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1.
Sci Rep ; 11(1): 11555, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078992

RESUMO

Black, Asian and Minority Ethnic (BAME) populations are at an increased risk of developing COVID-19 and consequentially more severe outcomes compared to White populations. The aim of this study was to quantify how much of the disproportionate disease burden can be attributed to ethnicity and deprivation as well as its interaction. An ecological study was conducted using data derived from the Office for National Statistics data at a Local Authority District (LAD) level in England between 1st March and 17th April 2020. The primary analysis examined how age adjusted COVID-19 mortality depends on ethnicity, deprivation, and the interaction between the two using linear regression. The secondary analysis using spatial regression methods allowed for the quantification of the extent of LAD spillover effect of COVID-19 mortality. We find that in LADs with the highest deprivation quartile, where there is a 1 percentage point increase in "Black-African (regression coefficient 2.86; 95% CI 1.08-4.64)", "Black-Caribbean (9.66: 95% CI 5.25-14.06)" and "Bangladeshi (1.95: 95% CI 1.14-2.76)" communities, there is a significantly higher age-adjusted COVID-19 mortality compared to respective control populations. In addition, the spatial regression results indicated positive significant correlation between the age-adjusted mortality in one LAD and the age-adjusted mortality in a neighbouring LAD, suggesting a spillover effect. Our results suggest targeted public health measures to support those who are deprived and belong to BAME communities as well as to encourage restricted movement between different localities to limit disease propagation.


Assuntos
COVID-19/etnologia , COVID-19/mortalidade , Grupo com Ancestrais do Continente Africano , Fatores Etários , Estudos Transversais , Inglaterra/epidemiologia , Humanos , Grupos Minoritários/estatística & dados numéricos , Análise de Regressão , Fatores Socioeconômicos
2.
Sci Rep ; 11(1): 11728, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083593

RESUMO

University students have unique living, learning and social arrangements which may have implications for infectious disease transmission. To address this data gap, we created CONQUEST (COroNavirus QUESTionnaire), a longitudinal online survey of contacts, behaviour, and COVID-19 symptoms for University of Bristol (UoB) staff/students. Here, we analyse results from 740 students providing 1261 unique records from the start of the 2020/2021 academic year (14/09/2020-01/11/2020), where COVID-19 outbreaks led to the self-isolation of all students in some halls of residences. Although most students reported lower daily contacts than in pre-COVID-19 studies, there was heterogeneity, with some reporting many (median = 2, mean = 6.1, standard deviation = 15.0; 8% had ≥ 20 contacts). Around 40% of students' contacts were with individuals external to the university, indicating potential for transmission to non-students/staff. Only 61% of those reporting cardinal symptoms in the past week self-isolated, although 99% with a positive COVID-19 test during the 2 weeks before survey completion had self-isolated within the last week. Some students who self-isolated had many contacts (mean = 4.3, standard deviation = 10.6). Our results provide context to the COVID-19 outbreaks seen in universities and are available for modelling future outbreaks and informing policy.


Assuntos
COVID-19/etiologia , COVID-19/psicologia , Quarentena/estatística & dados numéricos , Estudantes/psicologia , Universidades , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Quarentena/psicologia , Análise de Regressão , Isolamento Social , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido , Adulto Jovem
3.
J Pak Med Assoc ; 71(4): 1069-1075, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34125745

RESUMO

Objectives: To explore the socio-demographic determinants of nutritional status of Pakistani women. METHODS: The retrospective secondary-data study was conducted at Lahore College for Women University, Lahore, Pakistan from March to July 2019, and comprised a review of the Pakistan Demographic and Health Survey 2017-18 for which the data-collection period was from November 22, 2017, to April 30, 2018. Body mass index was taken as a reflection of the women's nutritional status. Ordinary least square and quantile regression models were used for statistical analysis. RESULTS: Age, education, frequency of watching TV, wealth index, husband's education and region showed a positive effect on women's body mass index, while age of women at first birth, women's working status, gender of household head and region showed negative effect on women's body mass index (p<0.05). CONCLUSIONS: Overweight/obesity was found to be a more serious problem compared to under-nutrition in Pakistani women.


Assuntos
Características da Família , Índice de Massa Corporal , Feminino , Humanos , Paquistão/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores Socioeconômicos
4.
Artigo em Inglês | MEDLINE | ID: mdl-34067291

RESUMO

As COVID-19 run rampant in high-density housing sites, it is important to use real-time data in tracking the virus mobility. Emerging cluster detection analysis is a precise way of blunting the spread of COVID-19 as quickly as possible and save lives. To track compliable mobility of COVID-19 on a spatial-temporal scale, this research appropriately analyzed the disparities between spatial-temporal clusters, expectation maximization clustering (EM), and hierarchical clustering (HC) analysis on Texas county-level. Then, based on the outcome of clustering analysis, the sensitive counties are Cottle, Stonewall, Bexar, Tarrant, Dallas, Harris, Jim hogg, and Real, corresponding to Southeast Texas analysis in Geographically Weighted Regression (GWR) modeling. The sensitive period took place in the last two quarters in 2020 and the first quarter in 2021. We explored PostSQL application to portray tracking Covid-19 trajectory. We captured 14 social, economic, and environmental impact's indices to perform principal component analysis (PCA) to reduce dimensionality and minimize multicollinearity. By using the PCA, we extracted five factors related to mortality of COVID-19, involved population and hospitalization, adult population, natural supply, economic condition, air quality or medical care. We established the GWR model to seek the sensitive factors. The result shows that adult population, economic condition, air quality, and medical care are the sensitive factors. Those factors also triggered high increase of COVID-19 mortality. This research provides geographical understanding and solution of controlling COVID-19, reference of implementing geographically targeted ways to track virus mobility, and satisfy for the need of emergency operations plan (EOP).


Assuntos
COVID-19 , Adulto , Humanos , Análise de Regressão , SARS-CoV-2 , Regressão Espacial , Texas/epidemiologia
5.
Nat Commun ; 12(1): 3307, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083538

RESUMO

Despite decades of intensive search for compounds that modulate the activity of particular protein targets, a large proportion of the human kinome remains as yet undrugged. Effective approaches are therefore required to map the massive space of unexplored compound-kinase interactions for novel and potent activities. Here, we carry out a crowdsourced benchmarking of predictive algorithms for kinase inhibitor potencies across multiple kinase families tested on unpublished bioactivity data. We find the top-performing predictions are based on various models, including kernel learning, gradient boosting and deep learning, and their ensemble leads to a predictive accuracy exceeding that of single-dose kinase activity assays. We design experiments based on the model predictions and identify unexpected activities even for under-studied kinases, thereby accelerating experimental mapping efforts. The open-source prediction algorithms together with the bioactivities between 95 compounds and 295 kinases provide a resource for benchmarking prediction algorithms and for extending the druggable kinome.


Assuntos
Inibidores de Proteínas Quinases/farmacologia , Proteínas Quinases/metabolismo , Algoritmos , Benchmarking , Crowdsourcing , Bases de Dados de Produtos Farmacêuticos , Aprendizado Profundo , Descoberta de Drogas , Avaliação Pré-Clínica de Medicamentos , Humanos , Cinética , Aprendizado de Máquina , Modelos Biológicos , Modelos Químicos , Inibidores de Proteínas Quinases/química , Inibidores de Proteínas Quinases/farmacocinética , Proteínas Quinases/química , Proteômica , Análise de Regressão
6.
BMC Infect Dis ; 21(1): 467, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022827

RESUMO

BACKGROUND: Identifying and treating individuals with high risk of progression from latent tuberculosis infection to active tuberculosis (TB) disease is critical for eliminating the disease. We aimed to conduct a systematic review and meta-regression analysis to quantify the dose-response relationship between interferon-gamma release assay (IGRA) levels and the risk of progression to active TB. METHODS: We searched PubMed and Embase from 1 January 2001 to 10 May 2020 for longitudinal studies that reported the risk of progression from latent to active TB as a function of baseline IGRA values. We used a novel Bayesian meta-regression method to pool effect sizes from included studies and generate a continuous dose-response risk curve. Our modeling framework enabled us to incorporate random effects across studies, and include data with different IGRA ranges across studies. The quality of included studies were assessed using the Newcastle-Ottawa scale (NOS). RESULTS: We included 34 studies representing 581,956 person-years of follow-up with a total of 788 incident cases of TB in the meta-regression analysis. Higher levels of interferon-gamma were associated with increased risk of progression to active tuberculosis. In the dose-response curve, the risk increased sharply between interferon-gamma levels 0 and 5 IU/ml, after which the risk continued to increase moderately but at a slower pace until reaching about 15 IU/ml where the risk levels off. Compared to 0 IU/ml, the relative risk of progression to active TB among those with interferon-gamma levels of 0.35, 1, 5, 10, 15, and 20 IU/ml were: 1.64 (1.28-2.08), 2.90 (2.02-3.88), 11.38 (6.64-16.38), 19.00 (13.08-26.90), 21.82 (14.65-32.57), and 22.31 (15.43-33.00), respectively. The dose-response relationship remains consistent when limiting the analysis to studies that scored highest in the NOS. CONCLUSION: The current practice of dichotomizing IGRA test results simplifies the TB infection disease continuum. Evaluating IGRA test results over a continuous scale could enable the identification of individuals at greatest risk of progression to active TB.


Assuntos
Progressão da Doença , Testes de Liberação de Interferon-gama/métodos , Interferon gama/sangue , Tuberculose Latente/sangue , Tuberculose Latente/epidemiologia , Mycobacterium tuberculosis/imunologia , Teorema de Bayes , Humanos , Tuberculose Latente/microbiologia , Tuberculose Latente/patologia , Estudos Longitudinais , Masculino , Análise de Regressão , Fatores de Risco , Teste Tuberculínico/métodos
7.
Nutrients ; 13(5)2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33946360

RESUMO

Sarcopenia is a disease of old age characterized by decreased muscle mass and strength. Branched-chain amino acids (BCAAs) promote muscle mass synthesis and increase muscle strength. We aimed to develop a dietary amino acid database and to examine the association between BCAA intake and handgrip strength in Korean older adults. Data from the Korea National Health and Nutrition Examination Survey 2014-2018 were used. Overall, 4852 participants aged ≥65 years were included in the study. Demographic, lifestyle, and health data were obtained through interviews and questionnaires. The 24-h recall method was used to assess dietary intake. An amino acid database was established using the 9th revision of the Korean Standard Food Composition Table. The mean handgrip strength was estimated from triplicate measurements obtained using the dominant hand. Multivariable linear regression analysis was performed to assess the association between BCAA intake and handgrip strength. Grains greatly contributed to amino acid intake; however, a significant negative association was observed between handgrip strength and increased BCAA intake through grains. In the fully adjusted model, leucine intake and handgrip strength showed a positive association. Thus, consuming BCAAs (especially leucine) via a variety of food sources can help maintain muscle health in older people.


Assuntos
Aminoácidos de Cadeia Ramificada/administração & dosagem , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/química , Força da Mão , Idoso , Estudos Transversais , Dieta , Feminino , Humanos , Masculino , Análise Multivariada , Inquéritos Nutricionais , Análise de Regressão , República da Coreia
8.
CMAJ Open ; 9(2): E548-E555, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021012

RESUMO

BACKGROUND: Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination. METHODS: Participants from the All Our Families pregnancy longitudinal cohort whose children had reached ages 9-12 years were invited in May-June 2020 to complete a survey on the impact of COVID-19. The survey covered topics about the impact of the pandemic and included 2 specific questions on mothers' intentions to vaccinate their child against SARS-CoV-2. Current responses were linked to previously collected data, including infant vaccine uptake. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status and vaccination intention. Qualitative responses regarding factors affecting decision-making were analyzed thematically. RESULTS: The response rate was 53.8% (1321/2455). A minority of children of participants had partial or no vaccinations at age 2 (n = 200, 15.1%). A total of 60.4% of mothers (n = 798) intended to vaccinate their children with the SARS-CoV-2 vaccine, 8.6% (n = 113) did not intend to vaccinate and 31.0% (n = 410) were unsure. Lower education, lower income and incomplete vaccination history were inversely associated with intention to vaccinate. Thematic analysis of qualitative responses showed 10 themes, including safety and efficacy, long-term effects and a rushed process. INTERPRETATION: Within a cohort with historically high infant vaccination, a third of mothers remained unsure about vaccinating their children against SARS-CoV-2. Given the many uncertainties about future SARS-CoV-2 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Intenção , Mães/psicologia , Vacinação/psicologia , Adulto , Fatores Etários , Vacinas contra COVID-19/efeitos adversos , Canadá , Criança , Escolaridade , Grupos Étnicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Renda , Estado Civil , Pessoa de Meia-Idade , Análise de Regressão , SARS-CoV-2
9.
Medicine (Baltimore) ; 100(21): e26157, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032773

RESUMO

ABSTRACT: Among the main types of neoplasms in the female population, breast and cervical cancers are the most important due to their high morbidity and mortality rates. The mortality has been proportionally higher in developing countries. Analysis of the trend of cancer mortality in Brazil revealed a considerable difference in the pattern of deaths between the regions.To analyze the trend of mortality due to breast and cervical cancers in women.Retrospective study of a series of death cases, using secondary data from the mortality information system (SIM) of the Ministry of Health. The deaths were identified as the underlying cause of breast and cervical cancers, including malignant neoplasms of the uterus without other specifications, occurring from 1980 to 2014. Thus, the annual standardized age-specific mortality rates by the world population were applied. For trend analysis, regression models were utilized in which the mortality rates were considered dependent variables and years the independent variable. Polynomial regression models and a Prais-Winsten regression model were adopted.Cervical cancer presented a mortality rate ranging from 2.15 to 10.69 per 100,000 women from 1980 to 2014, with a tendency for stability.Breast cancer mortality rate varied from 3.81 to 11.47 per 100,000 women from 1981 to 2014, indicating a growing trend.There is a significant increase in the mortality rate for breast cancer and stability of cervical cancers in the State of Acre from 1980 to 2014, evidencing a concern in their care and monitoring. Above all, guaranteed access, especially to the population of women at social risk, and the search for effective screening should be emphasized in the formation of the care line and the Health Care Network in the State of Acre.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Mortalidade/tendências , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
10.
Biomed Res Int ; 2021: 6645252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33969122

RESUMO

Objectives: Handgrip strength (HS) is a risk factor of all-cause mortality and cardiovascular diseases. However, the influencing factors and mechanisms contributing to this correlation remain unclear. Therefore, we aimed to explore factors related to HS and investigated the mechanism underlying its risk predictive value. Methods: This was a prospective, cross-sectional study. One hundred forty-five participants were recruited from December 2019 to November 2020. HS was measured using a hydraulic hand dynamometer and adjusted for body mass index (HSBMI) and body surface area (HSBSA). Body composition was assessed via bioimpedance spectroscopy. Physical fitness was measured using a cardiopulmonary exercise test system. Univariate, multiple linear regression analyses and receiver operator characteristic curve (ROC) were conducted to evaluate the associations between various participant characteristics and HS. Results: The average participant age was 21.68 ± 2.61 years (42.8% were male). We found positive correlations between HSBMI/HSBSA and VO2max, VEmax, Loadmax, and METmax in both sexes (p < 0.05). Lean-tissue, protein, total water, and inorganic salt percentages were positively correlated, and fat percentage was negatively correlated with HSBMI in men and with HSBMI and HSBSA in women (p < 0.05). Multiple regression revealed that VO2max was independently associated with HSBSA in both sexes (ß = 0.215, 0.173; 95%confidence interval [CI] = 0.032 - 0.398, 0.026-0.321; p = 0.022, 0.022, respectively) and independently associated with HSBMI in women (ß = 0.016, 95%CI = 0.004 - 0.029, p = 0.011). ROC analysis showed that HSBMI and HSBSA can moderately identify normal VO2max in men (area under curve [AUC] = 0.754, 0.769; p = 0.002, 0.001, respectively) and marginally identify normal VO2max in women (AUC = 0.643, 0.635; p = 0.029, 0.042, respectively). Conclusions: BMI- and BSA-adjusted HS could serve as indicators of physical health, and HSBSA may moderately reflect cardiorespiratory fitness levels in healthy young adults, particularly in males. Clinical trials registry site and number: China Clinical Trial Center (ChiCTR1900028228).


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Força da Mão/fisiologia , Saúde , Índice de Massa Corporal , Superfície Corporal , Feminino , Humanos , Masculino , Análise Multivariada , Consumo de Oxigênio/fisiologia , Curva ROC , Análise de Regressão , Adulto Jovem
11.
Am J Orthod Dentofacial Orthop ; 159(5): 695-696, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33931224
12.
Biomed Res Int ; 2021: 6628016, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954186

RESUMO

Aim: This study is aimed at exploring the relationship between green behavior intentions and green behavior and analyzing the moderating role of ethical leadership in this relationship. Background: Nurses' green behavior can directly reduce costs and protect the natural environment and organizational sustainability by saving resources and energy. It is not clear how green behavior intention affects green behavior or how the positive influence of green behavior intention on green behavior can be enhanced. Design and Methods. This is a cross-sectional study, and the surveys are collected from 3 hospitals in China. Of the initial cohort of 489 nurses, 89.6% were female. There were 327 subjects (66.9%) aged 35 or less, 267 subjects (54.6%) with 10 years or less of work experience, and 220 unmarried subjects (44.9%). Data were collected from January to July 2018, using three surveys: green behavior intentions, green behavior, and ethical leadership. Results: Green behavior intentions impacted employee green behavior (b = 0.32, t = 5.37, p < 0.01). The interaction term for green behavior intentions and ethical leadership was significant (b = 0.28, t = 2.53, p ≤ 0.01); the conditional direct effect of green behavior intentions was only significant at a high level of ethical leadership (conditional effect = 0.53, SE = 0.16, t = 3.38, p < 0.01, 95% confidence interval of 0.22-0.84). Conclusion: The intention to engage in green behavior influences nurses' green behavior positively, and the relationship is stronger when ethical leadership is high in the organization than when ethical leadership is low. The results of this study can help both academics and practitioners to understand the micromechanism of environmentally sustainable development in more detail and to identify the mechanisms and boundary conditions of green behavioral intentions, green behavior, and ethical leadership.


Assuntos
Atitude do Pessoal de Saúde , Conservação dos Recursos Naturais , Ética em Enfermagem , Intenção , Liderança , Enfermeiras e Enfermeiros/psicologia , Adulto , Feminino , Humanos , Masculino , Análise de Regressão
13.
Health Qual Life Outcomes ; 19(1): 145, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980245

RESUMO

BACKGROUND: Existing studies on health-related quality of life (HRQoL) mainly covered single growth stages of childhood or adolescence and did not report on the trends in the relationships of HRQoL with sleep duration, physical activity, and screen time. This study aimed to establish the population norm of HRQoL in children and adolescents aged 6-17 years and examine the associations of screen time, sleep duration, and physical activity with HRQoL in this population. METHODS: We conducted a large-scale cross-sectional population-based survey study of Hong Kong children and adolescents aged 6 to 17 years. A representative sample of students were interviewed to assess their HRQoL using PedsQL and EQ-5D-Y-5L. Multivariable homoscedastic Tobit regression with linear form or restricted cubic spline of predictors was used to analyze the associations between screen time, sleep duration, and HRQoL. Multiple imputation by chained equations was performed to deal with missing data. RESULTS: A total of 7555 respondents (mean age 11.5, SD 3.2; 55.1% female) were sampled. Their EQ VAS scores, PedsQL physical summary scores, and psychosocial summary scores were positively correlated with sleep duration and moderate/vigorous activity but was negatively correlated with screen time. CONCLUSIONS: Children and adolescents who had longer exposure to screen, shorter sleep duration, and lower physical activity levels appeared to have poorer HRQoL as assessed by PedsQL and EQ-5D-Y-5L. Advice and guidance on screen time allocation for children and adolescents should be provided at the levels of school, community, and family.


Assuntos
Exercício Físico , Qualidade de Vida/psicologia , Tempo de Tela , Sono , Estudantes/psicologia , Adolescente , Criança , Estudos Transversais , Feminino , Hong Kong , Humanos , Masculino , Análise de Regressão , Estudantes/estatística & dados numéricos
14.
Int Heart J ; 62(3): 592-600, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34054000

RESUMO

The clinical evidence is accumulating since 2015 that anti-diabetic sodium-glucose cotransporter 2 (SGLT2) inhibitors have the beneficial effect of cardiovascular and, recently, renal protection. Although it is not well analyzed how the transfer of this new evidence into daily practice has expedited, we hypothesize that the recent usage of the drugs is positively associated with several certified cardiologists in each region.The 2016 annual and 2016-2017 increased number of SGLT2 inhibitor tablets, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan, were divided by the estimated number of patients with type 2 diabetes mellitus for each of the 47 prefectures. Then, regression analyses were performed to investigate the potential association of the number of certified cardiologists with the drug prescription.The 2016 prescription of ipragliflozin, dapagliflozin, luseogliflozin, canagliflozin, and empagliflozin was 2.7- to 4.4-fold different between prefectures. The 2016-2017 increased prescription volume also varied among prefectures by as large as 7.3-fold for ipragliflozin. Regression analysis revealed that the annual and increased prescription volume of all the SGLT2 inhibitors except luseogliflozin were higher in regions with more certified cardiologists (P < 0.05), even after adjusting for regional parameters.In conclusion, the regional number of certified cardiologists was positively associated with a 2016 annual of and 2016-2017 increase in SGLT2 inhibitor prescription amount, implying an early adopter role of clinical experts in healthcare delivery.


Assuntos
Cardiologistas/estatística & dados numéricos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Prescrições/estatística & dados numéricos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/farmacologia , Compostos Benzidrílicos/uso terapêutico , Canagliflozina/farmacologia , Canagliflozina/uso terapêutico , Sistema Cardiovascular/efeitos dos fármacos , Análise de Dados , Feminino , Glucosídeos/farmacologia , Glucosídeos/uso terapêutico , Humanos , Japão/epidemiologia , Rim/efeitos dos fármacos , Masculino , Análise de Regressão , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Sorbitol/análogos & derivados , Sorbitol/farmacologia , Sorbitol/uso terapêutico , Tiofenos/farmacologia , Tiofenos/uso terapêutico
15.
Front Public Health ; 9: 648278, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33937176

RESUMO

Background: In Flanders, breast cancer (BC) screening is performed in a population-based breast cancer screening program (BCSP), as well as in an opportunistic setting. Women with different socio-demographic characteristics are not equally covered by BC screening. Objective: To evaluate the role of socio-demographic characteristics on the lowest 10th and highest 90th quantile levels of BC screening coverage. Methods: The 2017 neighborhood-level coverage rates of 8,690 neighborhoods with women aged 50-69 and eligible for BCSP and opportunistic screening were linked to socio-demographic data. The association between socio-demographic characteristics and the coverage rates of BCSP and opportunistic screening was evaluated per quantile of coverage using multivariable quantile regression models, with specific attention to the lowest 10th and highest 90th quantiles. Results: The median coverage in the BCSP was 50%, 33.5% in the 10th quantile, and 64.5% in the 90th quantile. The median coverage of the opportunistic screening was 12, 4.2, and 24.8% in the 10th and 90th quantile, respectively. A lower coverage of BCSP was found in neighborhoods with more foreign residents and larger average household size, which were considered indicators for a lower socioeconomic status (SES). However, a higher average personal annual income, which was considered an indicator for a higher SES, was also found in neighborhoods with lower coverage of BCSP. For these neighborhoods, that have a relatively low and high SES, the negative association between the percentage of foreign residents, average household size, and average personal annual income and the coverage in the BCSP had the smallest regression coefficient and 95% confidence interval (CI) values were -0.75 (95% CI: -0.85, -0.65), -13.59 (95% CI: -15.81, -11.37), and -1.05 (95% CI: -1.18, -0.92), respectively, for the 10th quantile. The neighborhoods with higher coverage of opportunistic screening had a relatively higher average personal annual income, with the largest regression coefficient of 1.72 (95% CI: 1.59, 1.85) for the 90th quantile. Conclusions: Women from relatively low and high SES neighborhoods tend to participate less in the BCSP, whereas women with a relatively high SES tend to participate more in opportunistic screening. For women from low SES neighborhoods, tailored interventions are needed to improve the coverage of BCSP.


Assuntos
Neoplasias da Mama , Idoso , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Classe Social , Fatores Socioeconômicos
17.
Health Qual Life Outcomes ; 19(1): 151, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011369

RESUMO

PURPOSE: This study aims to explore the incidence of hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and the influence of hypoglycemia on the specific quality of life in T2DM patients. METHODS: It was a comparative cross-sectional study consisting of 519 T2DM patients in Xi'an, China and patients were investigated by self-reported hypoglycemia and specific quality of life questionnaires from September 2019 to January 2020. Descriptive analysis, t-test, Chi-square test, hierarchical regression analysis and stepwise multiple regression analysis were applied to assess the influence of hypoglycemia on the specific quality of life. RESULTS: The incidence of hypoglycemia in T2DM patients was 32.18%. The mean score of specific quality of life in diabetes without hypoglycemia was 57.33 ± 15.36 and was 61.56 ± 17.50 in those with hypoglycemia, which indicated that hypoglycemia had a serious impact on the quality of life of diabetics (t = - 5.172, p = 0.000). In the Univariate analysis of specific quality of life, age, education background, marital status, living status, duration of diabetes, monthly income per capita were independent and significant factors associated with specific quality of life of two groups of T2DM patients (p < 0.05). In the hierarchical regression analysis, the duration of the diabetes more than 11 years and the frequency of hypoglycemia more than 6 times in half a year entered the equation of specific quality of life of 519 diabetics respectively (p < 0.001). In multiple linear regression analysis, age, marital status and income all entered the regression equation of quality of life of the two groups (p < 0.05). CONCLUSION: Hypoglycemia will have a serious impact on the quality of life of T2DM patients. In order to improve the living quality in diabetics, effective measurements should be taken to strengthen the management of blood glucose and to avoid hypoglycemia.


Assuntos
Glicemia/análise , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Hipoglicemia/complicações , Hipoglicemia/fisiopatologia , Autorrelato/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipoglicemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão , Inquéritos e Questionários , Adulto Jovem
18.
Front Immunol ; 12: 651715, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33936073

RESUMO

Background: The course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses. Objective: In this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs. Methods: Between April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome. Results: 165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive. Conclusions: Among IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.


Assuntos
Antirreumáticos/uso terapêutico , COVID-19/complicações , Glucocorticoides/efeitos adversos , Doenças Reumáticas/imunologia , Adulto , Idoso , Assistência Ambulatorial , Antirreumáticos/efeitos adversos , COVID-19/imunologia , COVID-19/mortalidade , COVID-19/fisiopatologia , Estudos de Coortes , Comorbidade , Cuidados Críticos , Feminino , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Oxigenoterapia , Análise de Regressão , Doenças Reumáticas/complicações , Doenças Reumáticas/mortalidade , Doenças Reumáticas/fisiopatologia , Turquia
19.
BMC Health Serv Res ; 21(1): 427, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952273

RESUMO

BACKGROUND: Multimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE). METHODS: We conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE. RESULTS: Overall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07-0.14 for outpatient care and coefficient 0.09 (95% CI 0.02-0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4-42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5-1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9-46.2). CONCLUSION: Multimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation.


Assuntos
Gastos em Saúde , Doenças não Transmissíveis , Idoso , Estudos Transversais , Humanos , Indonésia/epidemiologia , Multimorbidade , Análise de Regressão
20.
Health Qual Life Outcomes ; 19(1): 156, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049560

RESUMO

BACKGROUND: As China's aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters. METHODS: A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL. RESULTS: The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester's QOL (P < 0.05) (R2 = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (ß = 0.446, P < 0.001). Socio-economic status had an indirect effect (ß = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (ß = 0.115, P < 0.001) on QOL. CONCLUSION: Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.


Assuntos
Adaptação Psicológica , Estilo de Vida Saudável , Relações Pais-Filho , Pais/psicologia , Qualidade de Vida/psicologia , Classe Social , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários
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