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2.
BMC Public Health ; 19(1): 1442, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675931

RESUMO

BACKGROUND: This study explored the relationship between community social capital and cognitive impairment, with a focus on the buffering role of community social capital in the association between educational disadvantage and cognitive impairment in community-dwelling older adults in Japan. METHODS: We used data from two population-based, cross-sectional surveys targeting people aged ≥65 years in a suburban city of the Tokyo metropolitan area (n = 897; 49.8% men; average age = 74.4 years). Social capital included social support (emotional and instrumental support) and the strength of social networks (neighborly ties). To create district-level social capital indicators, we aggregated individual responses on social capital within each district. The Mini-Mental State Examination, Japanese version was used for the assessment of cognitive function. RESULTS: Using multilevel logistic regression analysis, we found that lower amounts of district-level emotional and instrumental support were associated with a greater likelihood of cognitive impairment among men. For women, district-level emotional support was associated with a greater likelihood of cognitive impairment. Additionally, a strong district-level social network buffered the relationship between low education and cognitive impairment in both sexes. CONCLUSIONS: Community social capital appears to have a protective role in determining cognitive function in old age. Our findings may facilitate the development of new community-based strategies to combat dementia.


Assuntos
Disfunção Cognitiva/prevenção & controle , Escolaridade , Características de Residência/estatística & dados numéricos , Capital Social , Idoso , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Demência/epidemiologia , Demência/prevenção & controle , Feminino , Humanos , Vida Independente , Masculino , Análise Multinível , Rede Social , Apoio Social , Tóquio/epidemiologia
3.
Medicine (Baltimore) ; 98(41): e17490, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593113

RESUMO

Lifestyle in preschool children is associated with the onset of childhood obesity. However, the effect of environmental factors in childcare facilities on lifestyle and obesity in preschool children is unknown. The aim of this study was to determine the effect of environmental factors in childcare facilities on the association between obesity and individual lifestyle in preschool children.Subjects included 2902 infants, aged 4 to 6 years old in Kitakyushu City, Japan. A stratified multilevel analysis was conducted with 2 strata: factors related to individual lifestyle and maternal factors as the individual level and factors related to the childcare facility as the environmental level. Two-level multilevel regression analysis was conducted with the presence or absence of obesity.The proportion of infants with obesity was 4.2%. The childhood obesity was significantly associated with the mastication, nutritional methods during infancy, absence of breakfast, presence of skipping meals due to overeating of snacks, usual play activity, screen time on weekdays, maternal body mass index, and maternal weight increase during pregnancy at the individual level. On the other hand, childhood obesity had a significantly negative association with the receiving snacks in facilities by using multilevel analysis.The present study revealed that establishing and maintaining environmental factors in childcare facilities may play important roles in the prevention of obesity from early childhood.


Assuntos
Creches , Meio Ambiente , Estilo de Vida , Obesidade Pediátrica/epidemiologia , Criança , Pré-Escolar , Exercício , Comportamento Alimentar , Feminino , Humanos , Lactente , Japão/epidemiologia , Masculino , Refeições , Análise Multinível , Análise Multivariada , Obesidade Pediátrica/etiologia , Fatores de Risco
4.
Artigo em Inglês | MEDLINE | ID: mdl-31505832

RESUMO

Proteinuria is a significant sign of childhood renal disorders. However, little is known about how sociodemographic and environmental factors are related to the presence of proteinuria among children and adolescents. This paper focuses on the prevalence of proteinuria and its risk factors among children and adolescents. This study conducted a secondary analysis of data from the 2016 Sample Schools Raw Data of Health Examination for School Students (SSRDHESS). Data collected from 27,081 students who had undergone a health screening were analyzed using Chi-square tests, independent t-tests, and multilevel logistic regression analysis. The prevalence of proteinuria was higher in the thin group than in the normal weight group (adjusted odds ratio (aOR) = 1.77; 95% confidence interval (CI) = 1.34-2.33) and lower in the overweight/obese group (aOR = 0.64; 95% CI = 0.51-0.80). Additionally, those in metropolitan and small-medium sized cities had a proteinuria prevalence about 1.5-fold higher than that of those in rural areas (95% CI = 1.08-2.02, 95% CI = 1.19-1.92, respectively). Proteinuria was associated with environmental pollution, including smoking rate, ambient particulate matter and heavy metals in drinking water (aOR = 1.10; 95% CI = 1.01-1.20; aOR = 1.06; 95% CI = 1.01-1.11, aOR = 1.001; 95% CI = 1.0001-1.0015). These results suggest that to improve health management effectiveness, kidney disease prevention efforts for children and adolescents should focus on geographical area and environmental pollution, as well as body weight as individual factors.


Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Proteinúria/epidemiologia , Adolescente , Criança , Estudos Transversais , Feminino , Geografia , Humanos , Masculino , Análise Multinível , Prevalência , Proteinúria/induzido quimicamente , República da Coreia/epidemiologia , Fatores de Risco
5.
BMC Public Health ; 19(1): 1212, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481044

RESUMO

BACKGROUND: To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries. METHODS: Data from World Health Survey conducted in 2002-2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede's cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants' sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede's cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable. RESULTS: A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI. CONCLUSION: National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.


Assuntos
Índice de Massa Corporal , Comparação Transcultural , Saúde Global/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível
6.
BMC Public Health ; 19(1): 1194, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470822

RESUMO

BACKGROUND: In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial for evidence-based decision-making. However, the spatial pattern of measles-containing vaccine (MCV1) and its predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of childhood MCV1 coverage. METHODS: An in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a total of 3722 children nested in 611 enumeration areas were included in the analysis. Global Moran's I statistic and Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with childhood MCV1. RESULTS: Spatial hetrogeniety of childhood MCV1 was observed (Global Moran's I = 0.13, p-value < 0.0001), and seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region. In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25-1.88), pentavalent vaccination first dose (AOR = 9.09; 95%CI: 6.86-12.03) and third dose (AOR = 7.12; 95%CI: 5.51-9.18, secondary and above maternal education (AOR = 1.62; 95%CI: 1.03-2.55) and media exposure were the factors that increased the odds of MCV1 vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI = 1.12-1.61). CONCLUSION: A clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination interventions.


Assuntos
Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Características de Residência/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Pré-Escolar , Etiópia/epidemiologia , Feminino , Geografia , Humanos , Lactente , Masculino , Sarampo/epidemiologia , Análise Multinível , Fatores Socioeconômicos , Análise Espacial
7.
J Autism Dev Disord ; 49(11): 4390-4399, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372802

RESUMO

Preschool children with autism spectrum disorder (ASD) experience slower development of daily living skills (DLS) that are essential for independent functioning compared to typically developing children. Few studies have examined the trajectories of DLS in preschoolers with ASD and the existing literature has reported conflicting results. This study examined DLS trajectories and potential covariates for preschoolers with ASD from a multi-site longitudinal study following children from diagnosis to the end of grade 1. Multi-level modeling was conducted with DLS domain scores from the Vineland Adaptive Behavior Scales-2. The results demonstrated a positive trajectory of increasing scores over time, associations of age of diagnosis, developmental level, stereotypy, and language skills with the mean score at T4 or age 6 years, whereas rate of change was only associated with ASD symptom severity, such that an improvement in DLS trajectory was associated with lower and improving ASD symptom severity.


Assuntos
Atividades Cotidianas/psicologia , Transtorno do Espectro Autista/psicologia , Criança , Desenvolvimento Infantil , Linguagem Infantil , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Análise Multinível , Índice de Gravidade de Doença , Fatores de Tempo
8.
Braz Oral Res ; 33: e081, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31460607

RESUMO

This retrospective study evaluated the influence of known risk factors on nonsurgical periodontal treatment (NSPT) response using a pocket depth fine-tuning multilevel linear model (MLM). Overall, 37 patients (24 males and 13 females) with moderate-to-severe chronic periodontitis underwent NSPT. Follow-up visits at 3, 6, and 12 months included measurements of several clinical periodontal parameters. Data were sourced from a previously reported database. In a total of 1416 initially affected sites (baseline PD ≥ 4 mm) on 536 teeth, probing depth (PD) and clinical attachment loss (CAL) reductions after NSPT were evaluated against known risk factors at 3 hierarchical levels (patient, tooth, and site). For each post-treatment follow-up, the variance component models fitted to evaluate the 3-level variance of PD and CAL decrease revealed that all levels contributed significantly to the overall variance (p < 0.001). Patients who underwent NSPT and were continually monitored had curative results. All 3 hierarchical levels included risk factors influencing the degree of PD and CAL reduction. Specifically, the type of tooth, surfaces involved, and tooth mobility site-level risk factors had the strongest impact on these reductions and were highly relevant for the success of NSPT.


Assuntos
Periodontite Crônica/terapia , Análise Multinível/métodos , Medição de Risco/métodos , Adulto , Fatores Etários , Idoso , Análise de Variância , Periodontite Crônica/patologia , Índice de Placa Dentária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal , Índice Periodontal , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-31438459

RESUMO

(1) The present study aims to explore the impact of job demands and resources (JDR), personal resources, and the organizational culture on workers' wellbeing and health. (2) A cross-sectional survey of Spanish workers in small and medium-sized enterprises (SMEs) was conducted with a sample of 1599 workers from 154 SMEs. A multivariate multilevel analysis was performed to analyze the different relationships. (3) In light of the results obtained, we observed that job demands were negatively associated with workers' health, while job resources were positively correlated to workers' health and wellbeing. Secondly, the different types of identification at work are positively related to job satisfaction and organizational citizenship behaviors (OCBs), but the intensity of this association differs with the form of identification. Finally, at the organization level, the dimensions of organizational culture are related differently to employees' job satisfaction, OCBs, and health; (4) these results confirm the role of organizational culture and its association with desirable outcomes, allowing us to expand the JDR model.


Assuntos
Nível de Saúde , Satisfação no Emprego , Cultura Organizacional , Carga de Trabalho , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Análise Multinível , Saúde do Trabalhador
10.
Accid Anal Prev ; 132: 105256, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31442922

RESUMO

This study analyzed the potentially dangerous driving behaviors of commercial truck drivers from both macro and micro perspectives. The analysis was based on digital tachograph data collected over an 11-month period and comprising 4373 trips made by 70 truck drivers. First, different types of truck drivers were identified using principal component analysis (PCA) and a density-based spatial clustering of applications with noise (DBSCAN) at the macro level. Then, a multilevel model was built to extract the variation properties of speeding behavior at the micro level. Results showed that 40% of the truck drivers tended to drive in a substantially dangerous way and the explained variance proportion of potentially extremely dangerous truck drivers (79.76%) was distinctly higher than that of other types of truck drivers (14.70%˜34.17%). This paper presents a systematic approach to extracting and examining information from a big data source of digital tachograph data. The derived findings make valuable contributions to the development of safety education programs, regulations, and proactive road safety countermeasures and management.


Assuntos
Condução de Veículo/psicologia , Comportamento Perigoso , Adulto , Condução de Veículo/estatística & dados numéricos , Big Data , Humanos , Masculino , Pessoa de Meia-Idade , Veículos Automotores/estatística & dados numéricos , Análise Multinível , Ocupações/estatística & dados numéricos , Análise Espaço-Temporal
11.
Artigo em Inglês | MEDLINE | ID: mdl-31382596

RESUMO

Disaster preparedness initiatives are increasingly focused on building community resilience. Preparedness research has correspondingly shifted its attention to community-level attributes that can support a community's capacity to respond to and recover from disasters. While research at the community level is integral to building resilience, it may not address the specific barriers and motivators to getting individuals prepared. In particular, people with disabilities are vulnerable to disasters, yet research suggests that they are less likely to engage in preparedness behaviors. Limited research has examined what factors influence their ability to prepare, with no studies examining both the individual and community characteristics that impact these behaviors. Multilevel modeling thus offers a novel contribution that can assess both levels of influence. Using Los Angeles County community survey data from the Public Health Response to Emergent Threats Survey and the Healthy Places Index, we examined how social cognitive and community factors influence the relationship between disability and preparedness. Results from hierarchical linear regression models found that participants with poor health and who possessed activity limitations engaged in fewer preparedness behaviors. Self-efficacy significantly mediated the relationship between self-rated health and disaster preparedness. Living in a community with greater advantages, particularly with more advantaged social and housing attributes, reduced the negative association between poor self-rated health and preparedness. This study highlights the importance of both individual and community factors in influencing people with disabilities to prepare. Policy and programming should therefore be two-fold, both targeting self-efficacy as a proximal influence on preparedness behaviors and also addressing upstream factors related to community advantage that can create opportunities to support behavioral change while bolstering overall community resilience.


Assuntos
Pessoas com Deficiência , Planejamento em Desastres/organização & administração , Autoeficácia , Adolescente , Adulto , Desastres , Planejamento Ambiental , Feminino , Nível de Saúde , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Motivação , Análise Multinível , Características de Residência , Fatores Socioeconômicos , Adulto Jovem
12.
BMC Health Serv Res ; 19(1): 516, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340809

RESUMO

BACKGROUND: Suboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants. METHODS: We use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance. RESULTS: Health worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge. CONCLUSIONS: We find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.


Assuntos
Aleitamento Materno , Comportamentos Relacionados com a Saúde , Pessoal de Saúde , Qualidade da Assistência à Saúde , Adulto , Bangladesh , Aleitamento Materno/estatística & dados numéricos , Serviços de Saúde da Criança , Aconselhamento , Dieta , Prática Clínica Baseada em Evidências , Feminino , Fidelidade a Diretrizes , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Análise Multinível , Competência Profissional , Desempenho Profissional
13.
Artigo em Inglês | MEDLINE | ID: mdl-31344971

RESUMO

Mental health is an intrinsic dimension of health influenced by individual and contextual factors. This cross-sectional study analyzes the association between the individual, neighborhood characteristics, and one's self-assessed mental health status in the Lisbon region after an economic crisis. Via the application of multilevel regression models, the study assesses the link between one's neighborhood environment-deprivation, low self-assessed social capital, and low self-assessed satisfaction with the area of residence-and mental health regardless of one's individual characteristics. Constraints related to the economic crisis play an important role in the explanation of poor mental health.


Assuntos
Recessão Econômica , Saúde Mental , Características de Residência , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Satisfação Pessoal , Portugal , Capital Social , Adulto Jovem
14.
Med Care ; 57(9): 673-679, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295165

RESUMO

BACKGROUND: Authorities recommend universal substance use screening, brief intervention, and referral to treatment (SBIRT) for all (ie, universal) adult primary care patients. OBJECTIVE: The objective of this study was to examine long-term (24-mo) changes in health care utilization and costs associated with receipt of universal substance use SBIRT implemented by paraprofessionals in primary care settings. RESEARCH DESIGN: This study used a difference-in-differences design and Medicaid administrative data to assess changes in health care use among Medicaid beneficiaries receiving SBIRT. The difference-in-differences estimates were used in a Monte Carlo simulation to estimate potential cost-offsets associated with SBIRT. SUBJECTS: The treatment patients were Medicaid beneficiaries who completed a 4-question substance use screen as part of an SBIRT demonstration program between 2006 and 2011. Comparison Medicaid patients were randomly selected from matched clinics in Wisconsin. MEASURES: The study includes 4 health care utilization measures: outpatient days; inpatient length of stay; inpatient admissions; and emergency department admissions. Each outcome was assigned a unit cost based on mean Wisconsin Medicaid fee-for-service reimbursement amounts. RESULTS: We found an annual increase of 1.68 outpatient days (P=0.027) and a nonsignificant annual decrease in inpatient days of 0.67 days (P=0.087) associated with SBIRT. The estimates indicate that the cost of a universal SBIRT program could be offset by reductions in inpatient utilization with an annual net cost savings of $782 per patient. CONCLUSIONS: Paraprofessional-delivered universal SBIRT is likely to yield health care cost savings and is a cost-effective mechanism for integrating behavioral health services in primary care settings.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Implementação de Plano de Saúde , Humanos , Modelos Lineares , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Análise Multinível , Atenção Primária à Saúde/métodos , Psicoterapia Breve/economia , Encaminhamento e Consulta/economia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
15.
BMC Public Health ; 19(1): 861, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269940

RESUMO

BACKGROUND: Considering the lack of studies that examine built environmental factors associated with life satisfaction among old people in developing countries, particularly those focused on Brazil, the aim of this study was to estimate the prevalence of life satisfaction among old adults residents in a Brazilian urban center and to investigate its association with individual characteristics and objective measures of the built environment. METHODS: A household survey (N = 832) in Belo Horizonte, Minas Gerais, Brazil (2008-2009) and a Systematic Social Observation (SSO) was used in this study. Life satisfaction was assessed through Self-Anchoring Ladder Scale, developed by Cantril, in 1965. Participants' answers were categorized as satisfied (rungs 6-10) and dissatisfied (rungs 0-5). A Multilevel Poisson regression analysis with robust variance was performed. RESULTS: The prevalence of satisfaction with life was approximately 82%. Higher prevalence of life satisfaction was significantly associated with old people who reported higher incomes, higher religious participation, who practice physical activity and who perceive their health as good and very good. In contextual level, results showed that when the contextual features were adjusted separately by the individual characteristics they were no longer significant. The results also showed a lower prevalence of life satisfaction among those living in neighborhoods with higher physical disorder, even after adjusting for individual and other contextual characteristics. CONCLUSIONS: The present findings suggest that life satisfaction should be assessed whenever evaluating urban redevelopment programs designed to improve neighborhood characteristics, reducing physical disorder, especially among old adults.


Assuntos
Ambiente Construído/estatística & dados numéricos , Satisfação Pessoal , Características de Residência/estatística & dados numéricos , População Urbana , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multinível , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos
16.
Biomed Res Int ; 2019: 8132520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31275984

RESUMO

Aim: To evaluate the influence of primary insertion torque (IT) values of narrow dental implants on the peri-implant health, implant stability, immunoinflammatory responses, bone loss, and success and survival rates. Methods: Thirty-one edentulous patients received two narrow implants (2.9x10mm, Facility NeoPoros) to retain mandibular overdentures. The implants were categorized in four groups according to their IT: (G1) IT > 10 Ncm; (G2) IT ≥ 10Ncm and ≤ 30 Ncm; (G3) IT >30Ncm and < 45Ncm; (G4) IT ≥ 45Ncm, and all implants were loaded after 3 months of healing. The following clinical outcomes were evaluated 1, 3, 6, and 12 months after implant insertion: (i) peri-implant tissue health (PH), gingival index (GI), plaque index (PI), calculus presence (CP), probing depth (PD), and bleeding on probing (BOP); (ii) implant stability quotient (ISQ) by resonance frequency analysis; and (iii) IL-1ß and TNF-α concentration in the peri-implant crevicular fluid. The marginal bone level (MBL) and changes (MBC) were evaluated. The Chi2 test, Kruskal-Wallis test, mixed-effects regression analysis, and the Kendall rank correlation coefficient were used for statistical analysis (α = 5%). Results: G1 presented the highest PD at all evaluated periods. G2 presented higher PI at month 6 and 12. G4 showed increased GI at month 3 and 12 and more CP at month 1 (p=.003). G2 and G4 had higher ISQ values over the study period, while those from G1 and G3 presented lower ISQ values. The IL-1ß concentration increased until month 12 and was independent of IT and bone type; G4 had a higher IL-1ß concentration in month 3 than the other groups (p=.015). The TNF-α release was negatively correlated with IT, and TNF-α release was highest in G1 at month 12. The MBL immediately after surgery and the MBC at month 12 were similar between the groups, and G4 presented a positive MBC at month 12. The survival and success rates were 75% for G1, 81.3% for G2, 64.3% for G3, and 95% for G4. Conclusion: The IT did not influence the clinical outcomes and the peri-implant immunoinflammatory responses and was weakly correlated with the narrow dental implants primary stability. The observed success rates suggest that the ideal IT for atrophic fully edentulous patients may deviate from the standardized IT of 32 Ncm.


Assuntos
Implantes Dentários , Revestimento de Dentadura , Arcada Edêntula/cirurgia , Mandíbula/cirurgia , Torque , Idoso , Idoso de 80 Anos ou mais , Citocinas/metabolismo , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multinível , Suporte de Carga
17.
BMC Public Health ; 19(1): 893, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286931

RESUMO

BACKGROUND: Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. METHODS: A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. RESULTS: Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group. CONCLUSIONS: An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. TRIAL REGISTRATION: Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.


Assuntos
Doenças Cardiovasculares/psicologia , Educação em Saúde/métodos , Relações Interpessoais , Características de Residência , Comportamento de Redução do Risco , Adolescente , Adulto , Pressão Sanguínea , Determinação da Pressão Arterial , Peso Corporal , Doenças Cardiovasculares/etiologia , Análise por Conglomerados , Dieta , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Estilo de Vida , Modelos Lineares , Masculino , Análise Multinível , Fatores de Risco , Sri Lanka , Adulto Jovem
18.
AIDS Behav ; 23(11): 2946-2955, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31332597

RESUMO

Transactional sex is associated with socioeconomic disadvantage and HIV risk but few studies in the United States (US) have examined both individual and area-level predictors of transactional sex or distinguished transactional sex from sex work. We combined data from HIV Prevention Trials Network 064 study and the US Census to estimate prevalence ratios (PR) for the relationship between census-level and individual measures of economic deprivation and housing instability on transactional sex in 417 women in North Carolina. Increased transactional sex was associated with food insecurity (PR 1.86; 95%; CI 1.57, 2.19), housing instability (PR 1.33; 95% CI 1.11, 1.59), substance abuse (PR 1.90; 95% CI 1.64, 2.19) and partner incarceration (PR 1.32; 95% CI 1.09, 1.61). Census-level indicators were not associated with transactional sex, adjusted for individual-level covariates. Interventions should support housing stability and financial opportunities among southern African American women to reduce HIV risk, particularly among women with incarcerated partners.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/prevenção & controle , Habitação , Pobreza , Trabalho Sexual , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Masculino , Análise Multinível , North Carolina/epidemiologia , Prevalência , Trabalho Sexual/estatística & dados numéricos , Parceiros Sexuais , Rede Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos
19.
BMC Public Health ; 19(1): 887, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277619

RESUMO

BACKGROUND: Depression has become a severe societal problem in China. Although many studies have analyzed how environmental characteristics within neighborhoods affect depression, only a few have dealt with developing countries, and even fewer have considered built, natural, and social environments concurrently. METHODS: Based on a sample of 20,533 Chinese residents assessed in 2016, the present study examined associations between depressive symptoms and respondents' built, natural, and social environments. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and multilevel regression models were fitted accounting for potential covariates. RESULTS: Results indicated that living in neighborhoods with more green spaces and a higher population density were negatively associated with CES-D scores. Living in neighborhoods with more social capital was protective against depression. Furthermore, results showed that the social environment moderated the association between the built environment and depression. CONCLUSIONS: Social environments moderate the relationship between the built environment and depression. As environments seem to interact with each other, we advise against relying on a single environment when examining associations with depressive symptoms.


Assuntos
Ambiente Construído/estatística & dados numéricos , Depressão/epidemiologia , Características de Residência/estatística & dados numéricos , Meio Social , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Fatores de Risco
20.
Artigo em Inglês | MEDLINE | ID: mdl-31357578

RESUMO

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0-14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014-1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010-1.013; RR = 1.002, 95% CI = 1.001-1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.


Assuntos
Asma/epidemiologia , Asma/etiologia , Poluição Ambiental/efeitos adversos , Material Particulado/toxicidade , Adolescente , Asma/patologia , California/epidemiologia , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Análise Multinível , Características de Residência , Estudos Retrospectivos , Populações Vulneráveis
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