additional setbacks should be used for settings where vulnerable groups are found, including schools, daycare centers, and hospitals. The lack of consensus on setback distances between 1/4 and 2 miles reflects the limited health and exposure studies and need to better define exposures and track health.


Assuntos
Indústria de Petróleo e Gás , Saúde Pública , Consenso , Técnica Delfos , Pessoal de Saúde , Humanos , Pesquisadores , Inquéritos e Questionários
19.
Prev Med ; 115: 39-46, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30099046

RESUMO

Community planning documents can play an important role in promoting the design and maintenance of walkable communities. This study estimates the prevalence among US municipalities of (1) community wide planning documents and (2) inclusion of plan objectives supportive of active living within these documents. Data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL), a survey of local officials, were analyzed (n = 2005). Prevalence of comprehensive or general plans, 3 specific plan types, and 3 objectives supportive of active living were analyzed using survey weights to create national estimates. Overall, 64% of municipalities had a comprehensive/general plan, 46% had a transportation plan, 48% had a bicycle or pedestrian plan and 76% had a land use plan. Of municipalities with a plan, 78% included at least one of the three objectives measured supportive of active living. Differences in presence of plans and objectives were observed by population size of the municipality, urban status, region, and median education. Helping communities, especially smaller or rural municipalities and those with lower median education levels, create and adopt planning documents supportive of active living may be an important step in creating more walkable communities.


Assuntos
Ambiente Construído , Planejamento de Cidades/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Promoção da Saúde , População Urbana/estatística & dados numéricos , Ciclismo , Cidades , Exercício Físico , Humanos , Prevalência , Caminhada
20.
Biomolecules ; 8(3)2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30071596

RESUMO

Aging is the most prominent risk factor for most neurodegenerative diseases. However, incorporating aging-related changes into models of neurodegeneration rarely occurs. One of the significant changes that occurs in the brain as we age is the shift in phenotype of the resident microglia population to one less able to respond to deleterious changes in the brain. These microglia are termed dystrophic microglia. In order to better model neurodegenerative diseases, we have developed a method to convert microglia into a senescent phenotype in vitro. Mouse microglia grown in high iron concentrations showed many characteristics of dystrophic microglia including, increased iron storage, increased expression of proteins, such as ferritin and the potassium channel, Kv1.3, increased reactive oxygen species production and cytokine release. We have applied this new model to the study of α-synuclein, a protein that is closely associated with a number of neurodegenerative diseases. We have shown that conditioned medium from our model dystrophic microglia increases α-synuclein transcription and expression via tumor necrosis factor alpha (TNFα) and mediated through nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB). The conditioned medium also decreases the formation of α-synuclein tetramers, associated ferrireductase activity, and increases aggregates of α-synuclein. The results suggest that we have developed an interesting new model of aged microglia and that factors, including TNFα released from dystrophic microglia could have a significant influence on the pathogenesis of α-synuclein related diseases.


Assuntos
Senescência Celular , Regulação da Expressão Gênica , Microglia/patologia , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/patologia , alfa-Sinucleína/metabolismo , Animais , Morte Celular , Linhagem Celular Tumoral , Proliferação de Células , Humanos , Camundongos , Doenças Neurodegenerativas/genética , Fenótipo , Regiões Promotoras Genéticas/genética , Agregados Proteicos , Fator de Necrose Tumoral alfa/metabolismo , alfa-Sinucleína/química , alfa-Sinucleína/genética
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