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1.
Innov Aging ; 5(3): igab028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34568586

RESUMO

Background and Objectives: We examined the prospective association between 2 measures of child abuse, one based on official child welfare records and the other based on parent self-reports, and the perpetration of elder mistreatment by an adult child. We also examined measures of adolescent and adult depression and substance use problems as predictors of elder mistreatment. Research Design and Methods: Data are from a prospective study that began in the 1970s with a sample of children aged 18 months to 6 years of age. Analyses draw on data collected when child participants were in preschool and elementary school, when they were adolescents, and as adults at midlife (at ages 36 and 46, on average). Results are from bivariate correlations and multivariable path models in which variables from different life stages were entered in steps to assess their prediction of elder mistreatment. Results: All variables were significantly correlated with elder mistreatment. In a final path model, parent self-reports of physical child abuse remained a significant, unique predictor of elder mistreatment. Adolescent and adult substance use problems were also statistically significant. Discussion and Implications: Few longitudinal studies have tracked patterns of abuse over time and relationships. Findings suggest that child abuse is a risk factor for the perpetration of elder mistreatment by an adult child. Substance use problems may also increase the risk for the perpetration of elder mistreatment. Further longitudinal research is needed to replicate and extend these findings in order to advance prevention and intervention programs and policies.

2.
Child Abuse Negl ; 120: 105203, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34280710

RESUMO

BACKGROUND: The long-term health effects of physical child abuse are well documented in self-report, retrospective studies. However, there have been few longitudinal, multimethod studies on physiological responses to stress and the onset of chronic disease, thereby slowing the advancement of prevention and intervention programs. OBJECTIVES: This study used survey data from an extended longitudinal study to examine prospective and retrospective associations between measures of physical child abuse and adult health in the 40s. PARTICIPANTS AND SETTING: Data are from an ongoing longitudinal study of the correlates and consequences of child maltreatment that began in the 1970s with a sample of 457 children. METHODS: Bivariate correlations and multiple regression models with covariates were used to assess associations between measures of physical child abuse and outcomes of self-reported health in adulthood. RESULTS: Physical child abuse, measured retrospectively, was moderately related to reports of overall health, as well as a number of adult health problems and conditions, such as back and chest pain, hypertension, and certain forms of cancer. Associations were also observed for lifetime alcohol problems and past-year doctor and emergency room visits. Fewer associations between prospective parent self-report measures of physical child abuse and adult health were identified, although child welfare (official record) reports performed similarly to retrospective measures. CONCLUSIONS: This study adds important information on the long-term health effects of child physical abuse, as well as measurement differences in the prediction of adult health outcomes. Conclusions drawn from prospective and retrospective studies of abuse are at best inconsistent, and possibly incompatible.

3.
Sci Rep ; 11(1): 13066, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158561

RESUMO

This study aimed to investigate the association between domain-specific physical activity (PA) and diabetes in Korean adults. We analyzed 26,653 men and women (aged > 18 years) from the Korea National Health and Nutrition Examination Survey (2014-2018). PA was measured using a validated Global PA Questionnaire. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for various confounders. Transport PA accounted for the majority of total PA (46%, men; 58%, women), followed by leisure-time PA (30%; 22%) and work PA (24%; 20%). In men, ORs (95% CI) of diabetes comparing ≥ 600 metabolic task of equivalent (MET)-min/week vs. no activity were 0.82 (0.71-0.95) for leisure-time PA, 0.85 (0.75-0.96) for transport PA, and 0.88 (0.78-0.99) for leisure-time + transport PA. In women, ORs (95% CI) of diabetes comparing the same groups were 0.73 (0.60-0.89) for leisure-time PA, 0.97 (0.85-1.10) for transport PA, and 0.88 (0.78-1.00) for leisure-time + transport PA. However, work PA showed no association with diabetes. In conclusion, leisure-time PA was inversely associated with diabetes in both men and women, while transport PA was inversely associated only in men. But work PA was not associated with diabetes in Korean adults.


Assuntos
Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus/epidemiologia , Exercício Físico/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia
4.
Child Maltreat ; : 10775595211007566, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33853354

RESUMO

Neighborhoods have profound impacts on children and families. Using structural equation modeling and data from 4,898 children in the Fragile Families and Child Wellbeing Study, the current study examines the direct and indirect effects of neighborhood poverty on the likelihood of being maltreated at age 5. Two neighborhood social processes, social cohesion and informal social control, were examined as mediators. The study found that neighborhood poverty was indirectly related to physical assault and psychological aggression through its impact on social cohesion, and indirectly related to neglect through its impact on informal social control. The results highlight the need to reduce poverty across communities and increase social cohesion and social control as potential pathways for interrupting the impact of neighborhood poverty on maltreatment.

5.
J Allergy Clin Immunol Pract ; 9(5): 1939-1947.e7, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33307277

RESUMO

BACKGROUND: Tiotropium has the potential to alleviate asthmatic symptoms caused by the aging of lungs. However, few studies have focused on specific treatments for elderly patients with asthma. OBJECTIVES: To estimate the cost-effectiveness of adding tiotropium to inhaled corticosteroids and long-acting beta-agonists in elderly patients with severe asthma using real-world data. METHODS: Phase I was a retrospective cohort study using the National Health Insurance claims data to measure clinical and economic outcomes. In phase II, a Markov model was constructed to evaluate cost-effectiveness from Korean health care system perspective, based on phase I, including 2 health states, and an asthma exacerbation event. We estimated cost given in 2018 US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Subgroup analyses for patients with poorly controlled symptoms (frequent short-acting beta-agonist users; frequent exacerbators) were performed. RESULTS: In elderly patients with severe asthma, the incremental cost and effectiveness in the tiotropium group compared with the inhaled corticosteroid and long-acting beta-agonist group were $2281 and 0.038 QALYs, respectively. The incremental cost-effectiveness ratio was $60,074/QALY, indicating that the addition of tiotropium is not a cost-effective alternative. Meanwhile, 2 subgroups with poorly controlled symptoms showed that adding tiotropium is a cost-effective alternative (frequent short-acting beta-agonist users $4078/QALY; frequent exacerbators $8332/QALY). CONCLUSIONS: Tiotropium shows a higher cost-effectiveness profile when applied to elderly patients with uncontrolled symptoms. These results using real-world evidence provide information beyond the clinical outcomes reported by randomized controlled trials, providing a complementary ground in establishing the reimbursement criteria of tiotropium for elderly patients with severe asthma.


Assuntos
Asma , Corticosteroides/uso terapêutico , Idoso , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Análise Custo-Benefício , Humanos , Estudos Retrospectivos , Brometo de Tiotrópio/uso terapêutico
6.
Mol Cells ; 43(11): 899-908, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33243935

RESUMO

Intrinsically disordered proteins or regions (IDPs or IDRs) are widespread in the eukaryotic proteome. Although lacking stable three-dimensional structures in the free forms, IDRs perform critical functions in various cellular processes. Accordingly, mutations and altered expression of IDRs are associated with many pathological conditions. Hence, it is of great importance to understand at the molecular level how IDRs interact with their binding partners. In particular, discovering the unique interaction features of IDRs originating from their dynamic nature may reveal uncharted regulatory mechanisms of specific biological processes. Here we discuss the mechanisms of the macromolecular interactions mediated by IDRs and present the relevant cellular processes including transcription, cell cycle progression, signaling, and nucleocytoplasmic transport. Of special interest is the multivalent binding nature of IDRs driving assembly of multicomponent macromolecular complexes. Integrating the previous theoretical and experimental investigations, we suggest that such IDR-driven multiprotein complexes can function as versatile allosteric switches to process diverse cellular signals. Finally, we discuss the future challenges and potential medical applications of the IDR research.


Assuntos
Proteínas Intrinsicamente Desordenadas/metabolismo , Substâncias Macromoleculares/metabolismo , Humanos , Transdução de Sinais
7.
Arch Osteoporos ; 15(1): 180, 2020 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-33188505

RESUMO

This study analyzed the incidence and risk factors of subsequent osteoporotic fractures in South Korea. The results showed that the incidence rate of subsequent fractures within 24 months was 10.23 per 100 person-years. Additionally, the index hip fracture site was a significant risk factor for a subsequent fracture. PURPOSE: To identify and analyze the incidence and risk factors of subsequent osteoporotic fractures in South Korea. METHODS: This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database from 2012 to 2017. Men and women with osteoporosis, aged ≥50 years, with index fractures between July 1, 2014, and July 1, 2015, were included. The incidence rate of subsequent fractures was calculated by determining the number of second event within 2 years from the index fracture. To identify the risk factors for subsequent fractures, we applied the Cox proportional hazard model to estimate the hazard ratios (HRs). RESULTS: Of the 73,717 patients with osteoporotic fractures, 13,203 (17.91%) had a subsequent fracture. The incidence rate of subsequent fractures within 24 months was 10.23/100 person-years. The index fracture site was a significant risk factor for a subsequent fracture, with the hip showing the highest risk (HR, 7.51; 95% confidence interval [CI], 6.77-8.34), followed by the vertebra (HR, 1.99; 95% CI, 1.91-2.06). The risk of subsequent fractures increased with a higher Charlson Comorbidity Index (CCI) score (CCI score ≥ 5: HR, 1.79; 95% CI, 1.67-1.92). CONCLUSION: The incidence rate of subsequent osteoporotic fractures in South Korea is similar or higher than that reported in the USA and Europe. A hip fracture within the prior 2 years, relative to other fracture sites, significantly increased the risk of subsequent fractures in osteoporosis patients. Patients who have these risk factors need closer disease management to prevent subsequent fractures.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Estudos de Coortes , Europa (Continente) , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Masculino , Fraturas por Osteoporose/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
8.
J Med Econ ; 23(12): 1598-1605, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33001716

RESUMO

OBJECTIVES: This study aimed to assess the economic burden of subsequent fracture in osteoporosis patients with incident fracture. METHODS: The authors conducted a retrospective cohort analysis of the South Korean national health insurance claims data. Study subjects included osteoporosis patients aged ≥50 with incident fracture (July 1, 2014-June 30, 2015). Fracture-related 1-year healthcare cost was evaluated after incident fracture for patients with and without subsequent fracture, defined as a fracture occurring within 2 years from incident fracture at a different site or at the same site after 6-months washout period. Per-patient-per-month (PPPM) cost was calculated by dividing each patient's cumulative healthcare cost until subsequent fracture with time-to-subsequent-fracture. For the patients without subsequent fracture, PPPM cost equaled 1-year monthly cost. A generalized linear model (GLM) was used to estimate the ratio of increase in healthcare cost to assess the economic impact of subsequent fracture. RESULTS: A total of 73,717 osteoporosis patients with incident fracture were identified, consisting of 52.1% vertebral, 1.9% hip, and 46.0% non-vertebral-non-hip fractures. Subsequent fracture occurred in 17.9% of patients with average time-to-subsequent-fracture of 256 days. Patients with subsequent fracture had significantly higher 1-year healthcare cost after incident fracture than those without subsequent fracture ($4,307 vs $1,721) and the difference was greater in PPPM cost ($930 vs $141). GLM analysis showed that having subsequent fracture increased both 1-year healthcare cost and PPPM cost by 1.91-fold (95% CI = 1.87-1.95) and 6.14-fold (95% CI = 5.99-6.28), respectively. CONCLUSIONS: Subsequent fracture imposes a substantial burden on osteoporosis patients and, therefore, more efforts are needed for preventing subsequent fracture among osteoporosis patients.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Efeitos Psicossociais da Doença , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
9.
Complement Ther Med ; 45: 19-24, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331559

RESUMO

INTRODUCTION: In this study we examined the acceptability and feasibility of a mindfulness based group intervention for socio-economically disadvantaged women in an urban community health center (M-Body). METHOD: Women ages 18-65 with depressive symptoms who participated in an 8-week mindfulness based group intervention were invited to attend follow up focus groups about their experience. Inductive content analysis was used to identify themes from transcripts. RESULTS: All participants were African-American (N = 27). Participants had limited past experience with mindfulness. They reported benefits included anger management, increased control of thoughts, emotions and behaviors, enhanced awareness/focus and feeling calm and relaxed. Barriers to session attendance included transportation, employment, family responsibilities and child care. Participants suggested modifications such as providing the audio in multiple formats, increasing time spent doing yoga, modifying yoga postures and providing an orientation session. They stated that the content and delivery format of the group was acceptable. DISCUSSION: The mindfulness based intervention for depression was acceptable, reduced stress and improved coping and functioning among women in a community health center.


Assuntos
Afro-Americanos/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Adulto , Idoso , Centros Comunitários de Saúde , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Atenção Plena/métodos , Pesquisa Qualitativa , Ioga/psicologia
10.
Am J Community Psychol ; 64(3-4): 373-388, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31355976

RESUMO

When children experience stress and adversity in their homes and communities, schools become a critically important setting in which to intervene and foster their resilience. Changing practices within schools so that vulnerable and traumatized children are better understood and more compassionately served is a goal shared by many school professionals, yet schools remain poorly equipped to address the needs of these children. Any number of school-based programs have the potential to benefit children with an elevated risk for academic difficulties and mental health disorders, although questions remain as to which programs are most promising, effective, and sustainable. Questions also remain about which programs best serve diverse populations and which have potential to reach the largest number of children, including those who do not outwardly manifest behaviors consistent with an underlying disorder but nonetheless require support. In this review, we take stock of existing programs used in schools to address the social, emotional, and academic needs of children with trauma histories. We summarize components of a various trauma-focused programs, categorized as: (a) individual and group-based approaches, (b) classroom-based approaches, and (c) school-wide approaches. For each category, we review and comment on the state and quality of research findings and provide illustrative examples from the literature to show how programs address trauma in the school context. Findings of the review suggest that empirical evidence currently favors individual and group-based approaches, although classroom-based and school-wide programs may be better positioned for integration, access to services, and sustainability. Implications and recommendations center on future research, practice, and policy.


Assuntos
Prática Clínica Baseada em Evidências , Serviços de Saúde Escolar , Ferimentos e Lesões/psicologia , Adolescente , Criança , Humanos , Resiliência Psicológica
11.
Respir Res ; 20(1): 80, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039780

RESUMO

BACKGROUND: Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), little is known about the estimates of their incidence in patients with asthma-COPD overlap (ACO), which has been described and acknowledged as a distinct clinical entity. We aimed to estimate the risk of depression and anxiety among patients with ACO and compare it with the risk among those with COPD alone in the general population. METHODS: We conducted a nationwide population-based retrospective cohort study using the Korean National Sample Cohort database between 1 January, 2002, and 31 December, 2013. Patients who were diagnosed with COPD (International Classification of Diseases, 10th revision [ICD-10] codes J42-J44) at least twice and prescribed COPD medications at least once between 2003 and 2011 were classified into two categories: patients who were diagnosed with asthma (ICD-10 codes J45-J46) more than twice and at least once prescribed asthma medications comprised the ACO group, and the remaining COPD patients comprised the COPD alone group. Patients who had been diagnosed with depression or anxiety within a year before the index date were excluded. We defined the outcome as time to first diagnosis with depression and anxiety. Matched Cox regression models were used to compare the risk of depression and anxiety among patients with ACO and patients with COPD alone after propensity score matching with a 1:1 ratio. RESULTS: After propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 15,644 patients. The risk of depression during the entire study period was higher for patients with ACO than for patients with COPD alone (adjusted hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; P value = 0.0039), with an elevated risk in patients aged 40-64 years (1.21; 1.10-1.34; 0.0001) and in women (1.18; 1.07-1.29; 0.0005). The risk of anxiety was higher for patients with ACO than for patients with COPD alone (1.06; 1.01-1.12; 0.0272), with a higher risk in patients aged 40-64 years (1.08; 1.00-1.17; 0.0392); however, the risk was not significant when stratified by sex. CONCLUSIONS: This population-based study revealed a higher incidence of depression and anxiety in patients with ACO than in patients with COPD alone.


Assuntos
Asma/epidemiologia , Transtornos do Humor/epidemiologia , Vigilância da População , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Asma/psicologia , Estudos de Coortes , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Doença Pulmonar Obstrutiva Crônica/psicologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
12.
J Allergy Clin Immunol Pract ; 7(8): 2642-2652.e3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31108218

RESUMO

BACKGROUND: Although elderly patients with asthma have clinical characteristics different from those of young adults, few studies or guidelines have focused on specific treatments for this population. OBJECTIVE: This study compared the effectiveness of leukotriene receptor antagonists (LTRAs) versus inhaled corticosteroids (ICSs) in elderly patients with asthma in real-world settings. METHODS: We extracted records for elderly patients with asthma who were newly prescribed LTRAs or low-dose ICSs from January 2003 to December 2010 from National Sample Cohort data of Korea. We defined the first prescription date for each medication as the index date. We compared the risks of asthma exacerbation between the 2 groups using Cox proportional-hazard regression after propensity score-based inverse probability of treatment weighting to balance covariates between treatment groups. We also compared asthma-related health care resource utilization and medication compliance in both groups using chi-square test and t test. RESULTS: The number of identified patients newly treated with LTRAs and low-dose ICSs was 1571 and 121, respectively. The risks of asthma exacerbation in the LTRA and low-dose ICS groups after weighting were not significantly different (hazard ratio, 0.98; 95% CI, 0.65-1.54). The proportion with high compliance (medication possession ratio ≥ 80%) in the LTRA group was higher than that in the low-dose ICS group. CONCLUSIONS: The effectiveness of LTRAs was not different from that of low-dose ICSs regarding the risk of asthma exacerbation in elderly patients with asthma in real-world settings. Given the practical benefits gained from convenient administration, LTRAs can be considered a reasonable alternative first-line therapy for elderly patients with mild asthma.


Assuntos
Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Grupos Populacionais , Administração por Inalação , Idoso , Asma/epidemiologia , Estudos de Coortes , Humanos , Coreia (Geográfico)/epidemiologia , Adesão à Medicação/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
13.
Clin Ther ; 41(6): 1066-1079, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31101372

RESUMO

PURPOSE: Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is a possible treatment option for chronic heart failure patients with reduced ejection fraction (HFrEF). The aim of this study was to estimate the cost-effectiveness of sacubitril/valsartan use in South Korea for treating patients with HFrEF compared with that of enalapril, an angiotensin-converting enzyme inhibitor, and with angiotensin receptor blockers (ARBs). METHODS: A Markov model was designed to estimate the lifetime cost-effectiveness of treatment for patients with HFrEF. Cohorts in the alive-state incurred a monthly risk of hospitalization because of deteriorated HF, adverse events (AEs), or death. Transition probabilities of sacubitril/valsartan and enalapril were estimated by using data from the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. The effectiveness of ARBs (eg, reduction in mortality and hospitalization rates) was assumed to be identical to that of enalapril, according to the results of the meta-analysis. However, there was no comparative evidence for AEs. We therefore conducted a Bayesian network meta-analysis and adjusted the incidence rate of AEs for ARBs. The utility for estimating quality-adjusted life years (QALYs) was elicited by the survey of the general South Korean population by using EuroQol-5 dimensions. We calculated the medical costs, including medication, monitoring, hospitalization, AEs, and terminal care, from the health care sector perspective. Costs and effectiveness were discounted by 5%. One-way sensitivity analyses and a probabilistic sensitivity analysis were conducted to determine the model robustness. FINDINGS: The total cost per patient for sacubitril/valsartan and enalapril was $25,832 and $18,295, respectively. Sacubitril/valsartan was associated with an ∼8- month longer life expectancy compared with enalapril and a QALY gain of 0.59. As a result, the incremental cost-effectiveness ratio for sacubitril/valsartan versus enalapril was $12,722 per QALY. The incremental cost-effectiveness ratio of sacubitril/valsartan versus ARB was $11,970 with an incurred cost of $18,741 for the ARB group. The main results and those of various sensitivity analyses were lower than a threshold of $20,000. IMPLICATIONS: From a health care sector perspective, sacubitril/valsartan is a cost-effective treatment for HFrEF compared with enalapril and ARBs. This finding could be helpful for cardiologists or decision makers in reaching cost-effective choices regarding the treatment selection process.


Assuntos
Aminobutiratos , Antagonistas de Receptores de Angiotensina , Insuficiência Cardíaca , Tetrazóis , Aminobutiratos/economia , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/economia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Doença Crônica , Análise Custo-Benefício , Combinação de Medicamentos , Custos de Cuidados de Saúde , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Estatísticos , República da Coreia , Tetrazóis/economia , Tetrazóis/uso terapêutico , Disfunção Ventricular Esquerda
14.
J Altern Complement Med ; 25(7): 699-708, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30912681

RESUMO

Introduction: In the present study, the authors pilot a streamlined mindfulness teacher training protocol for Federally Qualified Health Center (FQHC) staff and examine the distribution and variability of psychologic outcomes for participants in groups led by an experienced instructor compared to a FQHC staff instructor who received the streamlined training. Methods: Seventy-four adult women aged 18-65 with depressive symptoms enrolled to participate in the 8-week group mindfulness intervention led by an experienced instructor (N = 33) or a novice instructor (N = 41). The effect of instructor on the outcomes depression, stress, mindfulness, functioning, well-being, and depression stigma was assessed at baseline, 8, and 16 weeks. Results: Depressive symptoms and stress significantly decreased, and mindfulness significantly increased in the experienced and novice instructor groups. In the novice instructor group, there was also a significant increase in well-being and functioning. The change in depressive symptoms, stress, functioning, and well-being was significantly greater in the novice instructor group than the experienced instructor groups. Conclusions: Preliminary data suggest that health care staff who receive streamlined training to deliver mindfulness-based interventions have comparable outcomes as experienced instructors.


Assuntos
Depressão/terapia , Educação em Saúde/estatística & dados numéricos , Atenção Plena , Adulto , Afro-Americanos , Idoso , Feminino , Educação em Saúde/normas , Humanos , Pessoa de Meia-Idade , Atenção Plena/educação , Atenção Plena/métodos , Adulto Jovem
15.
Pharmacoepidemiol Drug Saf ; 28(4): 479-488, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30848536

RESUMO

PURPOSE: Given the severity and high-costs demand of Clostridium difficile-associated diarrhea (CDAD), management of risk factors is very important. Although the association between proton-pump inhibitors (PPIs) and CDAD has been established, little is known among high-risk antibiotics users. This study aimed to identify the association between PPIs and CDAD in high-risk antibiotics users by using a case-crossover design. METHODS: We conducted a case-crossover study using a nationwide population-based cohort in South Korea. Participants who developed CDAD from 1 January 2003 to 31 December 2013 and had prior prescription records of both PPIs and high-risk antibiotics were included. The hazard period was 49 days, and the three prior control periods had the same duration as the hazard period. The status of exposure to PPIs was assessed during the hazard and control periods in each patient and discordant pairs of exposure were used to estimate the matched odds ratio (OR). RESULTS: In total, 200 participants with CDAD who had histories of both PPIs and high-risk antibiotics use were included. A twofold increased risk for CDAD due to PPI use was observed (OR = 2.0; 95% confidence interval, 1.2-3.2). The time-invariant variables including age group, sex, and comorbidities were proven not to modify the association between PPIs and CDAD. CONCLUSIONS: Our study suggested that PPIs increase the risk of developing CDAD in high-risk antibiotics users. Thus, PPIs should be used cautiously in patients requiring high-risk antibiotics in the situation of medical treatment to prevent further incidence of CDAD.


Assuntos
Antibacterianos/efeitos adversos , Clostridioides difficile/isolamento & purificação , Diarreia/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Estudos Cross-Over , Diarreia/microbiologia , Enterocolite Pseudomembranosa/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco
16.
Complement Ther Clin Pract ; 33: 93-99, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30396633

RESUMO

BACKGROUND AND PURPOSE: We evaluated the feasibility of using an activity monitor to support mindfulness practice, reduce self-reported stress and physiological indicators of stress. MATERIALS AND METHODS: Adult women (N = 19) who previously participated in a mindfulness intervention wore an activity monitor for eight-weeks. The activity monitor notified them when they were stressed (based on standard deviation pulse pressure). Heart rate and pulse pressure were continuously collected via the activity monitor. Mindfulness, stress, depression and trauma symptoms were collected via self-report surveys. RESULTS: There were no significant changes in self-reported stress, depression, post-traumatic stress and mindfulness from baseline to eight-weeks. Pulse pressure and standard deviation of pulse pressure increased over time. Those who were high on the non-judge mindfulness subscale had a lower standard deviation pulse pressure and spent less time stressed. CONCLUSION: Those who are more mindful are less likely to have physiological signs of stress.


Assuntos
Pressão Sanguínea , Depressão , Frequência Cardíaca , Atenção Plena/métodos , Monitorização Ambulatorial , Estresse Psicológico , Adulto , Tecnologia Biomédica/métodos , Depressão/diagnóstico , Depressão/prevenção & controle , Estudos de Viabilidade , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Aplicativos Móveis , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Determinação de Necessidades de Cuidados de Saúde , Medidas de Resultados Relatados pelo Paciente , Escalas de Graduação Psiquiátrica , Estresse Psicológico/etnologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/terapia , Estados Unidos
17.
Proc Natl Acad Sci U S A ; 115(33): 8448-8453, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30065116

RESUMO

The circadian clock coordinates the daily cyclic rhythm of numerous biological processes by regulating a large portion of the transcriptome. In animals, the circadian clock is involved in aging and senescence, and circadian disruption by mutations in clock genes frequently accelerates aging. Conversely, aging alters circadian rhythmicity, which causes age-associated physiological alterations. However, interactions between the circadian clock and aging have been rarely studied in plants. Here, we investigated potential roles for the circadian clock in the regulation of leaf senescence in plants. Members of the evening complex in Arabidopsis circadian clock, EARLY FLOWERING 3 (ELF3), EARLY FLOWERING 4 (ELF4), and LUX ARRHYTHMO (LUX), as well as the morning component PSEUDO-RESPONSE REGULATOR 9 (PRR9), affect both age-dependent and dark-induced leaf senescence. The circadian clock regulates the expression of several senescence-related transcription factors. In particular, PRR9 binds directly to the promoter of the positive aging regulator ORESARA1 (ORE1) gene to promote its expression. PRR9 also represses miR164, a posttranscriptional repressor of ORE1 Consistently, genetic analysis revealed that delayed leaf senescence of a prr9 mutant was rescued by ORE1 overexpression. Thus, PRR9, a core circadian component, is a key regulator of leaf senescence via positive regulation of ORE1 through a feed-forward pathway involving posttranscriptional regulation by miR164 and direct transcriptional regulation. Our results indicate that, in plants, the circadian clock and leaf senescence are intimately interwoven as are the clock and aging in animals.


Assuntos
Proteínas de Arabidopsis/fisiologia , Arabidopsis/fisiologia , Ritmo Circadiano/fisiologia , Fatores de Transcrição/fisiologia , Envelhecimento , Proteínas de Arabidopsis/genética , MicroRNAs/fisiologia , Folhas de Planta/fisiologia , Regiões Promotoras Genéticas , Fatores de Transcrição/genética
18.
Plant Cell Physiol ; 59(9): 1753-1764, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30099525

RESUMO

Leaf senescence is regulated by diverse developmental and environmental factors to maximize plant fitness. The red to far-red light ratio (R:FR) detected by plant phytochromes is reduced under vegetation shade, thus initiating leaf senescence. However, the role of phytochromes in promoting leaf senescence under FR-enriched conditions is not fully understood. In this study, we investigated the role of phyA and phyB in regulating leaf senescence under FR in Arabidopsis thaliana (Arabidopsis). FR enrichment and intermittent FR pulses promoted the senescence of Arabidopsis leaves. Additionally, phyA and phyB mutants showed enhanced and repressed senescence phenotypes in FR, respectively, indicating that phyA and phyB antagonistically regulate FR-dependent leaf senescence. Transcriptomic analysis using phyA and phyB mutants in FR identified differentially expressed genes (DEGs) involved in leaf senescence-related processes, such as responses to light, phytohormones, temperature, photosynthesis and defense, showing opposite expression patterns in phyA and phyB mutants. These contrasting expression profiles of DEGs support the antagonism between phyA and phyB in FR-dependent leaf senescence. Among the genes showing antagonistic regulation, we confirmed that the expression of WRKY6, which encodes a senescence-associated transcription factor, was negatively and positively regulated by phyA and phyB, respectively. The wrky6 mutant showed a repressed senescence phenotype compared with the wild type in FR, indicating that WRKY6 plays a positive role in FR-dependent leaf senescence. Our results imply that antagonism between phyA and phyB is involved in fine-tuning leaf senescence under varying FR conditions in Arabidopsis.


Assuntos
Arabidopsis/fisiologia , Regulação da Expressão Gênica de Plantas/efeitos da radiação , Luz , Fitocromo A/metabolismo , Fitocromo B/metabolismo , Folhas de Planta/fisiologia , Proteínas de Arabidopsis/metabolismo , Fatores de Tempo
19.
Clin Drug Investig ; 38(8): 727-736, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29804184

RESUMO

BACKGROUND AND OBJECTIVE: Utility provides a preference for specific health state in economic evaluation, and they obtained from general population could be useful in respect of societal resource allocation. We aimed to investigate the utilities of health states for heart failure (HF), a major and growing public health problem, related to hospitalization and adverse drug effects by interrogating the general Korean population. METHODS: Five health states for patients with HF were developed based on literature reviews: stable chronic heart failure (SCHF), hospitalization, SCHF + cough, SCHF + hypotension, and SCHF + hyperkalemia. We selected 100 individuals from the general population through quota sampling by age, sex, and region, and conducted face-to-face interviews. We measured utilities for 5 hypothetical health states of HF using both time trade-off (TTO) and EuroQol-5 dimensions-5 levels (EQ-5D-5L). Repeated-measures analysis of variance compared the utilities between all health states for each instrument. To identify the factors affecting the utility, a linear mixed model (LMM) analysis was performed. RESULTS: The mean utility value for SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization was calculated as 0.815, 0.732, 0.646, 0.548, and 0.360, respectively, by using TTO. The respective values using EQ-5D-5L were 0.871, 0.793, 0.710, 0.589, and 0.215. The utilities for HF significantly differed between all health states in each instrument (p < 0.001). In LMM analysis, hospitalization had a significantly negative effect on the utilities of both instruments. CONCLUSIONS: The utilities decreased in order of SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization. These results can be useful for decision making in resource allocation for HF interventions.


Assuntos
Nível de Saúde , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Hospitalização/tendências , Modelos Lineares , Adulto , Análise Custo-Benefício/métodos , Análise Custo-Benefício/tendências , Tosse/diagnóstico , Tosse/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , República da Coreia/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
20.
Proc Natl Acad Sci U S A ; 115(21): E4930-E4939, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29735710

RESUMO

Senescence is controlled by time-evolving networks that describe the temporal transition of interactions among senescence regulators. Here, we present time-evolving networks for NAM/ATAF/CUC (NAC) transcription factors in Arabidopsis during leaf aging. The most evident characteristic of these time-dependent networks was a shift from positive to negative regulation among NACs at a presenescent stage. ANAC017, ANAC082, and ANAC090, referred to as a "NAC troika," govern the positive-to-negative regulatory shift. Knockout of the NAC troika accelerated senescence and the induction of other NACs, whereas overexpression of the NAC troika had the opposite effects. Transcriptome and molecular analyses revealed shared suppression of senescence-promoting processes by the NAC troika, including salicylic acid (SA) and reactive oxygen species (ROS) responses, but with predominant regulation of SA and ROS responses by ANAC090 and ANAC017, respectively. Our time-evolving networks provide a unique regulatory module of presenescent repressors that direct the timely induction of senescence-promoting processes at the presenescent stage of leaf aging.


Assuntos
Arabidopsis/crescimento & desenvolvimento , Senescência Celular , Redes Reguladoras de Genes , Folhas de Planta/crescimento & desenvolvimento , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Regulação da Expressão Gênica de Plantas , Mutação , Fenótipo , Desenvolvimento Vegetal , Folhas de Planta/genética , Proteínas Repressoras/genética , Proteínas Repressoras/metabolismo , Fatores de Tempo , Transcriptoma
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