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1.
J Dent Res ; : 220345221128226, 2022 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-36314491

RESUMO

Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.

2.
J Dent Res ; 101(4): 407-413, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34582311

RESUMO

One-third of the UK population is composed of problem-oriented dental attenders, seeking dental care only when they have acute dental pain or problems. Patients seek urgent dental care from a range of health care professionals, including general medical practitioners. This study aimed to identify trends in dental attendance at Welsh medical practices over a 44-y period, specifically in relation to dental policy change and factors associated with repeat attendance. A retrospective observational study was completed via the nationwide Secure Anonymised Information Linkage (SAIL) Databank of visits to general medical practice in Wales. Read codes associated with dental diagnoses were extracted for patients attending their general medical practitioner between 1974 and 2017. Data were analyzed with descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 439,361 dental Read codes, accounting for 288,147 patient attendances. The overall attendance rate was 2.60 attendances per 1,000 patient-years (95% CI, 2.59 to 2.61). The attendance rate was negligible through 1987 but increased sharply to 5.0 per 1,000 patient-years in 2006 (95% CI, 4.94 to 5.09) before almost halving to 2.6 per 1,000 in 2017 (95% CI, 2.53 to 2.63) to a pattern that coincided with changes to National Health Service policies. Overall 26,312 patients were repeat attenders and were associated with living in an area classified as urban and deprived (odds ratio [OR], 1.22; 95% CI, 1.19 to 1.25; P < 0.0001) or rural (OR, 0.84; 95% CI, 0.83 to 0.85; P < 0.0001). Repeat attendance was associated with greater odds of having received an antibiotic prescription (OR, 2.53; 95% CI, 2.50 to 2.56; P < 0.0001) but lower odds of having been referred to another service (OR, 0.75; 95% CI, 0.70 to 0.81; P < 0.0001). Welsh patients' reliance on medical care for dental problems was influenced by social deprivation and health policy. This indicates that future interventions to discourage dental attendance at medical practitioners should be targeted at those in the most deprived urban areas or rural areas. In addition, health policy may influence attendance rates positively and negatively and should be considered in the future when decisions related to policy change are made.


Assuntos
Encaminhamento e Consulta , Medicina Estatal , Pessoal de Saúde , Humanos , Estudos Retrospectivos , País de Gales/epidemiologia
3.
Clin Epigenetics ; 13(1): 8, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436068

RESUMO

BACKGROUND: High early postnatal weight gain has been associated with childhood adiposity; however, the mechanism remains unknown. DNA methylation is a hypothesised mechanism linking early life exposures and subsequent disease. However, epigenetic changes associated with high early weight gain have not previously been investigated. Our aim was to investigate the associations between early weight gain, peripheral blood DNA methylation, and subsequent overweight/obese. Data from the UK Avon Longitudinal study of Parents and Children (ALSPAC) cohort were used to estimate associations between early postnatal weight gain and epigenome-wide DNA CpG site methylation (Illumina 450 K Methylation Beadchip) in blood in childhood (n = 125) and late adolescence (n = 96). High weight gain in the first year (a change in weight z-scores > 0.67), both unconditional (rapid weight gain) and conditional on birthweight (rapid thrive), was related to individual CpG site methylation and across regions using the meffil pipeline, with and without adjustment for cell type proportions, and with 5% false discovery rate correction. Variation in methylation at high weight gain-associated CpG sites was then examined with regard to body composition measures in childhood and adolescence. Replication of the differentially methylated CpG sites was sought using whole-blood DNA samples from 104 children from the UK Southampton Women's Survey. RESULTS: Rapid infant weight gain was associated with small (+ 1% change) increases in childhood methylation (age 7) for two distinct CpG sites (cg01379158 (NT5M) and cg11531579 (CHFR)). Childhood methylation at one of these CpGs (cg11531579) was also higher in those who experienced rapid weight gain and were subsequently overweight/obese in adolescence (age 17). Rapid weight gain was not associated with differential DNA methylation in adolescence. Childhood methylation at the cg11531579 site was also suggestively associated with rapid weight gain in the replication cohort. CONCLUSIONS: This study identified associations between rapid weight gain in infancy and small increases in childhood methylation at two CpG sites, one of which was replicated and was also associated with subsequent overweight/obese. It will be important to determine whether loci are markers of early rapid weight gain across different, larger populations. The mechanistic relevance of these differentially methylated sites requires further investigation.


Assuntos
Metilação de DNA/genética , Marcadores Genéticos , Predisposição Genética para Doença , Obesidade/genética , Sobrepeso/genética , Aumento de Peso/genética , Adolescente , Adulto , Fatores Etários , Peso ao Nascer , Criança , Estudos de Coortes , Feminino , Estudo de Associação Genômica Ampla , Idade Gestacional , Humanos , Estudos Longitudinais , Masculino , Reino Unido
4.
J Public Health (Oxf) ; 42(2): 325-332, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-31220295

RESUMO

BACKGROUND: The influence of sedentary time and habitual physical activity on the bone health of middle aged adults is not well known. METHODS: Bone mineral density (BMD) and hip bone geometry were evaluated in 214 men (n = 92) and women (n = 112) aged 62.1 ± 0.5 years from the Newcastle Thousand Families Study birth cohort. Accelerometry was used to measure physical activity (PA) and sedentary time over 4 days. Regression models were adjusted for clinical risk factor covariates. RESULTS: Men were more sedentary than women (P < 0.05), and sedentary time was negatively associated with spine BMD in men, with 84 minutes more sedentary time corresponding to 0.268 g.cm-2 lower BMD (ß = -0.268; P = 0.017). In men, light PA and steps/day were positively associated with bone geometry and BMD. Steps/day was positively associated with bone geometry and femur BMD in women, with a positive difference of 1415 steps/day corresponding to 0.232 g.cm-2 greater BMD (ß = 0.232, P = 0.015). CONCLUSIONS: Sedentary time was unfavourably associated with bone strength in men born in North East England at age 62 years. Higher volumes of light PA, and meeting the public health daily step recommendations (10 000 steps/day) was positively associated with bone health in both sexes.


Assuntos
Exercício Físico , Comportamento Sedentário , Absorciometria de Fóton , Adulto , Densidade Óssea , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Clin Radiol ; 74(10): 816.e9-816.e17, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375261

RESUMO

AIM: To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk. MATERIALS AND METHODS: The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice. RESULTS: In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy. CONCLUSION: The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.


Assuntos
Cabeça/diagnóstico por imagem , Cristalino/efeitos da radiação , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Adolescente , Catarata/etiologia , Catarata/prevenção & controle , Criança , Pré-Escolar , Estudos de Coortes , Relação Dose-Resposta à Radiação , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Posicionamento do Paciente , Exposição à Radiação/efeitos adversos , Adulto Jovem
6.
J Dev Orig Health Dis ; 10(6): 621-626, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30621799

RESUMO

Birth weight and early growth have been associated with later blood pressure. However, not all studies consistently find a significant reduction in blood pressure with an increase in birth weight. In addition, the relative importance of birth weight and of other lifestyle and environmental factors is often overlooked and the association is rarely studied in adolescents. We investigated early life predictors, including birth weight, of adolescent blood pressure in the Gateshead Millennium Study (GMS). The GMS is a cohort of 1029 individuals born in 1999-2000 in Gateshead in Northern England. Throughout infancy and early childhood, detailed information were collected, including birth weight and measures of height and weight. Assessments of 491 returning participants at age 12 years included measures of body mass and blood pressure. Linear regression and path analysis were used to determine predictors and their relative importance on blood pressure. Birth weight was not directly associated with blood pressure at the age of 12. However, after adjustment for contemporaneous body mass index (BMI), an inverse association of standardized birth weight on systolic blood pressure was significant. The relative importance of birth weight on later systolic blood pressure was smaller than other contemporaneous body measures (height and BMI). There was no independent association of birth weight on blood pressure seen in this adolescent population. Contemporaneous body measures have an important role to play. Lifestyle factors that influence body mass or size, such as diet and physical activity, where interventions are directed at early prevention of hypertension should be targeted.


Assuntos
Peso ao Nascer , Pressão Sanguínea , Índice de Massa Corporal , Hipertensão/epidemiologia , Adolescente , Criança , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Estilo de Vida , Masculino , Estudos Prospectivos
7.
Osteoporos Int ; 30(4): 829-836, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30623213

RESUMO

Obesity increases the likelihood of prevalent vertebral fracture (VF) in men and women at age 62 years. The higher absolute bone mineral density (BMD) observed in obese individuals is disproportionate to body weight, and this may partly explain the greater prevalence of VF in this group. INTRODUCTION: Obesity is a global epidemic, and there remains uncertainty over the effect of obesity on skeletal health, particularly in the context of osteoporosis. The aim of this study was to investigate associations of body mass index (BMI) and obesity with BMD and prevalent VF in men and women aged 62 years. METHODS: Three hundred and forty-two men and women aged 62.5 ± 0.5 years from the Newcastle Thousand Families Study birth cohort underwent DXA evaluations of femoral neck and lumbar spine BMD and of the lateral spine for vertebral fracture assessment. RESULTS: The likelihood of prevalent VF was significantly increased in men when compared to women (OR = 2.7, p < 0.001, 95% Cl 1.7-4.4). As BMI increased in women, so did the likelihood of prevalent any-grade VF (OR = 1.09, p = 0.006, 95% CI 1.02-1.17). Compared to normal weight women, obese women were more likely to have at least one VF (OR = 2.65, p = 0.025, CI 1.13-6.20) and at least one grade 1 vertebral deformity (OR = 4.39, p = 0.005, CI 1.57-12.28). Obese men were more likely to have a grade 2 and/or grade 3 VF compared to men of normal weight (OR = 3.36, p = 0.032, CI 1.11-10.16). In men and women, BMI was negatively associated with femoral neck BMD/weight (R = - 0.65, R = - 0.66, p < 0.001) and lumbar spine BMD/weight (R = - 0.66, R - 0.60, p < 0.001). CONCLUSIONS: Obesity appears to be a risk factor for prevalent VF, and although absolute BMD is higher in obese individuals, this does not appear commensurate to their increased body weight.


Assuntos
Densidade Óssea/fisiologia , Obesidade/complicações , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/etiologia , Absorciometria de Fóton/métodos , Idoso , Índice de Massa Corporal , Estudos de Coortes , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Colo do Fêmur/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/fisiopatologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/fisiopatologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/fisiopatologia
8.
Public Health ; 164: 72-81, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30212722

RESUMO

OBJECTIVES: Refugees are most vulnerable to mental health problems of all migrant groups, and an understanding of the role of postdisplacement social factors in refugee emotional well-being can help to shape the future interventions for this group. We aimed to investigate the effect of social determinants, such as employment, language ability and accommodation, on mental health in refugees in the UK. STUDY DESIGN: This prospective longitudinal cohort study was set in the UK. The study population of new UK refugees was drawn from an existing data set of the Longitudinal Survey of New Refugees (n = 5678), in which all new UK refugees (2005-2007) were sent a postal questionnaire at four time points across 2 years. METHODS: Ordered logistic regression models were used to evaluate associations between social determinants and the dependent variables, emotional well-being or change in emotional well-being, using a question from the Short Form-36 Health Survey Questionnaire. RESULTS: Refugees who were unemployed in the UK, could not speak English well or were unsatisfied with their accommodation had significantly higher odds of poorer emotional well-being in the cross-sectional analysis (P < 0.05 at all time points measured). CONCLUSIONS: Postdisplacement social factors, including language ability, employment status and accommodation satisfaction, were important determinants of refugee emotional well-being. Changes in these social determinants have the potential to improve refugee mental health, making them legitimate, modifiable targets for important public health interventions. Accounting for this, further research into how to improve refugee well-being is crucial given the increase in refugee numbers around the developed world.


Assuntos
Saúde Mental/estatística & dados numéricos , Refugiados/psicologia , Determinantes Sociais da Saúde , Adolescente , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Refugiados/estatística & dados numéricos , Reino Unido , Adulto Jovem
9.
BMC Med ; 16(1): 111, 2018 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-30032726

RESUMO

BACKGROUND: Most evidence about what works in transitional care comes from small studies in single clinical specialties. We tested the hypothesis that exposures to nine recommended features of transitional healthcare were associated with better outcomes for young people with long-term conditions during transition from child-centred to adult-oriented health services. METHODS: This is a longitudinal, observational cohort study in UK secondary care including 374 young people, aged 14-18.9 years at recruitment, with type 1 diabetes (n = 150), cerebral palsy (n = 106) or autism spectrum disorder with an associated mental health problem (n = 118). All were pre-transfer and without significant learning disability. We approached all young people attending five paediatric diabetes centres, all young people with autism spectrum disorder attending four mental health centres, and randomly selected young people from two population-based cerebral palsy registers. Participants received four home research visits, 1 year apart and 274 participants (73%) completed follow-up. Outcome measures were Warwick Edinburgh Mental Wellbeing Scale, Mind the Gap Scale (satisfaction with services), Rotterdam Transition Profile (Participation) and Autonomy in Appointments. RESULTS: Exposure to recommended features was 61% for 'coordinated team', 53% for 'age-banded clinic', 48% for 'holistic life-skills training', 42% for 'promotion of health self-efficacy', 40% for 'meeting the adult team before transfer', 34% for 'appropriate parent involvement' and less than 30% for 'written transition plan', 'key worker' and 'transition manager for clinical team'. Three features were strongly associated with improved outcomes. (1) 'Appropriate parent involvement', example association with Wellbeing (b = 4.5, 95% CI 2.0-7.0, p = 0.001); (2) 'Promotion of health self-efficacy', example association with Satisfaction with Services (b = - 0.5, 95% CI - 0.9 to - 0.2, p = 0.006); (3) 'Meeting the adult team before transfer', example associations with Participation (arranging services and aids) (odds ratio 5.2, 95% CI 2.1-12.8, p < 0.001) and with Autonomy in Appointments (average 1.7 points higher, 95% CI 0.8-2.6, p < 0.001). There was slightly less recruitment of participants from areas with greater socioeconomic deprivation, though not with respect to family composition. CONCLUSIONS: Three features of transitional care were associated with improved outcomes. Results are likely to be generalisable because participants had three very different conditions, attending services at many UK sites. Results are relevant for clinicians as well as for commissioners and managers of health services. The challenge of introducing these three features across child and adult healthcare services, and the effects of doing so, should be assessed.


Assuntos
Serviços de Saúde/tendências , Adolescente , Protocolos Clínicos , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino
10.
Diabet Med ; 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29852520

RESUMO

AIM: We hypothesized that participant well-being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care. METHODS: Some 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well-being (Warwick-Edinburgh Mental Well-being Scale; WEMWBS) were captured. Change in HbA1c , episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4. RESULTS: Mean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a 'satisfactory' and 76 a 'suboptimal' clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups. CONCLUSIONS: The well-being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho-educational interventions can improve the clinical course is a research priority.

11.
J Public Health (Oxf) ; 40(3): 582-590, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29190364

RESUMO

Background: Parents tend to visually assess children to determine their weight status and typically underestimate child body size. A visual tool may aid parents to more accurately assess child weight status and so support strategies to reduce childhood overweight. Body image scales (BIS) are visual images of people ranging from underweight to overweight but none exist for children based on UK criteria. Our aim was to develop sex- and age-specific BIS for children, based on British growth reference (UK90) criteria. Methods: BIS were developed using 3D surface body scans of children, their associated weight status using UK90 criteria from height and weight measurements, and qualitative work with parents and health professionals. Results: Height, weight and 3D body scans were collected (211: 4-5 years; 177: 10-11 years). Overall, 12 qualitative sessions were held with 37 participants. Four BIS (4-5-year-old girls and boys, 10-11-year-old girls and boys) were developed. Conclusions: This study has created the first sex- and age-specific BIS, based on UK90 criteria. The BIS have potential for use in child overweight prevention and management strategies, and in future research. This study also provides a protocol for the development of further BIS appropriate to other age groups and ethnicities.


Assuntos
Imagem Corporal , Obesidade Pediátrica/prevenção & controle , Fatores Etários , Estatura , Imagem Corporal/psicologia , Peso Corporal , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade Pediátrica/diagnóstico , Padrões de Referência , Fatores Sexuais , Reino Unido
12.
Int J Obes (Lond) ; 41(7): 1042-1047, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28293017

RESUMO

BACKGROUND: Sedentary time (ST) has been reported to have a range of negative health effects in adults, however, the evidence for such effects among children and adolescents is sparse. The primary aim of the study was to examine associations between changes in sedentary behavior (time and fragmentation) and changes in adiposity across childhood and adolescence. METHODS: Participants were recruited as part of the Gateshead Millennium Study. Measures were taken at age 7 (n=502), 9 (n=506), 12 (n=420) and 15 years (n=306). Participants wore an ActiGraph GT1M and accelerometer epochs were 'sedentary' when recorded counts were ⩽25 counts per 15 s. ST was calculated and fragmentation (SF) was assessed by calculating the number of sedentary bouts per sedentary hour. Associations of changes in ST and SF with changes in adiposity (body mass index (BMI), and fat mass index (FMI)) were examined using bivariate linear spline models. RESULTS: Increasing ST by 1% per year was associated with an increase in BMI of 0.08 kg m-2 per year (95% CI: 0.06-0.10; P<0.001) and FMI of 0.15 kg m-2 per year (0.11-0.19; P<0.001). Change in SF was associated with BMI and FMI (P<0.001). An increase of 1 bout per sedentary hour per year (that is, sedentary time becoming more fragmented) was associated with an increase in BMI of 0.07 kg m-2 per year (0.06-0.09; P<0.001) and an increase in FMI of 0.14 kg m-2 per year (0.10-0.18; P<0.001) over the 8 years period. However, an increase in SF between 9-12 years was associated with a 0.09 kg m-2 per year decrease in BMI (-0.18-0.00; P=0.046) and 0.11 kg m-2 per year decrease in FMI (-0.22-0.00; P=0.049). CONCLUSIONS: Increased ST and increased SF from 7-15 years were associated with increased adiposity. This is the first study to show age-specific associations between change in objectively measured sedentary behavior and adiposity after adjustment of moderate-to-vigorous-intensity physical activity in children and adolescents. The study suggests that, targeting sedentary behavior for obesity prevention may be most effective during periods in which we see large increases in ST.


Assuntos
Adiposidade , Comportamento do Adolescente , Comportamento Infantil , Exercício Físico/fisiologia , Comportamento Sedentário , Acelerometria/estatística & dados numéricos , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Obesidade Pediátrica/prevenção & controle , Comportamento de Redução do Risco , Reino Unido , População Urbana
13.
J Radiol Prot ; 36(4): R131-R144, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27893455

RESUMO

A large number of investigations into the radiation doses from x-ray guided interventional cardiology procedures in children have been carried out in recent years. A review was conducted of these studies, gathering data on kerma area product (P KA), fluoroscopic screening time (FT), air kerma, and estimates of effective dose and organ doses. The majority of studies focus on P KA and FT with no estimation of dose to the patient. A greater than ten-fold variation in average P KA was found between different studies, even where data were stratified by patient age or weight. Typical values of P KA were 0.6-10 Gy · cm2 (<1 year/10 kg), 1.5-30 Gy · cm2 (1-5 years), 2-40 Gy · cm2 (5-10 years), 5-100 Gy · cm2 (10-16 years) and 10-200 Gy · cm2 (>16 years). P KA was lowest for heart biopsy (0.3-10 Gy · cm2 for all ages combined) and atrial septostomy (0.4-4.0 Gy · cm2), and highest for pulmonary artery angioplasty (1.5-35 Gy · cm2) and right ventricular outflow tract dilatation (139 Gy · cm2). Most estimates of patient dose were in the form of effective dose (typically 3-15 mSv) which is of limited usefulness in individualised risk assessment. Few studies estimated organ doses. Despite advances in radiation protection, recent publications have reported surprisingly large doses, as represented by P KA and air kerma. There is little indication of a fall in these dose indicators over the last 15 years. Nor is there much suggestion of a fall in doses associated with the use of flat panel detectors, as opposed to image intensifiers. An assessment of the impact of radiation dose in the context of overall patient outcome is required.


Assuntos
Cardiologia , Doses de Radiação , Proteção Radiológica/métodos , Radiografia Intervencionista , Criança , Humanos , Medição de Risco
14.
Eur J Cancer Care (Engl) ; 25(3): 428-39, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26391419

RESUMO

It is rare for studies to approach psychosocial outcomes of childhood cancer in a holistic and explanatory way. Doing so would enable a greater understanding of why and in what way a young person's life may be affected by cancer. This qualitative study aimed to explore the views of childhood cancer survivors (CCS) regarding how they perceive their illness to have influenced them and their subsequent lives. Twelve CCS with a median age of 23 years old took part in either a focus group or a telephone interview. Data were analysed using thematic analysis. The main themes were altered life perspectives, perceptions of self and lasting effects on relationships. Through these themes, the survivors gave insight into how their experience had influenced their views and how this had impacted on different areas of their lives. Although positive aspects were discussed, enduring issues were reported by some. Findings suggest that despite high levels of achievement, some survivors may still benefit from further information and support especially in relation to relationships and fertility. This study will inform the development of a questionnaire aiming to collect important information on the many factors which may influence long-term psychosocial outcomes in CCS.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Neoplasias/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idade de Início , Atitude Frente a Saúde , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Infertilidade/psicologia , Intenção , Relações Interpessoais , Acontecimentos que Mudam a Vida , Masculino , Pesquisa Qualitativa , Autoimagem , Adulto Jovem
15.
Br J Radiol ; 88(1048): 20140852, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25654205

RESUMO

OBJECTIVE: To gather data on radiation doses from fluoroscopically guided cardiac catheterization procedures in patients aged under 22 years at multiple centres and over a prolonged period in the UK. To evaluate and explain variation in doses. To estimate patient-specific organ doses and allow for possible future epidemiological analysis of associated cancer risks. METHODS: Patient-specific data including kerma area product and screening times from 10,257 procedures carried out on 7726 patients at 3 UK hospitals from 1994 until 2013 were collected. Organ doses were estimated from these data using a dedicated dosimetry system based on Monte Carlo computer simulations. RESULTS: Radiation doses from these procedures have fallen significantly over the past two decades. The organs receiving the highest doses per procedure were the lungs (median across whole cohort, 20.5 mSv), heart (19.7 mSv) and breasts (13.1 mSv). Median cumulative doses, taking into account multiple procedures, were 23.2, 22.2 and 16.7 mSv for these organs, respectively. Bone marrow doses were relatively low (median per procedure, 3.2 mSv; cumulative, 3.6 mSv). CONCLUSION: Most modern cardiac catheterizations in children are moderately low-dose procedures. Technological advances appear to be the single most important factor in the fall in doses. Patients undergoing heart transplants undergo the most procedures. An epidemiological assessment of cancer risks following these procedures may be possible, especially using older data when doses were higher. ADVANCES IN KNOWLEDGE: This is the first large-scale, patient-specific assessment of organ doses from these procedures in a young population.


Assuntos
Cateterismo Cardíaco , Fluoroscopia , Doses de Radiação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Método de Monte Carlo , Fatores de Risco , Dosimetria Termoluminescente , Reino Unido
16.
East Mediterr Health J ; 20(10): 589-95, 2014 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-25356689

RESUMO

The prevalence of obesity among adults in Saudi Arabia increased from 22% in 1990-1993 to 36% in 2005, and future projections of the prevalence of adult obesity are needed by health policy-makers. In a secondary analysis of published data, a number of assumptions were applied to estimate the trends and projections in the age-and sex-specific prevalence of adult obesity in Saudi Arabia over the period 1992-2022. Five studies conducted between 1989 and 2005 were eligible for inclusion, using body mass index (BMI) ≥ 30 kg/m(2) to define obesity. The overall prevalence of obesity was projected to increase from around 12% in 1992 to 41% by 2022 in men, and from 21% to 78% in women. Women had much higher projected prevalence than men, particularly in the age groups 35-44, 45-54 and 55-64 years. Effective national strategies are needed to reduce or halt the projected rise in obesity prevalence.


Assuntos
Ingestão de Energia/fisiologia , Política de Saúde , Obesidade/prevenção & controle , Comportamento Sedentário , Adulto , Distribuição por Idade , Dieta/efeitos adversos , Dieta/tendências , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Arábia Saudita/epidemiologia , Distribuição por Sexo
17.
Br J Cancer ; 111(9): 1814-23, 2014 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-25051410

RESUMO

BACKGROUND: Earlier studies have shown raised risks of leukaemia and non-Hodgkin lymphoma in children, teenagers and young adults resident either at birth or diagnosis in Seascale. Some increases in cancer risk in these age groups have also been noted among those living around Dounreay. We aimed to update previous analyses relating to areas close to these nuclear installations by considering data from an additional 16 years of follow-up. METHODS: Cross-sectional analyses compared cancer incidence rates for 1963-2006 among those aged 0-24 years at diagnosis living in geographically specified areas around either Sellafield or Dounreay with general population rates. Cancer incidence for the period 1971-2006 among the cohort of Cumbrian births between 1950 and 2006 was compared to national incidence for 1971-2006 using person-years analysis. Cancer among those born in the postcode sector closest to Dounreay was compared with that among those born in the three adjoining postcode sectors. Analyses considered both cancer overall and ICD-O-3 defined diagnostic subgroups including leukaemia, central nervous system tumours and other malignancies. RESULTS: Apart from previously reported raised risks, no new significantly increased risks for cancer overall or any diagnostic subgroup were found among children or teenagers and young adults living around either nuclear installation. Individuals born close to the installations from 1950 to 2006 were not shown to be at any increased risk of cancer during the period 1971 to date. CONCLUSIONS: Analysis of recent data suggests that children, teenagers and young adults currently living close to Sellafield and Dounreay are not at an increased risk of developing cancer. Equally, there is no evidence of any increased cancer risk later in life among those resident in these areas at birth.


Assuntos
Neoplasias Induzidas por Radiação/epidemiologia , Reatores Nucleares , Cinza Radioativa/efeitos adversos , Características de Residência , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Neoplasias Induzidas por Radiação/etiologia , Prognóstico , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
18.
J Dev Orig Health Dis ; 5(3): 240-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24901664

RESUMO

It has been suggested that in addition to genetic factors, fetal and post-natal growth influence cognition in early adulthood. However, most studies have been in developed populations, so it is unclear if the same findings would be seen in other, less developed, settings, and have used testing tools not applicable to an Australia Aboriginal population. This study investigated the relationships between cognitive function in early adulthood and birth weight and contemporary height. Simple reaction time (SRT), choice reaction time (CRT) and working memory (WM) were assessed using the CogState battery. A significant association was seen between birth weight and SRT in early adulthood, but not with the other two cognitive measures. Urban dwellers had significantly shorter SRT and CRT than their remote counterparts. Contemporary body mass index and maternal age were associated with CRT. Only fetal growth restriction was associated with WM, with greater WM in those with restricted growth. No associations were seen with contemporary height. These results suggest that fetal growth may be more important than the factors influencing post-natal growth in terms of cognition in early adulthood in this population, but that the associations may be inconsistent between cognitive outcomes. Further research is required to identify whether similar associations are seen in other, similar, populations and to assess why differences in cognitive outcome measures are seen.


Assuntos
Peso ao Nascer/fisiologia , Cognição/fisiologia , Memória de Curto Prazo/fisiologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Desempenho Psicomotor/fisiologia , Adolescente , Austrália/etnologia , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/etnologia , Retardo do Crescimento Fetal/psicologia , Seguimentos , Humanos , Masculino , Estimulação Luminosa/métodos , Estudos Prospectivos , Tempo de Reação/fisiologia , Adulto Jovem
19.
Epidemiol Infect ; 142(2): 388-98, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23657202

RESUMO

The aim of this study was to investigate spatial variation in risk of hospitalization in childhood pneumonia and empyema in the North of England and associated risk factors. Data on childhood (0-14 years) hospital admissions with a diagnosis pneumonia or empyema were linked to postcode districts. Bayesian conditional autoregressive models were used to evaluate spatial variation and the relevance of specific spatial covariates in an area-based study using postcode as the areal unit. There was a sixfold variation in the risk of hospitalization due to pneumonia across the study region. Variation in risk was associated with material deprivation, Child Well-being Index (CWI) health domain score, number of children requiring local authority support, and distance to hospital. No significant spatial variation in risk for empyema was found.


Assuntos
Empiema Pleural/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia/epidemiologia , Adolescente , Criança , Pré-Escolar , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pneumonia/terapia , Pobreza/estatística & dados numéricos , Fatores de Risco , Análise Espacial
20.
Br J Cancer ; 108(11): 2339-45, 2013 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-23652301

RESUMO

BACKGROUND: Despite marked improvements in childhood leukaemia survival, 20% still die within 5 years of diagnosis. The aim of this study was to evaluate the relationship between socioeconomic status, as assessed by paternal occupation at birth, and survival from childhood leukaemia in children, using data from the Northern Region Young Persons Malignant Disease Registry. METHODS: All 1007 cases of leukaemia in children aged 0-14 years, diagnosed between 1968 and 2010 and registered with the Registry were studied. Paternal occupational social class at the time of the child's birth was obtained and analysed in relation to survival using Cox-proportional regression. RESULTS: Compared with the most advantaged group (I/II), those in the middle group (IIIN/M) had a 68% increased risk of death, while those in the least advantaged group (IV/V) had 86% higher risk for acute lymphoblastic leukaemia. While the survival advantage of children in class I/II was apparent from the time of diagnosis, survival for children in groups IIIN/M and IV/V were comparable until 3-4 years after diagnosis, when they began to minimally diverge. CONCLUSION: The existence of such socioeconomic disparities cannot be attributed to accessibility to health care in the United Kingdom. Further research into the likely factors underlying these disparities is required.


Assuntos
Leucemia/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Lactente , Recém-Nascido , Leucemia/economia , Leucemia/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Classe Social , Adulto Jovem
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