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1.
Huan Jing Ke Xue ; 43(6): 3288-3298, 2022 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-35686799

RESUMO

The golden snub-nosed monkey is one of the most endangered animal species endemic to China. In order to explore the characteristics and health risks of golden snub-nosed monkeys exposed to heavy metals, we collected the plant food sources, soil, and water samples from the golden snub-nosed monkey habitat in the Shennongjia Mountains; examined the contents of seven heavy metals (Cu, Zn, Pb, Cd, Cr, Ni, and As); and adopted the comprehensive pollution index, potential ecological risk index, and Nemerow index to evaluate pollutants in the water, soil, and food plants. At the same time, the Target Hazard Quotient method was used to assess heavy metals in the food plants. The results showed that the heavy metal concentration of the habitat water was 0.004-1.220 µg·L-1. The water comprehensive pollution index showed that the habitat water was safe. In addition, the ω(Cd)(0.162-0.822 mg·kg-1) in the soil was 2.71 times the background value of the soil in Hubei province, indicating a moderate risk of ecological harm. The over-standard rates of Pb, Cd, Cr, and Ni in food plants were 29%, 29%, 18%, and 35%, respectively; the pollution indexes of lichen and bark were 6.038 and 7.709, which were at a heavy pollution level; and the pollution indexes of Abies fragesii and Vicia cracca were 2.716 and 2.034, which indicated a moderately polluted level. The rest of the plants were at a safe level. Our health risk analysis showed that the risk of lichen and bark were higher than that of leaves, followed by fruits. Among the seven metals, As most threatened the health of the golden snub-nosed monkeys (THQ>1). In general, heavy metals had polluted the habitats of the golden snub-nosed monkeys in the Shennongjia Mountains, and we are certain that the heavy metal pollution was associated with human activities. Thus, human activities in the Shennongjia Mountains should be reasonably restricted in the future. Our results can provide scientific support for the population conservation of golden snub-nosed monkeys in China and provide research samples in the health risk valuation of heavy metals in endangered animals through food plants.


Assuntos
Cádmio , Metais Pesados , Animais , Cádmio/análise , Colobinae , Ecossistema , Chumbo/análise , Metais Pesados/análise , Medição de Risco , Solo , Água/análise
2.
Front Neurol ; 13: 860083, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35547390

RESUMO

Background: Neuromyelitis Optica spectrum disorder (NMOSD) is severe relapsing and disabling autoimmune disease of the central nervous system. Its optimal first-line treatment to reduce relapse rate and ameliorate neurological disability remains unclear. We will conduct a prospective, multicenter, randomized, placebo-controlled clinical trial to study the safety and effectiveness of human umbilical cord mesenchymal stem cells (hUC-MSCs) in treating NMOSD. Methods: The trial is planned to recruit 430 AQP4-IgG seropositive NMOSD patients. It consists of three consecutive stages. The first stage will be carried out in the leading center only and aims to evaluate the safety of hUC-MSCs. Patients will be treated with three different doses of hUC-MSCs: 1, 2, or 5 × 106 MSC/kg·weight for the low-, medium-, and high-dose group, respectively. The second and third stages will be carried out in six centers. The second stage aims to find the optimal dosage. Patients will be 1:1:1:1 randomized into the low-, medium-, high-dose group and the controlled group. The third stage aims to evaluate the effectiveness. Patients will be 1:1 randomized into the optimal dose and the controlled group. The primary endpoint is the first recurrent time and secondary endpoints are the recurrent times, EDSS scores, MRI lesion numbers, OSIS scores, Hauser walking index, and SF-36 scores. Endpoint events and side effects will be evaluated every 3 months for 2 years. Discussion: Although hUC-MSC has shown promising treatment effects of NMOSD in preclinical studies, there is still a lack of well-designed clinical trials to evaluate the safety and effectiveness of hUC-MSC among NMOSD patients. As far as we know, this trial will be the first one to systematically demonstrate the clinical safety and efficacy of hUC-MSC in treating NMOSD and might be able to determine the optimal dose of hUC-MSC for NMOSD patients. Trial registration: The study was registered with the Chinese Clinical Trial Registry (CHICTR.org.cn) on 2 March 2016 (registration No. ChiCTR-INR-16008037), and the revised trial protocol (Protocol version 1.2.1) was released on 16 March 2020.

3.
Am J Prev Med ; 62(6): 921-929, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35221175

RESUMO

INTRODUCTION: It is unclear whether changes in beverage price and sales after beverage tax implementation can be sustained long term. This study aims to quantify the changes in beverage prices and sales in large retailers 2 years after the implementation of the 1.5 cents per ounce Philadelphia beverage tax. METHODS: Data on price and volume sales of beverages and potential food substitutes were collected from 109 supermarkets, 45 mass merchandizers, and 350 pharmacies in Philadelphia, Baltimore (control), and Pennsylvania ZIP codes bordering Philadelphia (to investigate potential cross-border shopping for tax avoidance). Difference-in-differences analyses compared beverage prices and volume sales in the year before tax implementation (2016) to 2 years after (2018). Data were analyzed in 2020-2021. RESULTS: Difference-in-differences analyses found that after tax implementation, taxed beverage prices in Philadelphia increased by 1.02 cents per ounce (95% CI=0.94, 1.11; 68% pass through), and taxed beverage volume sales in stores decreased by 50% (95% CI=36%, 61%). After accounting for cross-border shopping, taxed beverage volume sales decreased in Philadelphia by 35% in 2018. Volume sales of nontaxed beverages did not change after tax implementation (difference-in-differences=4%, 95% CI= -3%, 12%). Volume sales of nontaxed beverage concentrates increased on average by 34% (95% CI=19%, 51%), but there was no evidence of substitution to high-calorie foods. CONCLUSIONS: There was a large reduction in taxed beverage volume sales 2 years after Philadelphia tax implementation, even after accounting for cross-border shopping. Increases in nontaxed beverage concentrate sales likely partially offset this decline, but there was no evidence of post-tax food substitution.


Assuntos
Bebidas Adoçadas com Açúcar , Bebidas , Comércio , Humanos , Philadelphia , Impostos
4.
Support Care Cancer ; 30(4): 3321-3327, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34988704

RESUMO

PURPOSE: The influence of innovative chimeric antigen receptor T cell (CAR-T) therapy for hematological malignancies on nutritional status remains unknown. Therefore, we aim to explore the alterations of nutritional status after CAR-T cell therapy in patients with hematological malignancies. METHODS: We retrospectively collected the data of patients with acute leukemia (AL), lymphoma, and multiple myeloma (MM), who underwent CAR-T therapy at our hospital from 2018 to 2020. The serum albumin, triglyceride, and cholesterol before and 7, 14, and 21 days after CAR-T cell infusion were compared and analyzed. RESULT: A total of 117 patients were enrolled, consisting of 39 AL, 23 lymphoma, and 55 MM patients. The baseline albumin, triglyceride, and cholesterol were 37.43 ± 5.08 mg/L, 1.63 ± 0.74 mmol/L, and 3.62 ± 1.03 mmol/L, respectively. The lowest albumin level was found at 7 days after CAR-T cell infusion compared with baseline (P < 0.001), while the levels of triglyceride increased at 14 and 21 days (P < 0.001, P = 0.036). The levels of cholesterol at 7, 14, and 21 days after CAR-T cell infusion were lower than baseline (all P < 0.05). Spearman's correlation coefficient showed cytokine release syndrome grade was negatively correlated with the levels of albumin at 7 days and cholesterol at 21 days after CAR-T cell infusion (r = - 0.353, P < 0.001; r = - 0.395, P = 0.002). CONCLUSION: The alterations of different nutrition-related biochemical parameters varied after CAR-T cell therapy. The levels of albumin and total cholesterol after CAR-T cell infusion were negatively correlated with the grade of cytokine release syndrome. Specific screening and intervention for malnutrition in patients receiving CAR-T cell therapy need to be explored in further studies.


Assuntos
Neoplasias Hematológicas , Imunoterapia Adotiva , Estado Nutricional , Terapia Baseada em Transplante de Células e Tecidos , Neoplasias Hematológicas/terapia , Humanos , Receptores de Antígenos Quiméricos , Estudos Retrospectivos
5.
J Nutr ; 152(3): 880-888, 2022 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-34910200

RESUMO

BACKGROUND: Evidence suggests that sweetened beverage taxes reduce taxed beverage purchases, but few studies have used individual-level data to assess whether these taxes affect purchases of nontaxed foods, beverages, and alcohol. Additionally, research has not examined whether sweetened beverage taxes influence restaurant purchases. OBJECTIVES: We assessed changes in individuals' purchases of taxed beverage types; low-calorie/low-added-sugar nontaxed beverages; high-calorie/high-added-sugar nontaxed beverages, foods, and alcohol; and beverages from restaurants following implementation of the 1.5 cent-per-ounce Philadelphia sweetened beverage tax. METHODS: A longitudinal cohort of adult sugar-sweetened beverage consumers in Philadelphia (n = 306; 67% female; mean age: 43.9 years) and Baltimore (n = 297; comparison city without a beverage tax; 58% female; mean age: 41.7 years) submitted all food and beverage receipts during 2-week periods at baseline and at 3, 6, and 12 months posttax. Difference-in-differences analyses compared changes in purchases from pre- to posttax in Philadelphia to changes in Baltimore. RESULTS: Purchases of taxed juice drinks [ratio of incidence rate ratios (RIRR) = 0.62; 95% CI, 0.42-0.91], but not other taxed beverage types, decreased in Philadelphia compared to Baltimore following the tax. Analyses did not find changes in purchases of low-calorie/low-added-sugar nontaxed beverages, such as water or milk. Additionally, analyses did not find increases in purchases of most high-calorie/high-added-sugar nontaxed products, including alcohol, juice, candy, sweet snacks, salty snacks, and desserts. Purchases of beverage concentrates increased in Philadelphia (RIRR = 2.22; 95% CI, 1.39-3.54). CONCLUSIONS: In this difference-in-differences analysis, the Philadelphia beverage tax was associated with reduced purchases of taxed juice drinks. Purchases of beverage concentrates increased after the tax, but no increases were observed for other high-calorie/high-added-sugar nontaxed foods, beverages, or alcohol.


Assuntos
Comércio , Impostos , Adulto , Bebidas , Etanol , Feminino , Humanos , Masculino , Philadelphia , Lanches , Açúcares
6.
Am J Public Health ; 111(11): 1997-2007, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34709859

RESUMO

Objectives. To test whether fruit drink countermarketing messages alone or combined with water promotion messages reduce Latinx parents' purchases of fruit drinks for children aged 0 to 5 years. Methods. We performed a 3-arm randomized controlled online trial enrolling 1628 Latinx parents in the United States during October and November 2019. We assessed the effect of culturally tailored fruit drink countermarketing messages (fruit drink‒only group), countermarketing and water promotion messages combined (combination group), or car-seat safety messages (control) delivered via Facebook groups for 6 weeks on parental beverage choices from a simulated online store. Results. The proportion of parents choosing fruit drinks decreased by 13.7 percentage points in the fruit drink‒only group (95% confidence interval [CI] = -20.0, -7.4; P < .001) and by 19.2 percentage points in the combination group (95% CI = -25.0, -13.4; P < .001) relative to control. Water selection increased in both groups. Conclusions. Fruit drink countermarketing messages, alone or combined with water promotion messages, significantly decreased parental selection of fruit drinks and increased water selection for their children. Public Health Implications. Countermarketing social media messages may be an effective and low-cost intervention for reducing parents' fruit drink purchases for their children. (Am J Public Health. 2021;111(11):1997-2007. https://doi.org/10.2105/AJPH.2021.306488).


Assuntos
Comportamento do Consumidor/economia , Frutas , Promoção da Saúde/métodos , Mídias Sociais , Bebidas Adoçadas com Açúcar/economia , Água , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
7.
JAMA Netw Open ; 4(10): e2121908, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34605920

RESUMO

Importance: Financial incentives may improve health behaviors. It is unknown whether incentives are more effective if they target a key process (eg, medication adherence), an outcome (eg, low-density lipoprotein cholesterol [LDL-C] levels), or both. Objective: To determine whether financial incentives awarded daily for process (adherence to statins), awarded quarterly for outcomes (personalized LDL-C level targets), or awarded for process plus outcomes induce reductions in LDL-C levels compared with control. Design, Setting, and Participants: A randomized clinical trial was conducted from February 12, 2015, to October 3, 2018; data analysis was performed from October 4, 2018, to May 27, 2021, at the University of Pennsylvania Health System, Philadelphia. Participants included 764 adults with an active statin prescription, elevated risk of atherosclerotic cardiovascular disease, suboptimal LDL-C level, and evidence of imperfect adherence to statin medication. Interventions: Interventions lasted 12 months. All participants received a smart pill bottle to measure adherence and underwent LDL-C measurement every 3 months. In the process group, daily financial incentives were awarded for statin adherence. In the outcomes group, participants received incentives for achieving or sustaining at least a quarterly 10-mg/dL LDL-C level reduction. The process plus outcomes group participants were eligible for incentives split between statin adherence and quarterly LDL-C level targets. Main Outcomes and Measures: Change in LDL-C level from baseline to 12 months, determined using intention-to-treat analysis. Results: Of the 764 participants, 390 were women (51.2%); mean (SD) age was 62.4 (10.0) years, 310 (40.6%) had diabetes, 298 (39.0%) had hypertension, and mean (SD) baseline LDL-C level was 138.8 (37.6) mg/dL. Mean LDL-C level reductions from baseline to 12 months were -36.9 mg/dL (95% CI, -42.0 to -31.9 mg/dL) among control participants, -40.0 mg/dL (95% CI, -44.7 to -35.4 mg/dL) among process participants, -41.6 mg/dL (95% CI, -46.3 to -37.0 mg/dL) among outcomes participants, and -42.8 mg/dL (95% CI, -47.4 to -38.1 mg/dL) among process plus outcomes participants. In exploratory analysis among participants with diabetes and hypertension, no spillover effects of incentives were detected compared with the control group on hemoglobin A1c level and blood pressure over 12 months. Conclusions and Relevance: In this randomized clinical trial, process-, outcomes-, or process plus outcomes-based financial incentives did not improve LDL-C levels vs control. Trial Registration: ClinicalTrials.gov Identifier: NCT02246959.


Assuntos
Anticolesterolemiantes/economia , Colesterol/análise , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Reembolso de Incentivo/normas , Idoso , Anticolesterolemiantes/uso terapêutico , Colesterol/sangue , Correlação de Dados , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Philadelphia , Reembolso de Incentivo/estatística & dados numéricos
8.
BMJ Open ; 11(9): e047202, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475159

RESUMO

INTRODUCTION: Patients with frequent acute exacerbation phenotype chronic obstructive pulmonary disease (AECOPD) have a higher hospitalisation rate than infrequent exacerbation, the disease progresses quickly and treatment is more difficult. At present, it is impossible to predict patients with COPD with frequent acute exacerbation phenotypes. The composition of the lower respiratory tract flora and the intestinal flora is closely related to AECOPD, but the specific association mechanism between them is not very clear. This study used metagenomic next-generation sequencing (mNGS) technology to explore the microbial characteristics of the intestinal tract and airways of patients with COPD, and analyse the correlation between the sequencing results and inflammatory factors, immune factors and nutritional factors. METHODS AND ANALYSIS: This will be a prospective cohort study. We intend to recruit 152 patients with stable COPD. In the baseline, we will detect the participants' induced sputum and faecal flora through mNGS, and changes in blood immune levels, and the patient's condition is evaluated. Every 2 months, we will check the number of acute exacerbation through the phone range. After 12 months, we will check again the changes in the blood immune level, evaluate the patient's condition and count the number of episodes. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (approval number ZF2019-219-03). The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (ChiCTR2000032870).


Assuntos
Microbioma Gastrointestinal , Doença Pulmonar Obstrutiva Crônica , Progressão da Doença , Microbioma Gastrointestinal/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Pulmão , Fenótipo , Estudos Prospectivos
9.
Complement Med Res ; 28(6): 533-544, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34261065

RESUMO

Dingchuan decoction (DCD) is a traditional Chinese prescription for asthma that remains popular today. To systematically evaluate the effect of DCD on lung function, clinical effectiveness rate, and safety in children with asthma, significant databases were searched for randomized controlled trials from their inception to September 9, 2019. Randomized controlled trials assessing the effect of DCD on lung function and clinical effectiveness rate in children with asthma were included in this meta-analysis. The methodological quality of the included trials was assessed using the Cochrane risk of bias tool. RevMan 5.3 was used for data analysis. Fourteen studies with 1,384 children were reviewed. FEV1 improvement rate (mean difference [MD] 12.50, 95% confidence interval [CI] 8.72-16.29), PEF improvement rate (MD 14.28, 95% CI 11.08-17.49), and clinical effectiveness rate (relative risk 1.19, 95% CI 1.14-1.25) significantly increased in the DCD group when compared to simple conventional medication. Four trials suggest that DCD is safe for children. In conclusion, the use of DCD combined with conventional medication improves lung function and clinical effectiveness rate better than simple conventional medication. However, the selected trials lack blinding and large-scale studies. Therefore, to better manage DCD in clinical practice, more randomized controlled trials and large-scale studies are required for further evaluation.


Assuntos
Asma , Pontos de Acupuntura , Asma/tratamento farmacológico , Criança , Humanos , Pulmão , Resultado do Tratamento
10.
JAMA Netw Open ; 4(6): e2113527, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34129022

RESUMO

Importance: The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items. Objective: To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores. Design, Setting, and Participants: This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties. Main Outcomes and Measures: Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods. Results: Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001). Conclusions and Relevance: This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.


Assuntos
Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Legislação sobre Alimentos/economia , Bebidas Adoçadas com Açúcar/economia , Bebidas Adoçadas com Açúcar/legislação & jurisprudência , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Impostos/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Baltimore , Comércio/economia , Comércio/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Legislação sobre Alimentos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Philadelphia , Impostos/estatística & dados numéricos , Adulto Jovem
11.
JAMA Netw Open ; 4(5): e219211, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33944923

RESUMO

Importance: Financial incentives may improve health by rewarding patients for focusing on present actions-such as medication regimen adherence-that provide longer-term health benefits. Objective: To identify barriers to improving statin therapy adherence and control of cholesterol levels with financial incentives and insights for the design of future interventions. Design, Setting, and Participants: This qualitative study involved retrospective interviews with participants in a preplanned secondary analysis of a randomized clinical trial of financial incentives for statin therapy adherence. A total of 636 trial participants from several US insurer or employer populations and an academic health system were rank ordered by change in low-density lipoprotein cholesterol (LDLC) levels. Participants with the most LDLC level improvement (high-improvement group) and those with LDLC levels that did not improve (nonimprovement group) were purposively targeted, stratified across all trial groups, for semistructured telephone interviews that were performed from April 1 to June 30, 2018. Interviews were coded using a team-based, iterative approach. Data were analyzed from July 1, 2018, to October 31, 2020. Main Outcomes and Measures: The primary outcome was mean change in LDLC level from baseline to 12 months; the secondary outcome, statin therapy adherence during the first 6 months. Results: A total of 54 patients were interviewed, divided equally between high-improvement and nonimprovement groups, with a mean (SD) age of 43.5 (10.3) years; 36 (66.7%) were women, 28 (51.9%) had diabetes, and 18 (33.3%) had cardiovascular disease. Compared with the high-improvement group, the nonimprovement group had fewer interviewees with an annual income of greater than $50 000 (11 [40.7%] vs 22 [81.5%]), worse self-reported health (fair to poor, 13 [48.1%] vs 3 [11.1%]), more Black interviewees (16 [59.3%] vs 4 [14.8%]), and lower baseline LDLC levels (>160 mg/dL, 2 [7.4%] vs 25 [92.6%]). Participants in the nonimprovement group had a greater burden of chronic illness (≥2 chronic conditions, 13 [48.1%] vs 6 [22.2%]) and were less frequently employed (full-time, 6 [22.2%] vs 12 [44.4%]). In interviews, the nonimprovement group was less focused on risks of high LDLC levels, described less engagement in LDLC level management, articulated fewer specific nutritional choices for optimizing health, and recounted greater difficulty obtaining healthy food. Participants in both groups had difficulty describing the structure of the financial incentives but did recall features of the electronic pill containers used to track adherence and how those containers affected medication routines. Conclusions and Relevance: Participants in a statin adherence trial whose LDLC levels did not improve found it more difficult to create medication routines and respond to financial incentives in the context of complex living conditions and a high burden of chronic illness. These findings suggest that future studies should be more attentive to socioeconomic circumstances of trial participants. Trial Registration: ClinicalTrials.gov Identifier: NCT01798784.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adesão à Medicação , Adulto , Idoso , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa
12.
Sci Total Environ ; 784: 147187, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-33901960

RESUMO

Pyrite is widely used in Fenton reaction for degradation of pollutants and exhibits great potential for environmental remediation, however, its efficiency is greatly compromised by extra H2O2 and pH adjustment. Herein, a pyrite based green solar photo-Fenton system for carbamazepine (CBZ) treatment is constructed, involving the use of simulated sunlight and natural organic acids with in situ-generated H2O2 and without extra pH adjustment. The addition of organic acids including tartaric acid (TA), citric acid (CA), and ascorbic acid (AA) can form complex with iron in pyrite, which promotes the Fe(II) dissolution. Upon irradiation, pyrite could be excited to produce photoelectrons, which would reduce oxygen to produce H2O2 through a two-step route assisted by organic acids. The simulated sunlight and organic acids promoted the in-situ production of H2O2 and Fe(II) species, sustaining an efficient Fenton reaction. This produced massive hydroxyl radical (OH), as demonstrated by the active species capture experiment. Compared with no degradation of CBZ under pure pyrite, the degradation efficiency of CBZ reached to 70%, 60%, and 53% in pyrite/TA, pyrite/CA, pyrite/AA within 30 min under simulated solar light irradiation, respectively. This work reports the first use of natural pyrite, a typical Fe-mineral semiconductor, to produce OH for CBZ degradation through natural additive assisted Fenton reaction excluding the adding extra H2O2 and pH adjustment.

13.
PLoS One ; 16(2): e0247203, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606819

RESUMO

BACKGROUND: Identifying individuals at risk for future hospitalization or death has been a major priority of population health management strategies. High-risk individuals are a heterogeneous group, and existing studies describing heterogeneity in high-risk individuals have been limited by data focused on clinical comorbidities and not socioeconomic or behavioral factors. We used machine learning clustering methods and linked comorbidity-based, sociodemographic, and psychobehavioral data to identify subgroups of high-risk Veterans and study long-term outcomes, hypothesizing that factors other than comorbidities would characterize several subgroups. METHODS AND FINDINGS: In this cross-sectional study, we used data from the VA Corporate Data Warehouse, a national repository of VA administrative claims and electronic health data. To identify high-risk Veterans, we used the Care Assessment Needs (CAN) score, a routinely-used VA model that predicts a patient's percentile risk of hospitalization or death at one year. Our study population consisted of 110,000 Veterans who were randomly sampled from 1,920,436 Veterans with a CAN score≥75th percentile in 2014. We categorized patient-level data into 119 independent variables based on demographics, comorbidities, pharmacy, vital signs, laboratories, and prior utilization. We used a previously validated density-based clustering algorithm to identify 30 subgroups of high-risk Veterans ranging in size from 50 to 2,446 patients. Mean CAN score ranged from 72.4 to 90.3 among subgroups. Two-year mortality ranged from 0.9% to 45.6% and was highest in the home-based care and metastatic cancer subgroups. Mean inpatient days ranged from 1.4 to 30.5 and were highest in the post-surgery and blood loss anemia subgroups. Mean emergency room visits ranged from 1.0 to 4.3 and were highest in the chronic sedative use and polysubstance use with amphetamine predominance subgroups. Five subgroups were distinguished by psychobehavioral factors and four subgroups were distinguished by sociodemographic factors. CONCLUSIONS: High-risk Veterans are a heterogeneous population consisting of multiple distinct subgroups-many of which are not defined by clinical comorbidities-with distinct utilization and outcome patterns. To our knowledge, this represents the largest application of ML clustering methods to subgroup a high-risk population. Further study is needed to determine whether distinct subgroups may benefit from individualized interventions.


Assuntos
Hospitalização/estatística & dados numéricos , Aprendizado de Máquina , Idoso , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Veteranos
14.
J Asthma ; 58(5): 625-632, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-31922916

RESUMO

Objective: This study aimed to evaluate the diagnostic value of the modified hypertonic saline bronchial provocation test (HS-BPT) for children with asthma by using the high-power Aerosol Provocation System (APS).Methods: A total of 330 children suspected of having asthma and receiving HS-BPT-APS were included in this prospective survey conducted in Guangzhou, China from February 2017 to September 2018. The positive rate of HS-BPT-APS and the volume and types of adverse reactions were observed. There was also a retrospective cohort of 123 children with suspected asthma who underwent a methacholine BPT from 2015 to 2017. Using the method of nearest neighbor matching, a comparison was made of the positive rate and adverse reaction between the methacholine BPT group and HS-BPT-APS group.Results: The total positive rate of HS-BPT-APS was 43.9%. Common adverse reactions included cough, wheezing and chest tightness. There were no serious adverse reactions. Results of nearest neighbor matching showed a difference in the positive rate between the methacholine BPT group and HS-BPT-APS group (8.1% vs 18.2%, p = 0.026), but there was no statistically significant difference between the age groups in patients who received the methacholine BPT or HS-BPT-APS. There was a similar adverse reaction rate in the two groups (p = 0.609).Conclusions: HS-BPT-APS is simple, safe, and time-saving, with few adverse reactions. The positive rate of HS-BPT-APS was higher than that of methacholine BPT in children with asthma. HS-BPT-APS may be a valuable tool in the diagnosis of children with asthma, and further study is required.


Assuntos
Asma/diagnóstico , Testes de Provocação Brônquica/métodos , Solução Salina Hipertônica/administração & dosagem , Aerossóis , Asma/fisiopatologia , Broncoconstritores/administração & dosagem , Criança , Pré-Escolar , Tosse , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Cloreto de Metacolina/administração & dosagem , Sons Respiratórios , Solução Salina Hipertônica/efeitos adversos
15.
Environ Pollut ; 268(Pt B): 115944, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33160733

RESUMO

Cadmium bioavailability in paddy soils is strongly affected by flooding-draining cycle. In this study, we used synchrotron-based X-ray absorption spectroscopy and a stirred-flow method to investigate the effects of flooding-draining and amendments of CaCO3 and CaSO4 on Cd speciation and release kinetics from a Cd-spiked paddy soil (total Cd concentration of 165 mg kg-1). Extended X-ray absorption fine structure analysis showed that Cd was predominantly bound to non-iron-clay minerals (e.g. Cd-kaolinite, Cd-illite, and Cd-montmorillonite, accounting for 60-100%) in the air-dried soil and 1- or 7-day flooded samples. After prolonged flooding (30 and 120 days), Cd-iron mineral complexes (e.g. Cd bound to ferrihydrite and goethite) became the predominant species (accounting for 52-100%). Stirred-flow kinetic analysis showed that both prolonged flooding and the amendments with CaCO3 and CaSO4 decreased the maximum amount and the rate coefficient of Cd release. However, the effect of prolonged flooding was reversed after a short period of draining, indicating that although Cd was immobilized during flooding, it became mobile rapidly after the soil was drained, possibly due to pH decrease and rapid oxidation of CdS. The effects of the amendments on Cd uptake in rice plants were tested in a pot experiment using the same paddy soil without Cd spiking (total Cd 2.1 mg kg-1). Amendment with CaCO3 and, to a lesser extent, CaSO4, decreased the Cd accumulation in two cultivars of rice. The combination of CaCO3 amendment and a low Cd accumulating cultivar was effective at limiting grain Cd concentration to below the 0.2 mg kg-1 limit.


Assuntos
Oryza , Poluentes do Solo , Cádmio/análise , Cinética , Solo , Poluentes do Solo/análise
16.
Am J Prev Med ; 60(2): e49-e57, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33349471

RESUMO

INTRODUCTION: Evidence suggests real-world beverage taxes reduce sweetened beverage purchases, but it is unknown if consumers consequently increase food or alcohol purchases. This study examines whether Philadelphia's 1.5 cents/ounce beverage tax was associated with substitution to 3 kinds of hypothesized substitutes: snacks, nontaxed beverage concentrates, and alcohol. METHODS: Using commercial retail sales data and a difference-in-differences approach, analyses compared logged volume and dollar sales of snacks and beverage concentrates between 2016 (pretax) and 2017 (post-tax) at chain food retail stores in Philadelphia (n=180) and Baltimore (nontaxed control city; n=60), and logged volume and dollar sales of wine and spirits at liquor stores in Philadelphia (n=44) and nearby Pennsylvania counties (alternate control; n=66). Additional food analyses examined change in logged volume sales of hypothesized products compared to control products (other foods). Analyses were conducted in 2020. RESULTS: Across store types, analyses showed no statistically significant increases in logged volume or dollar sales of snacks or spirits in Philadelphia stores compared to control sites (decreased, ranging from -10% to 0%). Supermarket analyses showed substitution to nontaxed beverage concentrates (27% increase in volume, 36% increase relative to other food) but remained a relatively small percentage of overall beverage dollar sales (12% at baseline, 15% at post). CONCLUSIONS: At the population level, there is no evidence that Philadelphia's decline in taxed beverage purchases is offset by increases in snacks or spirits purchasing, but there is evidence of substitution to beverage concentrates in supermarkets. Future studies should explore individual-level purchasing changes.


Assuntos
Bebidas Adoçadas com Açúcar , Baltimore , Bebidas , Comércio , Alimentos , Humanos , Philadelphia , Impostos
17.
JAMA Netw Open ; 3(10): e2019429, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33034639

RESUMO

Importance: Financial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown. Objective: To determine whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipoprotein cholesterol (LDL-C) levels from baseline to 12 months. Design, Setting, and Participants: This 4-group, randomized clinical trial was conducted from August 2013 to July 2018 among several large US insurer or employer populations and the University of Pennsylvania Health System. The study population included adults with elevated risk of cardiovascular disease, suboptimal LDL-C control, and evidence of imperfect adherence to statin medication. Data analysis was performed from July 2017 to June 2019. Interventions: The interventions lasted 6 months during which all participants received daily medication reminders and an electronic pill bottle. Statin adherence was measured by opening the bottle. For participants randomized to the 3 intervention groups, adherence was rewarded with financial incentives. The sweepstakes group involved incentives for daily adherence. In the deadline sweepstakes group, incentives were reduced if participants were adherent only after a reminder. The sweepstakes plus deposit contract group split incentives between daily adherence and a monthly deposit reduced for each day of nonadherence. Main Outcomes and Measures: The primary outcome was change in LDL-C level from baseline to 12 months. Results: Among 805 participants randomized (199 in the simple daily sweepstakes group, 204 in the deadline sweepstakes group, 201 in the sweepstakes plus deposit contract group, and 201 in the control group), the mean (SD) age was 58.5 (10.3) years; 519 participants (64.5%) were women, 514 (63.9%) had diabetes, and 273 (33.9%) had cardiovascular disease. The mean (SD) baseline LDL-C level was 143.2 (42.5) mg/dL. Measured adherence at 6 months (defined as the proportion of 180 days with electronic pill bottle opening) in the control group (0.69; 95% CI, 0.66-0.72) was lower than that in the simple sweepstakes group (0.84; 95% CI, 0.81-0.87), the deadline sweepstakes group (0.86; 95% CI, 0.83-0.89), and the sweepstakes plus deposit contract group (0.87; 95% CI, 0.84-0.90) (P < .001 for each incentive group vs control). LDL-C levels were measured for 636 participants at 12 months. Mean LDL-C level reductions from baseline to 12 months were 33.6 mg/dL (95% CI, 28.4-38.8 mg/dL) in the control group, 32.4 mg/dL (95% CI, 27.3-37.6 mg/dL) in the sweepstakes group, 33.2 mg/dL (95% CI, 28.1-38.3 mg/dL) in the deadline sweepstakes group, and 36.5 mg/dL (95% CI, 31.3-41.7 mg/dL) in the sweepstakes plus deposit contract group (adjusted P > .99 for each incentive group vs control). Conclusions and Relevance: Compared with the control group, different financial incentives improved measured statin adherence but not LDL-C levels. This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors. Trial Registration: ClinicalTrials.gov Identifier: NCT01798784.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Participação do Paciente/economia , Reembolso de Incentivo/estatística & dados numéricos , Recompensa , Adulto , Anticolesterolemiantes/uso terapêutico , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Motivação , Participação do Paciente/psicologia , Fatores de Tempo
18.
Health Aff (Millwood) ; 39(9): 1486-1494, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32897788

RESUMO

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. We used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar beneficiaries who remained enrolled in fee-for-service Medicare plans (fee-for-service controls). We then compared three-year mortality and twelve-month utilization rates. Compared with fee-for-service controls, SNP enrollees had lower mortality and lower rates of utilization across the care continuum. These findings suggest that SNPs may be an effective alternative care financing and delivery model for patients with ESRD.


Assuntos
Falência Renal Crônica , Medicare Part C , Idoso , Custos e Análise de Custo , Planos de Pagamento por Serviço Prestado , Humanos , Falência Renal Crônica/terapia , Estados Unidos
19.
Health Aff (Millwood) ; 39(7): 1130-1139, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32634353

RESUMO

In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore, Maryland. Our sample included 134 stores with price data and 4,584 customer purchases. Compared with Baltimore, Philadelphia experienced significantly greater increases in the price of taxed beverages (1.81 cents per ounce, or 120.4 percent of the tax) and significantly larger declines in the volume of taxed beverages sold (5.76 ounces, or 38.9 percent) after tax implementation. Beverage excise taxes may be an effective policy tool for decreasing the purchase of sweetened drinks in small independent stores, particularly among populations at higher risk for sugar-sweetened beverage consumption.


Assuntos
Bebidas Adoçadas com Açúcar , Baltimore , Bebidas , Comércio , Humanos , Philadelphia , Impostos
20.
Am J Clin Nutr ; 112(3): 644-651, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32619214

RESUMO

BACKGROUND: Few longitudinal studies examine the response to beverage taxes, especially among regular sugar-sweetened beverage (SSB) consumers. OBJECTIVE: This study aimed to examine changes in objectively measured beverage purchases associated with the Philadelphia beverage tax on sugar-sweetened and artificially sweetened beverages. METHODS: A longitudinal quasi-experiment was conducted with adult sugar-sweetened beverage (SSB) consumers in Philadelphia (n = 306) and Baltimore (n = 297; a nontaxed comparison city). From 2016 to 2017 participants submitted all food and beverage receipts during a 2-wk period at: baseline (pretax) and 3, 6, and 12 mo posttax (91.0% retention; data analyzed in 2019). Linear mixed effects models were used to assess the difference-in-differences in total purchased ounces (fl oz) of taxed beverages in a 2-wk period in Philadelphia compared with Baltimore. Secondary analyses: 1) excluded weeks that contained major holidays at baseline and 12 mo (42% of measured weeks at baseline and 12 mo) because policy implementation timing necessitated data collection during holidays when SSB demand may be more inelastic, and 2) aggregated posttax time points to address serial correlation and low power. RESULTS: There were no statistically significant changes in purchased ounces of taxed beverages in Philadelphia compared with Baltimore in the primary analysis. After excluding holiday purchasing, the tax was associated with statistically significant reductions of taxed beverage purchases at 3 and 6 mo (-157.1 ounces, 95% CI: -310.1, -4.1 and -175.1 ounces, 95% CI: -328.0, -22.3, respectively) but not 12 mo. Analyses aggregating all 6 wk of posttax time points showed statistically significant reductions (-203.7 ounces, 95% CI: -399.6, -7.8). CONCLUSIONS: A sweetened beverage tax was not associated with reduced taxed beverage purchases among SSB consumers 12 mo posttax in the full sample. Both secondary analyses excluding holiday purchasing or aggregating posttax time periods found reductions in taxed beverage purchases ranging from -4.9 to -12.5 ounces per day. Larger longitudinal studies are needed to further understand tax effects.


Assuntos
Comércio , Comportamento do Consumidor , Bebidas Adoçadas com Açúcar/economia , Impostos , Adulto , Idoso , Animais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
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