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1.
CMAJ ; 193(38): E1483-E1493, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34580141

RESUMO

BACKGROUND: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. METHODS: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. RESULTS: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. INTERPRETATION: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.


Assuntos
COVID-19/epidemiologia , Hospitalização , Índice de Gravidade de Doença , Doença Aguda , Adolescente , COVID-19/diagnóstico , COVID-19/etiologia , COVID-19/terapia , Teste para COVID-19 , Canadá/epidemiologia , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Achados Incidentais , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Vigilância em Saúde Pública , Fatores de Risco
2.
J Adolesc Health ; 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34462192

RESUMO

PURPOSE: The purpose of this study was to compare pre/post-COVID-19 changes in mental health-related emergency department visits among adolescents. METHODS: We conducted a retrospective analysis of all mental health-related emergency department visits in two large tertiary pediatric hospital centers between January 2018 and December 2020. We described monthly pre/post-COVID-19 changes in frequency and proportion of mental health visits as well as changes in hospitalization rates for eating disorders, suicidality, substance use, and other mental health conditions. RESULTS: We found an increase in the proportion of mental health-related emergency department visits during the months of July-December 2020 (p < .01). There was a 62% increase in eating disorder visits between 2018-2019 and 2020 (p < .01). No pre pandemic/postpandemic changes were found in the proportion of visits resulting in hospitalization for any of the four diagnostic categories. CONCLUSIONS: Our study suggests significant impacts of COVID-19 on adolescent mental health and a need for further longitudinal research work in this area.

3.
Child Obes ; 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34264758

RESUMO

Background and Objective: Weight-related behaviors are determined by multiple individual and contextual factors, with recent evidence implicating personal social networks (PSNs). Greater understanding of these relationships could help inform healthy weight promoting interventions. We conducted a feasibility study among youth at risk of obesity to document process outcomes, to discern relationships between PSN features and weight-related behaviors, and to generate hypotheses with respect to perceived social support (SS) and sex. Methods: Participants (egos) nominated up to 10 people (alters) with whom they discussed important matters. Egos reported their own and each alter's age, sex, body shape, lifestyle behaviors, relation, frequency of exercising with each alter, and of being encouraged by each alter to exercise. We examined relationships between PSN features and weight-related outcomes and explored the role of SS, using both correlational and linear regression analyses. Results: There were 45 participants (mean age 16.4 years) and body mass index z-score (zBMI) ranged from -1.2 to 3.9. There were few missing responses to PSN items; broad variation across most items, including SS scores, was reported. Correlations pointed to plausible relationships implicating PSN features and lifestyle behaviors. In exploratory analyses, network-based SS was positively associated with adiposity in girls and negatively associated in boys, while lifestyle role modelling was not associated with adiposity. Conclusions: Our findings support the feasibility of measuring the PSN in youth and the potential for using social network analysis to investigate social and behavioral mechanisms associated with obesity.

4.
CJEM ; 23(5): 663-667, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34061344

RESUMO

BACKGROUND: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach. METHOD: This was a cross-sectional study, conducted in a tertiary pediatric ED. We investigated patient and parent perspectives on a newly implemented parental short-acting beta-agonist administration program. A convenience sample of families participating in this program was approached for study enrolment. The primary outcome was the proportion of parents and children who were satisfied with the program. We also evaluated the program's safety and impact on asthma education as reported by parents. RESULTS: From February 2019 to March 2020, 72 of 74 (97%) families approached for enrolment participated in the survey. A vast majority (95%) of parents appreciated the program and 93% would participate again. Among children > 7 years, 86% preferred receiving inhaled short-acting beta-agonist by their parents rather than by a healthcare provider. Nearly all parents (96%) found the program to be "safe" or "very safe". Some participants reported improvements in their inhaler administration technique (25%) and ability to recognize their child's respiratory distress (25%). CONCLUSION: A novel parental short-acting beta-agonist administration program in the pediatric ED was widely appreciated by participating families. Parents perceived it as being safe, educational, and contributing to their child's comfort.

5.
JAMA Netw Open ; 4(4): e213927, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33792730

RESUMO

Importance: Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. Objective: To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. Design, Setting, and Participants: This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. Exposures: The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. Main Outcomes and Measures: The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. Results: The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. Conclusions and Relevance: These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.


Assuntos
Terapia Comportamental/economia , Relações Pais-Filho , Atenção Primária à Saúde/economia , Abandono do Hábito de Fumar/economia , Adulto , Terapia Comportamental/métodos , Criança , Análise Custo-Benefício , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Pais , Pediatria/economia , Atenção Primária à Saúde/métodos , Abandono do Hábito de Fumar/métodos
6.
Can J Public Health ; 112(3): 417-420, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33742311

RESUMO

The COVID-19 pandemic is bringing about far-reaching structural changes on both the economy and public health, and conventional methodologies have to be fine-tuned to assist public health decision making. In this context, behavioural economics, which is situated at the crossroads between economics and social psychology, is an undeniably innovative field. In contrast with conventional models, the economic models of behavioural economics incorporate psychological and social determinants to produce more accurate predictions of individual behaviour. In the last 20 years, the scientific community has been using this approach's quantitative tool, experimental economics, in many areas of health, including prevention, promotion, human resources and social signage. Studies have come up with effective solutions that have improved best public health practices and provided sources of inspiration that should not be overlooked in the fight against COVID-19. They have allowed natural human behaviour to take a central role again, helped us to understand how the social and economic environment influences individuals, and enabled us to anticipate human reactions and so make faster adjustments to public policies.


Assuntos
COVID-19/prevenção & controle , Saúde Pública , Política Pública , COVID-19/epidemiologia , Canadá/epidemiologia , Economia Comportamental , Humanos
7.
Obes Res Clin Pract ; 15(2): 157-162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33608233

RESUMO

INTRODUCTION: Attrition in pediatric weight management programs is notoriously high. Greater understanding of its determinants is needed to inform retention strategies. We identified determinants of attrition in CIRCUIT, a healthy lifestyle intervention program for youth at risk of cardiovascular disease. METHODS: A one-arm intervention study of children aged 4-18 years who initiated the CIRCUIT program in the first five years of its existence (N = 403). We defined attrition as attending the baseline visit but ceasing attendance prior to the 1-year follow-up. Potential determinants of dropout included the child's age, sex, ethnicity, body mass index (BMI) z-score, family socio-demographic characteristics, and estimated driving time to the program, all measured at baseline. Associations were estimated bivariately, using chi-squared- and t-tests, and simultaneously in a multivariable logistic regression model. RESULTS: Of the 403 participants who started the program, 198 (49%) dropped out within 12 months of enrollment. Youth who dropped out were older (mean age 12.8y vs. 11.3y; p < 0.01), were less likely to live with both parents (62% vs. 71%; p = 0.05), and to have mothers who had completed high school (79% vs. 88%; p = 0.01). No group differences were observed for sex, ethnicity, baseline BMI z-score, fathers' education, or driving time to the program. In multivariate models, only older age at initiation of the intervention (OR: 1.2; CI: 1.1,1.3) and lower maternal education (OR: 2.0; CI: 1.0,3.8) were associated with dropout. CONCLUSION: Improved tailoring of interventions to older pediatric participants and to families of lower maternal education may help reduce attrition in CIRCUIT and similar lifestyle intervention programs.


Assuntos
Estilo de Vida Saudável , Pacientes Desistentes do Tratamento , Obesidade Pediátrica , Adolescente , Índice de Massa Corporal , Criança , Humanos , Pais , Obesidade Pediátrica/terapia
8.
Artigo em Inglês | MEDLINE | ID: mdl-32858864

RESUMO

Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents' perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0-18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants' perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child's risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10-0.34]) or cannabis (AOR: 0.21 [95% CI 0.12-0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.


Assuntos
Cannabis/efeitos adversos , Otimismo , Pais/psicologia , Fumar Tabaco , Uso de Tabaco/efeitos adversos , Adolescente , Comportamento do Adolescente/psicologia , Adulto , Controle Comportamental , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Relações Pais-Filho , Poder Familiar , Tabaco , Produtos do Tabaco , Uso de Tabaco/psicologia
9.
Am J Emerg Med ; 38(5): 890-894, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31300177

RESUMO

OBJECTIVE: Pediatric emergency departments (ED) develop strategies to decrease wait time. Yet, lowering wait times may incite patients to come back, and increase patient volume. We aim to determine if wait time in a first visit influenced the likelihood of a revisit to the same setting. METHODS: We performed a retrospective cohort study of children with a first visit to a single pediatric ED between November 1st 2016, and October 31st 2017. First visit was defined as no visit in the same ED in the previous 12 months. The primary outcome was the occurrence of a revisit at the same ED within 12 months of the first visit. Our main predictor was the wait time at the first visit for primary evaluation by a physician. We used multivariable logistic regression models to adjust for potential risk factors (age, triage level, day of visit and disposition). RESULTS: Among 85,844 ED visits during the study period, 36,844 were first visits and fulfilled inclusion/exclusion criteria. Median wait time was 101 min (interquartile range: 56-177 min). Among those with a first visit, 11,351 (30.8%) had a revisit within 12 months. In multivariable analysis, each one hour increase in wait time was associated with a lower probability of revisit (OR: 0.92; 95% CI: 0.91-0.94). CONCLUSIONS: Shorter wait time was associated with higher likelihood of a revisit to the same ED in the following 12 months. Strategies to reduce wait times should take into consideration possible concomitant increase in patient volume.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pediatria , Estudos Retrospectivos , Fatores de Tempo
10.
J Matern Fetal Neonatal Med ; 33(13): 2241-2245, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30415592

RESUMO

Background: Hypertensive disorders of pregnancy are major causes of maternal mortality and morbidity, and postpartum hypertensive complications have significant implications on maternal health and public health care system. Antepartum community care programs for hypertension are in place at major centers of Canada, however, such a program for postpartum are usually lacking, and could be a cost-effective solution to reduce postpartum hypertensive complications.Objectives: To assess the proportion of women who present to the emergency department (ED) or outpatient clinics for postpartum hypertensive (PPHTN) complications up to 6 weeks postpartum, among pregnancies complicated by antenatal hypertensive disorders in Calgary, Canada. Secondary objectives were to identify risk factors for PPHTN complications, and to perform a cost-benefit analysis to support postpartum community care program (PCCP) as a way to decrease ED and clinic visits for PPHTN complications, and thus has a favorable economic impact on the public health care system.Study design: Retrospective cohort study using administrative databases, followed by chart review of ED visits to confirm diagnoses and estimate cost of visits and admissions. The participants were women followed by the Calgary Antenatal Community Care Program (ACCP) for hypertensive disorders, from 2014 to 2015, inclusive. The primary outcome was ED or clinic visit associated with an outpatient database record of hypertensive disorder diagnosis, within 42 days postpartum.Results: Among 319 deliveries included in the study, 30 women (9.4, 95%CI: 6.2-12.6%) visited ED or clinics for PPHTN. We identified multiple antihypertensive medication uses and abnormal postpartum gestational hypertension labs as risk factors for ED visit among these women. We estimate a CAD$152 per antenatal hypertensive patient cost benefit for PCCP.Conclusion: The proposed PCCP appears to have an economic benefit to health care system with a decrease in ED and clinic visits. Further studies with greater sample size could strengthen the findings in this study.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/terapia , Alberta/epidemiologia , Anti-Hipertensivos/uso terapêutico , Análise Custo-Benefício , Bases de Dados Factuais , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/economia , Hipertensão Induzida pela Gravidez/epidemiologia , Período Pós-Parto , Gravidez , Estudos Retrospectivos
11.
BMJ Open ; 9(12): e035206, 2019 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-31871262

RESUMO

INTRODUCTION: Skin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or posterior to the orbital septum (ie, orbital cellulitis). These two conditions are often considered together in hospitalised children as clinical differentiation is difficult, especially in young children. Prior studies have identified variation in management of hospitalised children with orbital cellulitis; however, they have been limited either as single centre studies or by the use of administrative data which lacks clinical details important for interpreting variation in care. We aim to describe the care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis. METHOD AND ANALYSIS: This is a multisite retrospective cohort study including previously healthy children aged 2 months to 18 years admitted to hospital with periorbital or orbital cellulitis from 2009 to 2018. Clinical data from medical records from multiple Canadian hospitals will be collected, including community and academic centres. Demographic characteristics and study outcomes will be summarised using descriptive statistics, including diagnostic testing, antibiotic therapy, adjunctive therapy, surgical intervention and clinical outcomes. Variation will be described and evaluated using χ² test or Kruskal-Wallis test. Generalised linear mixed models will be used to identify predictors of surgical intervention and longer length of stay. ETHICS AND DISSEMINATION: Approval of the study by the Research Ethics Board at each participating site has been obtained prior to data extraction. Study results will be disseminated by presentations at national and international meetings and by publications in high impact open access journals. By identifying important differences in management and outcomes by each hospital, the results will identify areas where care can be improved, practice standardised, unnecessary diagnostic imaging reduced, pharmacotherapy rationalised and where trials are needed.


Assuntos
Estudos Multicêntricos como Assunto/métodos , Celulite Orbitária/terapia , Projetos de Pesquisa , Adolescente , Canadá , Estudos de Coortes , Hospitalização , Humanos , Lactente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Acad Pediatr ; 19(7): 764-772, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31128381

RESUMO

OBJECTIVE: To examine parents' interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation. METHODS: Participants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents' self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors. RESULTS: Of 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15-$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05-2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP. CONCLUSIONS: Most parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.


Assuntos
Gastos em Saúde , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Obesidade Pediátrica/terapia , Programas de Redução de Peso/economia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários , Volição
13.
Am J Perinatol ; 36(9): 930-935, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30414599

RESUMO

OBJECTIVE: This study aimed to estimate the performance of first-trimester uterine artery (UtA) pulsatility index (PI) for the prediction of preeclampsia (PE). STUDY DESIGN: We conducted a prospective cohort study of nulliparous women with singleton gestation at 11 to 13 6/7 weeks. UtA-Doppler's was performed on both UtAs and the mean UtA-PI was reported in multiple of median (MoM) adjusted for gestational age. Using receiver operating characteristic curves and their area under the curves (AUC); we calculated the performance of UtA-PI for the prediction of PE. Proportional hazard models were used to develop prediction models combining UtA-PI and maternal characteristics. RESULTS: Out of 4,676 participants with completed follow-up, 232 (4.9%) developed PE, including 202 (4.3%) term and 30 (0.6%) preterm PE. Mean UtA-PI decreased with gestational age between 11 and 13 6/7 weeks (p < 0.001). First-trimester UtA-PI was associated with preterm (AUC: 0.69; 95% CI [confidence interval]: 0.57-0.80) but not with term (AUC: 0.52; 95% CI: 0.48-0.56) PE. UtA-PI combined with maternal characteristics could predict 45% of preterm PE at a false positive rate of 10%. CONCLUSION: First-trimester UtA-PI decreases with gestational age between 11 and 13 6/7 weeks and is associated with the risk of preterm but not term PE.


Assuntos
Pré-Eclâmpsia/diagnóstico , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Artéria Uterina/diagnóstico por imagem , Adulto , Feminino , Humanos , Pré-Eclâmpsia/fisiopatologia , Gravidez , Primeiro Trimestre da Gravidez , Prognóstico , Estudos Prospectivos , Fluxo Pulsátil/fisiologia , Fluxo Sanguíneo Regional , Artéria Uterina/fisiologia
14.
Acad Pediatr ; 19(1): 90-96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30248470

RESUMO

BACKGROUND: Adults tend to underestimate their personal risk of disease, but little is known about parents' perceptions of children's risk. METHODS: In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 years old also were asked about their children's sugar-sweetened beverage (SSB) consumption and physical activity. Children were categorized as "at risk" or "not at risk" for each factor. Parents estimated the risk of their child becoming a smoker or gaining excessive weight and were categorized as "optimistic" if they believed their children were less likely than others to use tobacco or gain weight. RESULTS: Overall, 92% of parents thought their children were at lower risk than average for tobacco use, and 86% believed their children were at lower risk for excessive weight gain. A high frequency of optimistic bias occurred even among parents with "at-risk" children, including parents with children exposed to tobacco use (70.4%), SSB consumption (77.6%), >2 hours of screen time (82.1%), and low physical activity (84.1%). In multivariable analyses, parents with children exposed to tobacco smoke (odds ratio = 0.21, 95% confidence interval, 0.09-0.51); or who consumed SSBs daily (odds ratio = 0.44, 95% confidence interval 0.20-0.97) were less likely to be optimistic about their child's future tobacco use and excessive weight gain, respectively. CONCLUSIONS: Most parents believed their children were at lower risk than average for tobacco use or excessive weight gain. Eliciting parents' optimistic biases might facilitate behavior change counseling in pediatric settings.


Assuntos
Exercício Físico , Otimismo , Pais , Obesidade Pediátrica , Bebidas Adoçadas com Açúcar , Fumar Tabaco , Adulto , Atitude Frente a Saúde , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Tempo de Tela , Ganho de Peso
15.
J Obstet Gynaecol Can ; 40(12): 1592-1599, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314872

RESUMO

OBJECTIVE: To estimate the role of first-trimester uterine artery pulsatility index (UtA-PI) for the prediction of small-for-gestational age (SGA). METHODS: We conducted a prospective cohort study of nulliparous women with singleton pregnancy (Great Obstetrical Syndromes study). UtA-PI was performed at 11 + 0 to 13 + 6 weeks and was reported in multiple of median (MoM). SGA was defined as birth weight below the 10th percentile and stratified as term or preterm SGA. Receiver operating characteristic curves analyses with their area under the curve (AUC) were used to estimate the predictive values of UtA-PI, alone and UtA-PI combined with maternal characteristics. We computed the detection rate and false-positive rate (FPR) of the SOGC SGA screening guidelines in our population. RESULTS: Of 4610 participants, SGA was identified in 486 pregnancies (10.3%), including 15 (0.3%) associated with preterm delivery. Compared with unaffected pregnancies, the mean log UtA-PI was significantly higher in term SGA and preterm SGA. The difference between preterm SGA and unaffected pregnancies remains significant after exclusion of SGA without preeclampsia. First-trimester UtA-PI was more predictive of preterm (AUC: 0.89) than term (AUC: 0.60) SGA (P < 0.01). Combined with maternal characteristics, UtA-PI could have predicted 64% of preterm and 20% of term SGA (10% FPR). The SOGC guidelines criteria for early screening of SGA had a detection rate of 21% for a FPR of 21%. CONCLUSIONS: First-trimester UtA-PI can be used to predict SGA, but mainly preterm SGA. The current SOGC guidelines criteria for SGA screening are not efficient in nulliparous women.


Assuntos
Retardo do Crescimento Fetal/diagnóstico , Ultrassonografia Pré-Natal , Artéria Uterina/fisiologia , Adulto , Área Sob a Curva , Estudos de Coortes , Reações Falso-Positivas , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Pré-Eclâmpsia/epidemiologia , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Fluxo Pulsátil , Quebeque/epidemiologia
16.
Acad Pediatr ; 18(4): 460-467, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29367020

RESUMO

OBJECTIVE: Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians. METHODS: We used a pre/post design in one practice with a control practice to evaluate the effects of preappointment screening for 3 behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them. RESULTS: We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases. CONCLUSIONS: Counseling rates for tobacco, dental health, or sugar-sweetened beverage consumption were low in pediatric primary care, and preappointment screening did not significantly affect clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.


Assuntos
Bebidas , Atenção à Saúde , Assistência Odontológica para Crianças , Açúcares da Dieta , Comportamentos de Risco à Saúde , Serviços Preventivos de Saúde , Poluição por Fumaça de Tabaco , Adulto , Criança , Pré-Escolar , Aconselhamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Pais , Fatores de Risco
17.
Am J Health Promot ; 32(5): 1228-1233, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28558492

RESUMO

PURPOSE: To report on adults' recall of discussion by physicians and dentists about e-cigarettes. DESIGN: A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. PARTICIPANTS: Adults who ever used e-cigarettes. MEASURES: Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child's doctor in the past 12 months. ANALYSIS: Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. RESULTS: Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child's doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child's doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child's doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. CONCLUSIONS: Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.


Assuntos
Atitude do Pessoal de Saúde , Odontólogos/psicologia , Sistemas Eletrônicos de Liberação de Nicotina , Promoção da Saúde/métodos , Médicos/psicologia , Abandono do Hábito de Fumar/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
18.
Biomed Res Int ; 2017: 2403072, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29075641

RESUMO

A multi-LU-domain-containing protein denoted C4.4A exhibits a tightly regulated membrane-associated expression in the suprabasal layers of stratified squamous epithelia such as skin and the esophagus, and the expression of C4.4A is dysregulated in various pathological conditions. However, the biological function of C4.4A remains unknown. To enable further studies, we evaluated the expression of C4.4A in monolayer cultures of normal human keratinocytes and in tissue-engineered skin substitutes (TESs) produced by the self-assembly approach, which allow the formation of a fully differentiated epidermis tissue. Results showed that, in monolayer, C4.4A was highly expressed in the centre of keratinocyte colonies at cell-cell contacts areas, while some cells located at the periphery presented little C4.4A expression. In TES, emergence of C4.4A expression coincided with the formation of the stratum spinosum. After the creation of a wound within the TES, C4.4A expression was observed in the suprabasal keratinocytes of the migrating epithelium, with the exception of the foremost leading keratinocytes, which were negative for C4.4A. Our results are consistent with previous data in mouse embryogenesis and wound healing. Based on these findings, we conclude that this human TES model provides an excellent surrogate for studies of C4.4A and Haldisin expressions in human stratified epithelia.


Assuntos
Moléculas de Adesão Celular/genética , Desenvolvimento Embrionário/genética , Células Epiteliais/metabolismo , Proteínas Ligadas por GPI/genética , Engenharia Tecidual , Animais , Células Epiteliais/citologia , Esôfago/metabolismo , Regulação da Expressão Gênica/genética , Humanos , Queratinócitos/metabolismo , Camundongos , Receptores de Ativador de Plasminogênio Tipo Uroquinase/genética , Pele/crescimento & desenvolvimento , Pele/metabolismo , Cicatrização/genética
19.
Clin Infect Dis ; 62(12): 1595-1603, 2016 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-26951573

RESUMO

BACKGROUND: To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs). METHODS: Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/µL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. RESULTS: We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95% CI, $43.8-$49.4 million). CONCLUSIONS: There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Países em Desenvolvimento , Humanos , Incidência , Tuberculose/epidemiologia
20.
Clin Infect Dis ; 62(12): 1586-1594, 2016 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27001796

RESUMO

BACKGROUND: We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected children (aged <18 years) in low- and middle-income countries (LMICs), to understand regional burden of disease, and inform delivery of HIV services. METHODS: Eligible studies described the incidence of OIs and other infections in ART-naive and -exposed children from January 1990 to November 2013, using Medline, Global Health, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases. Summary incident risk (IR) and prevalent risk for each OI in ART-naive and ART-exposed children were calculated, and unadjusted odds ratios calculated for impact of ART. The number of OI cases and associated costs averted were estimated using the AIDS impact model. RESULTS: We identified 4542 citations, and 88 studies were included, comprising 55 679 HIV-infected children. Bacterial pneumonia and tuberculosis were the most common incident and prevalent infections in both ART-naive and ART-exposed children. There was a significant reduction in IR with ART for the majority of OIs. There was a smaller impact on bacterial sepsis and pneumonia, and an increase observed for varicella zoster. ART initiation based on 2010 World Health Organization guidelines criteria for ART initiation in children was estimated to potentially avert >161 000 OIs (2013 UNAIDS data) with estimated cost savings of at least US$17 million per year. CONCLUSIONS: There is a decrease in the risk of most OIs with ART use in HIV-infected children in LMICs, and estimated large potential cost savings in OIs averted with ART use, although there are greater uncertainties in pediatric data compared with that of adults.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adolescente , Criança , Pré-Escolar , Países em Desenvolvimento , Humanos , Incidência , Lactente , Recém-Nascido , Prevalência
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