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1.
Epidemiol Psychiatr Sci ; 29: e97, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31992376

RESUMO

AIMS: Prescription opioid misuse (POM) contributes to a larger opioid crisis in the US and Canada, with over 17 000 US POM-related overdose deaths in 2017. Our aims were to (1) identify specific profiles of respondents based on POM motives using the US National Survey on Drug Use and Health (NSDUH) and (2) compare profile respondents on sociodemographics, substance use and mental and physical health outcomes. METHODS: Analyses included 2017-18 NSDUH respondents with data on POM motives (n = 4810). POM was defined as prescription opioid use in a way not intended by the prescriber, including use without a prescription, in larger amounts or more frequently. Nine POM motives for the most recent episode were assessed, including 'to relieve physical pain' and 'to get high'. Latent classes, based on POM motives, were estimated. Classes were compared on sociodemographics, substance use and physical and mental health outcomes. RESULTS: Eight latent classes were identified (in order of prevalence): pain relief only, relax-pain relief, sleep-pain relief, multi-motive, high, experimenter, emotional coping and dependent/hooked. Compared to the pain relief only group, the high and multi-motive classes had higher odds of all substance use outcomes, with the dependent/hooked class having higher odds on all but one outcome. Six of the eight classes had higher odds of past-year mental health treatment and suicidal ideation than the pain relief only class. CONCLUSIONS: Screening for pain, pain conditions, problematic substance use and psychopathology are recommended in those with any POM. While those in the dependent/hooked, multi-motive and emotional coping classes are most likely to have prescription opioid use disorder (OUD), screening for OUD symptoms in all individuals with POM is also warranted.


Assuntos
Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Motivação , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/psicologia , Prevalência , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
2.
BMC Complement Altern Med ; 19(1): 321, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752832

RESUMO

OBJECTIVES: This study aimed to develop and validate scales to assess attitudes towards patient' s use of TCM (APUTCM) and to measure a communicative competence in TCM (CCTCM) among nurses. METHODS: The instrument development process was conducted from Sep 2013 to Jul 2014, using the following steps: 1) item development; 2) internal review and refinement; 3) face and content validation; 4) instrument administration to a development sample; and 5) evaluation of validity and reliability. A convenience sample was used to recruit registered and advanced practice nurses who worked in different regions throughout Taiwan. A total of 755 respondents completed the online questionnaire. Statistical analyses were performed using the software of SPSS Version 21.0 and Analysis of Moment Structures (AMOS) version 24.0. RESULTS: The scale-level indexes (S-CVI) of content validity for both scales were over 80%. The reliabilities for the 13-item APUTCM scale and for the five-item CCTCM scale were 0.88 and 0.84, respectively. The model suitability for both scales was assessed, and the findings revealed suitable parameters for all indicators: GFI = 0.954, AGFI = 0.932, CFI = 0.959, RMSEA = 0.62, and chi-square/df = 3.891 for APUTCM; and GFI = 0.992, AGFI = 0.969, CFI = 0.992, RMSEA = 0.63, and chi-square/df = 4.04 for CCTCM. The convergent and divergent validity of scores on both scales provided evidence in the expected direction. CONCLUSION: This scale development study provides preliminary evidence that suggests that the 13-item APUTCM and the five-item CCTCM are reliable and valid scales for assessing attitudes toward patient's TCM use and communicative competence in TCM.


Assuntos
Atitude do Pessoal de Saúde , Terapias Complementares , Enfermeiras e Enfermeiros , Psicometria , Adulto , Feminino , Humanos , Análise de Classes Latentes , Masculino , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Psicometria/métodos , Psicometria/normas , Reprodutibilidade dos Testes , Inquéritos e Questionários , Taiwan
3.
BMC Public Health ; 19(1): 1364, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651277

RESUMO

BACKGROUND: For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges - the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to vary across SES. This observation is called the 'alcohol harm paradox'. This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, full-time employment, occupational level and income is analysed. METHODS: Employing data from the ongoing cross-sectional WIRUS-study, N = 4311 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors were analysed and presented. RESULTS: We identified three classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES, with class 3 characterised by younger age, more males and lower educational attainment. CONCLUSIONS: Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Furthermore, the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Noruega/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
4.
Medicine (Baltimore) ; 98(39): e17287, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574848

RESUMO

Evidence suggests that mental health is associated with multiple factors such as physical activity, sedentary behavior, and physical function in older adults. The present study used latent profile analysis to identify classes of older adults based on their health profile among a representative sample of Korean older adults with hypertension. Differences in mental health between these classes were also examined.Seven hundred and sixty seven participants (mean age = 70.23, SD = 6.08; men 45.6%) were included in the analysis.There were 3 latent classes (class 1: a physically inactive lifestyle with low physical function and body perception; class 2: a physically moderate lifestyle with moderate physical function and low body perception; class 3: a physically active lifestyle with high physical function and body perception). According to class comparisons, older adults in class 3 had significantly lower anxiety/depression levels than classes 1 and 2. Older adults in class 3 had significantly lower stress levels than class 1.It is possible that among older adults, having a positive attitude of one's body shape may also be important for improving anxiety/depression along with having a physically active lifestyle and maintaining physical function.


Assuntos
Imagem Corporal/psicologia , Força da Mão , Hipertensão/psicologia , Postura Sentada , Caminhada , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Exercício/psicologia , Feminino , Humanos , Hipertensão/fisiopatologia , Análise de Classes Latentes , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Percepção , República da Coreia , Estresse Psicológico/psicologia
5.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190003, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576979

RESUMO

INTRODUCTION: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). OBJECTIVES: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). METHODS: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile's Successive Sampling estimator. RESULTS: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: "very high", "high", "moderate" and "low", with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. CONCLUSION: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Homossexualidade Masculina/etnologia , Humanos , Análise de Classes Latentes , Masculino , Autorrelato , Sexismo/etnologia , Fatores Socioeconômicos
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 207-214, sept.-oct. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183873

RESUMO

Introduction and objectives: The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms. Materials and methods: From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured. Results: The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA. Conclusions: In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location


Introducción y objetivos: El complejo comunicante anterior es una de las localizaciones más frecuentes para el desarrollo de aneurismas; recibe sangre de ambas circulaciones carotídeas y el efecto de la sincronía en la llegada de sangre no ha sido estudiado previamente. El objetivo de este estudio es comparar las condiciones de asincronía del pulso de A1 y sus efectos en las condiciones hemodinámicas de los aneurismas de la arteria comunicante anterior (ACoA). Materiales y métodos: Desde 2008 hasta 2017, 54 aneurismas de la ACoA tratados en nuestro centro se incluyeron en el estudio. Se emplearon técnicas de dinámica de fluidos computacional y las simulaciones consistieron en condiciones de completa sincronía y en la introducción de un retraso de 0,2s en la arteria A1 no dominante. Se realizaron mediciones del TAWSS, área de bajo cizallamiento (LSA), diámetros de A1 y ángulos de la AcoA. Resultados: La diferencia producida en el LSA en condiciones de sincronía y asincronía resultó en un amplio rango de valores positivos y negativos. El índice de simetría (p=0,04) y el ángulo A1/A2 en la arteria dominante (p=0,04) se relacionan con los cambios en el LSA. Conclusiones: En asincronía, el LSA se incrementó en ausencia de asimetría A1 y ángulos A1/A2 menores, incrementando potencialmente el riesgo de rotura de aneurismas en esta localización


Assuntos
Humanos , Masculino , Feminino , Fatores de Risco , Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Hemodinâmica , Análise de Classes Latentes , Procedimentos Endovasculares
7.
Nutr. hosp ; 36(5): 1055-1060, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184626

RESUMO

Introducción: el sobrepeso y la obesidad alcanzan una alta prevalencia desde la infancia en España. Objetivo: describir el efecto del sobrepeso y la obesidad en niños escolares de once años de edad, en pruebas que valoran la fuerza, tanto de las extremidades inferiores como de las superiores, así como la velocidad. Método: participaron en el estudio 423 escolares de once años de edad. Se obtuvieron características básicas antropométricas y desarrollaron diversos test de la batería EUROFIT. Resultados: los niños y niñas que se encuentran en normopeso poseen mejores puntuaciones en las pruebas de condición física en general. De este modo, los saltos verticales y horizontales, suspensión en barra y abdominales son superiores en los participantes con normopeso (p < 0,05). Además, recorren en menos tiempo un circuito de velocidad en ambos sexos (p < 0,001); sin embargo, en la fuerza isométrica manual, en el grupo de niñas poseen mejores resultados aquellas que se encuentran en sobrepeso u obesidad (p < 0,01). Conclusiones: los niños de once años con sobrepeso y obesidad muestran una menor prestación muscular, salvo en el caso de la fuerza isométrica manual. También se han determinado diversas ecuaciones de predicción de resultados de las pruebas físicas llevadas a cabo, como saltos, dinamometría y velocidad, a través del sexo e índice de masa corporal (IMC)


Introduction: overweight and obesity reach a high prevalence since childhood in Spain. Objective: to describe the effect of overweight and obesity, in schoolchildren of eleven years of age, in tests that assess the strength of both the lower and upper extremities, as well as speed. Method: four hundred and twenty-three schoolchildren of eleven years of age participated in the study. Basic anthropometric characteristics were obtained and several tests of the EUROFIT battery were developed. Results: normal-weight boys and girls had better scores in physical condition tests in general. Therefore, the vertical and horizontal jumps, bar suspension and abdominals were higher in the participants with normal-weight (p < 0.05). In addition, they performed in less time a speed circuit in both sexes (p < 0.001); however, in relation to the manual isometric strength, in the group of girls those who are overweight or obese have better results (p < 0.01). Conclusions: overweight and obese children of eleven year-olds showed a lower muscular performance, except in the case of manual isometric strength. Several equations haven been also determined for predicting the results of physical tests carried out such as jumps, dynamometry and speed, through sex and body mass index (BMI)


Assuntos
Humanos , Masculino , Feminino , Criança , Obesidade Pediátrica/epidemiologia , Sobrepeso/epidemiologia , Força Muscular/fisiologia , Dinamômetro de Força Muscular , Obesidade Pediátrica/complicações , Sobrepeso/complicações , Índice de Massa Corporal , Análise de Classes Latentes
8.
Accid Anal Prev ; 133: 105298, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31557617

RESUMO

In this study, we attempted to explain drivers' crash risk variation in car-following for crash avoidance considering the effects of drivers' visual perception, vehicle type, and horizontal curves, with a structural equations model. The model was built by incorporating drivers' speed risk perception and distance risk perception as latent variables. A series of on-road experiments was conducted on the curved segments of a freeway in China to collect naturalistic driving data to approximate the model. The results indicate that (1) the amount of variance in speed risk perception accounted for by the temporal and spatial frequency and the following vehicle type was 21%; (2) the amount of variance in distance risk perception accounted for by the temporal and spatial frequency, leading vehicle type, stopping sight distance (SSD), horizontal sightline offset (HSO), and radius was 29%; and (3) speed risk perception and distance risk perception explained 27% of the total variance in crash risk variation, which is significantly higher than previous similar results that were commonly limited to 10%. The results were explained from the perspective of the effect of line markings, vehicle type (size), and curves on driving behaviors, respectively. In addition, the difference between the effect of speed risk perception and distance perception on crash risk variation was discussed considering the direct and indirect origins of risk in driving. The findings suggests that the incorporation of visual perceptual, vehicular, and roadway factors and its relevant speed risk perception and distance risk perception can better explain the crash risk in car-following. This study also emphasized the possibility and the need of applying the line markings as a visual intervention to prevent the drivers from rear-end crashes on curves, which may provide new insights and be a new solution for roadway safety.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/psicologia , Acidentes de Trânsito/prevenção & controle , Adulto , Ambiente Construído , China , Humanos , Análise de Classes Latentes , Fatores de Risco , Percepção Visual/fisiologia
9.
Lett Appl Microbiol ; 69(6): 417-423, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563139

RESUMO

Molecular-based tools sometimes are the only laboratory techniques available to detect a recently discovered agent, and their validation without the existence of previously described 'gold standard' methods poses a challenge for the diagnosticians. A good example within this scenario is the recently described porcine circovirus 3 (PCV-3) in the swine population worldwide, from which only few PCR methods have been described. Therefore, the primary objective of this study was to estimate the diagnostic accuracy of a direct PCR (dPCR) and a real-time qPCR (qPCR) for detection of PCV-3 in Italian swine population. Bayesian latent class analysis approach was used to rigorously assess their features and applicability in routine diagnostic activity. Data on dPCR and qPCR were available from 116 domestic pigs, which were randomly selected from 55 farms located at different regions in Northern Italy. The sensitivity (Se) estimates of dPCR (94%; posterior credible interval (PCI%) 84-100) and qPCR (96%; PCI% 90-100) were high and similar. The estimated specificity (Sp) of both dPCR and qPCR assays was around 97%. dPCR and qPCR assays showed a high and comparable Se and Sp estimates for the detection of PCV-3 in Italian swine population. SIGNIFICANCE AND IMPACT OF THE STUDY: The continuous discovery of new pathogens poses a challenge in the development and evaluation of adequate diagnostic tools. In fact, since molecular-based tools sometimes are the only available laboratory techniques, it is typically difficult to evaluate their diagnostic performances in the absence of a gold standard. The present study assesses this issue, demonstrating the excellent performances of two PCR-based assays for porcine circovirus 3 (PCV-3) detection using a Bayesian latent class analysis approach. Therefore, the molecular tests evaluated under this study constitute reliable tools for the routine diagnosis and surveillance programs of PCV-3 circulating in swine populations.


Assuntos
Infecções por Circoviridae/diagnóstico , Infecções por Circoviridae/veterinária , Circovirus/genética , DNA Viral/genética , Doenças dos Suínos/diagnóstico , Animais , Teorema de Bayes , Bioensaio , Circovirus/isolamento & purificação , Itália , Análise de Classes Latentes , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Sus scrofa/virologia , Suínos
10.
Prev Vet Med ; 170: 104741, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421504

RESUMO

The aim of this paper is to explore whether and how dairy farmer's occupational well-being and stress are associated with animal welfare and farm expansion. A web-administered questionnaire was used to collect 914 dairy farmer's opinions on their quality of life, working situation and mental health. Factor analysis was used to describe farmer's occupational well-being and stress, and farmers who expand their farming operations. A structural equation model (SEM) was used to explore the association of the occupational well-being and stress with animal welfare. Animal welfare was measured by an animal welfare indicator, based on variables listed in the international standard that was available in the Norwegian Animal Recording System. The findings show that high farmer occupational well-being and a low level of stress have a direct positive association with the animal welfare indicator. Contrary, low occupational well-being and high level of stress is negatively associated with the animal welfare indicator. Finally, farmer's degree of loneliness and optimism, satisfaction with income and determination to continue production, is associated with animal welfare indirectly through farm expansion. In this study farm expansion was positively associated with the animal welfare indicator.


Assuntos
Criação de Animais Domésticos/estatística & dados numéricos , Bem-Estar do Animal , Fazendeiros/psicologia , Satisfação no Emprego , Estresse Ocupacional/psicologia , Adulto , Idoso , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-31416206

RESUMO

BACKGROUND: Given the lack of a gold standard for latent tuberculosis infection (LTBI) and paucity of performance data from endemic settings, we compared test performance of the tuberculin skin test (TST) and two interferon-gamma-release assays (IGRAs) among health-care workers (HCWs) using latent class analysis. The study was conducted in Cape Town, South Africa, a tuberculosis and human immunodeficiency virus (HIV) endemic setting Methods: 505 HCWs were screened for LTBI using TST, QuantiFERON-gold-in-tube (QFT-GIT) and T-SPOT.TB. A latent class model utilizing prior information on test characteristics was used to estimate test performance. RESULTS: LTBI prevalence (95% credible interval) was 81% (71-88%). TST (10 mm cut-point) had highest sensitivity (93% (90-96%)) but lowest specificity (57%, (43-71%)). QFT-GIT sensitivity was 80% (74-91%) and specificity 96% (94-98%), and for TSPOT.TB, 74% (67-84%) and 96% (89-99%) respectively. Positive predictive values were high for IGRAs (90%) and TST (99%). All tests displayed low negative predictive values (range 47-66%). A composite rule using both TST and QFT-GIT greatly improved negative predictive value to 90% (range 80-97%). CONCLUSION: In an endemic setting a positive TST or IGRA was highly predictive of LTBI, while a combination of TST and IGRA had high rule-out value. These data inform the utility of LTBI-related immunodiagnostic tests in TB and HIV endemic settings.


Assuntos
Infecções por HIV/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Testes de Liberação de Interferon-gama/métodos , Análise de Classes Latentes , Tuberculose Latente/diagnóstico , Teste Tuberculínico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/epidemiologia , Humanos , Tuberculose Latente/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , África do Sul/epidemiologia
12.
Res Nurs Health ; 42(5): 382-391, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31393017

RESUMO

A large amount of interindividual variability exists in symptom experiences of persons with irritable bowel syndrome (IBS). Thus, consideration of multiple symptoms to identify distinct symptom subgroups may be useful in directing personalized health strategies for symptom management. We aimed to identify latent classes (i.e., subgroups) of persons with IBS who share similar patterns of symptoms using symptom-related variables (six groups of daily diary symptoms, cognitive beliefs about IBS, and IBS quality of life [QOL]); and to examine how subgroups differed in patient characteristics. Data were derived from a baseline assessment of men and women enrolled in two cognitively-focused intervention trials (N = 332). Using latent class analysis, four latent classes were identified: Class 1 (low symptoms and good QOL, n = 153), Class 2 (low symptoms and moderate QOL, n = 106), Class 3 (high symptoms with diarrhea and poor QOL, n = 38), and Class 4 (high symptoms with low diarrhea and moderate QOL, n = 35). Diarrhea, being female, less formal education, unemployment, and previous history of major depressive disorder were associated with membership in Class 3. Using these distinct symptom profiles, the next step is to explore underlying mechanisms accounting for symptom burden with the goal of designing tailored interventions to reduce that burden.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Análise de Classes Latentes , Avaliação de Sintomas/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos/epidemiologia
13.
Accid Anal Prev ; 131: 284-296, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351231

RESUMO

There are more than 2000 pedestrians reported to be involved in traffic crashes with vehicles in North Carolina every year. 10%-20% of them are killed or severely injured. Research studies need to be conducted in order to identify the contributing factors and develop countermeasures to improve safety for pedestrians. However, due to the heterogeneity inherent in crash data, which arises from unobservable factors that are not reported by law enforcement agencies and/or cannot be collected from state crash records, it is not easy to identify and evaluate factors that affect the injury severity of pedestrians in such crashes. By taking advantage of the latent class clustering (LCC), this research firstly applies the LCC approach to identify the latent classes and classify the crashes with different distribution characteristics of contributing factors to the pedestrian-vehicle crashes. By considering the inherent ordered nature of the traffic crash severity data, a partial proportional odds (PPO) model is then developed and utilized to explore the major factors that significantly affect the pedestrian injury severities resulting from pedestrian-vehicle crashes for each latent class previously obtained in the LCC. This study uses police reported pedestrian crash data collected from 2007 to 2014 in North Carolina, containing a variety of features of motorist, pedestrian, environmental, roadway characteristics. Parameter estimates and associated marginal effects are mainly used to interpret the models and evaluate the significance of each independent variable. Lastly, policy recommendations are made and future research directions are also given.


Assuntos
Acidentes de Trânsito/mortalidade , Ambiente Construído/estatística & dados numéricos , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/classificação , Adulto , Dirigir sob a Influência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Ferimentos e Lesões/classificação , Adulto Jovem
14.
Maturitas ; 127: 1-11, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351514

RESUMO

OBJECTIVES: We sought to identify frailty profiles in individuals aged 50-75 by considering frailty as an unobservable latent variable in a latent class analysis (LCA). STUDY DESIGN: 589 prospectively enrolled community-dwelling individuals aged 50-75 (median: 61.7 years) had undergone a standardized, multidomain assessment in 2010-2015. Adverse health outcomes (non-accidental falls, fractures, unplanned hospitalizations, and death) that had occurred since the assessment were recorded in 2016-2017. MAIN OUTCOME MEASURES: The LCA used nine indicators (unintentional weight loss, relative slowness, weakness, impaired balance, osteoporosis, impaired cognitive functions, executive dysfunction, depression, and hearing impairment) and three covariates (age, gender, and consultation for health complaints). The resulting profiles were characterized by the Fried phenotype and adverse health outcomes. RESULTS: We identified five profiles: "fit" (LC1, 29.7% of the participants; median age: 59 years); "weight loss, relative slowness, and osteoporosis" (LC2, 33.2%; 63 years); "weakness and osteopenia" (LC3, 21.9%; 60 years); "impaired physical and executive functions" (LC4, 11%; 67 years); and "impaired balance, cognitive functions, and depression" (LC5, 4.3%; 70 years). Almost all members of LC3 and LC4 were female, and were more likely than members of other profiles to have a frail or pre-frail Fried phenotype. Non-accidental falls were significantly more frequent in LC4. LC5 (almost all males) had the highest number of comorbidities and cardiovascular risk factors but none was frail. CONCLUSIONS: Our data-driven approach covered most geriatric assessment domains and identified five frailty profiles. With a view to tailoring interventions and prevention, frailty needs to be detected among young seniors.


Assuntos
Fragilidade/diagnóstico , Vida Independente/estatística & dados numéricos , Idoso , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Inquéritos Epidemiológicos , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade
15.
Accid Anal Prev ; 131: 316-326, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352193

RESUMO

Due to the wide existence of heterogeneous nature in traffic safety data, traditional methods used to investigate motorcyclist rider injury severity always lead to masking of some underlying relationships which may be critical for the formulation of efficient safety countermeasures. Instead of applying one single model to the whole dataset or focusing on pre-defined crash types as done in previous studies, the present study proposes a two-step method integrating latent class cluster analysis and random parameters logit model to explore contributing factors influencing the injury levels of motorcyclists. A latent class cluster approach is first used to segment the motorcycle crashes into relatively homogeneous clusters. A mixed logit model is then elaborately developed for each cluster to identify its unique influential factors. The analysis was based on the police-reported crash dataset (2015-2017) of Hunan province, China. The goodness-of-fit indicators and the Receiver Operating Characteristic curves show that the proposed method is more accurate when modeling the riders' injury severities. The heterogeneity found in each homogeneous subgroup supports the application of the random parameters logit model in the study. More importantly, the results demonstrate that segmenting motorcycle crashes into relatively homogeneous clusters as a preliminary step helps to uncover some important influencing factors hidden in the whole-data model. The proposed method is proved to have great potential for accounting for the source of heterogeneity. The injury risk factors identified in specific cases provide more reliable information for traffic engineers and policymakers to improve motorcycle traffic safety.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Escala de Gravidade do Ferimento , Motocicletas/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Acidentes de Trânsito/classificação , Ambiente Construído , China , Feminino , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Curva ROC , Fatores de Risco
16.
BMC Med Imaging ; 19(1): 56, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299932

RESUMO

BACKGROUND: Ovarian torsion is an unprecedented gynecological crisis that regularly influences ladies of regenerative age. Its signs and indications are like those of other abdominal conditions, which make its differential determination testing. B-flow ultrasonography (B-flow USG), which is utilized for the differential determination of ovarian torsion, is the highest quality level non-intrusive indicative instrument in the early period of an ovarian torsion. The aim of this paper is to investigate and incorporate variety of factors affecting physicians' actual use of B-flow USG. METHODS: Drawing from technology acceptance model (TAM), five variables - actual use, behavioral intention to use, attitude toward use, perceived ease of use and perceived usefulness - are integrated with social influence and knowledge to propose a theoretical model. The data was collected from the medical doctors including radiologists, urologists, gynecologists, pediatric surgeons between June and October 2018. The sample size is N = 512 hence, structural equation modeling (SEM) methodology has been implemented to study the relationship between explanatory factors and actual use of B-flow USG. SmartPLS 3.2.7 software was used for the data analysis and testing of the validity of the eight hypotheses. RESULTS: The results indicate that actual use of B-flow USG is positively affected by knowledge, social influence, perceived ease of use, perceived usefulness, attitude toward use and behavioral intention to use. CONCLUSIONS: It is discovered that perceived usefulness mediates the relationship between perceived ease of use and attitude toward use, and attitude toward use mediates the relationship between perceived usefulness and behavioral intention to use B-flow USG. The implications of the outcomes are discussed, and suggestions for future research are made.


Assuntos
Doenças Ovarianas/diagnóstico por imagem , Adulto , Feminino , Humanos , Análise de Classes Latentes , Análise dos Mínimos Quadrados , Masculino , Modelos Teóricos , Tamanho da Amostra , Software , Ultrassonografia
17.
Int J Colorectal Dis ; 34(9): 1571-1576, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312891

RESUMO

PURPOSE: The state of North Dakota has one of the highest incidence rates for colorectal cancer in the USA. Its high incidence rate, coupled with a large variation in incidence rates among counties within the state, makes North Dakota a "natural laboratory" in which to investigate environmental clues to colorectal cancer. We conducted a hypothesis-generating study to explore potential determinants of colorectal cancer in North Dakota. METHODS: We obtained county-specific incidence rates for North Dakota's 53 counties from the statewide cancer registry and corresponding data on county demographic, agricultural, and geophysical features from population-based sources. Candidate demographic/agricultural variables included median household income, population density, colorectal cancer screening rates, average farm size (in acres), and the percent of county fertilized. Geophysical variables included the uranium content of soil, residential radon levels, and source of drinking water (municipal or well water). Statistical analyses were performed via multivariate regression and structural equation modeling. RESULTS: Colorectal cancer incidence rates across North Dakota counties varied 3-fold. The structural equation model identified a significant role for well water use (p < 0.05). This finding is consistent with studies that implicate well water in colorectal cancer. CONCLUSIONS: Well water contains several agents, e.g., bacteria, disinfection by-products, and nitrates that are potent colorectal carcinogens. Studies of well water use and colorectal cancer risk at the individual level in North Dakota are warranted.


Assuntos
Neoplasias Colorretais/epidemiologia , Análise de Classes Latentes , Geografia , Humanos , Incidência , Modelos Lineares , North Dakota/epidemiologia , Fatores de Risco
18.
Artigo em Inglês | MEDLINE | ID: mdl-31284381

RESUMO

The aim of this paper is to measure the knowledge and attitudes of primary care physicians toward antibiotic prescriptions and their impacts on antibiotic prescribing. A questionnaire survey was conducted on 625 physicians from 67 primary care facilities in Hubei, China. Structural equation modelling (SEM) was applied to test the theoretical framework derived from the Knowledge, Attitudes, and Practices (KAP) theory. Physicians' knowledge, five sub-types of attitudes, and three sub-types of behavioral intentions towards antibiotic use were measured. Physicians had limited knowledge about antibiotic prescriptions (average 54.55% correct answers to 11 questions). Although they were generally concerned about antibiotic resistance (mean = 1.28, SD = 0.43), and were reluctant to be submissive to pressures from consumer demands for antibiotics (mean = 1.29, SD = 0.65) and the requirements of defensive practice (mean = 1.11, SD = 0.63), there was a lack of motivation to change prescribing practices (mean = -0.29, SD = 0.70) and strong agreement that other stakeholders should take the responsibility (mean = -1.15, SD = 0.45). The SEM results showed that poor knowledge, unawareness of antibiotic resistance, and limited motivation to change contributed to physicians' high antibiotics prescriptions (p < 0.001). To curb antibiotic over-prescriptions, improving knowledge itself is not enough. The lack of motivation of physicians to change needs to be addressed through a systematic approach.


Assuntos
Antibacterianos/uso terapêutico , Atitude , Competência Clínica , Intenção , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/estatística & dados numéricos , China , Análise de Classes Latentes
19.
Medicina (Kaunas) ; 55(7)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31262057

RESUMO

Background: Our purpose is to clarify whether psychological distress (PD) affects the rate of continuous sedentary behavior (CSB). Materials and Methods: In this secondary analysis, a sample population of 80 healthy older adults aged 65 years or older participated in a health club of college A from 2016 to 2017. We conducted Structural Equation Modeling (SEM) using the cross-lagged and synchronous effects models. We adopted the following as proxy variables: CSB (based on the ratio of 1.5 METs sessions or more continuing for over 30 min) CSB and PD (based on the Kessler psychological distress scale: K6). Results: "2016 K6" had a significant influence on "2017 CSB" (standardization factor (ß) = 0.136, p = 0.020) using the cross-lagged effects model, and "2017 K6" significantly influenced "2017 CSB" (ß = 0.166, p = 0.039) using the synchronous effects model. Fit indices were Adjusted Goodness-of-Fit Index (AGFI) = 0.990, Confirmatory Fit Index (CFI) = 1.000, and Root Mean Square Error of Approximation (RMSEA) = 0.000. Conclusion: The results suggest that PD may affect the ratio of CSB one year later.


Assuntos
Comportamento Sedentário , Estresse Psicológico/complicações , Idoso , Idoso de 80 Anos ou mais , Correlação de Dados , Exercício/psicologia , Feminino , Geriatria/métodos , Humanos , Análise de Classes Latentes , Estudos Longitudinais , Masculino , Estresse Psicológico/psicologia , Inquéritos e Questionários
20.
Arch Endocrinol Metab ; 63(5): 487-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271576

RESUMO

OBJECTIVE: Different pathways may lead from night work to metabolic diseases, including type 2 diabetes. This study aimed to explore the direct and indirect pathways from night work to glycemic levels, considering the role of physical activity, waist circumference and snacking using data from ELSA-Brasil. MATERIALS AND METHODS: A structural equation model was used to confirm the pathways from night work to glycemic levels. The latent variable, "glycemic levels", included fasting glucose, glycated hemoglobin and 2-hour plasma glucose. RESULTS: A total of 10.396 participants were included in the analyses. The final model showed that among women, night work was associated with increased glycemic levels. A statistical significant association between night work and glycemic levels mediated by waist circumference was observed among women and men. CONCLUSIONS: The association between night shift and glycemic levels can be interpreted as an important step toward understanding the pathways that could explain night work as a risk factor for diabetes using epidemiological data.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/etiologia , Hemoglobina A Glicada/análise , Análise de Classes Latentes , Jornada de Trabalho em Turnos/efeitos adversos , Adulto , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Jornada de Trabalho em Turnos/estatística & dados numéricos , Circunferência da Cintura
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