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1.
Yakugaku Zasshi ; 140(11): 1351-1363, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33132271

RESUMO

Epidemiological studies have shown that coffee consumption may be associated with a lower risk of developing several chronic disorders. To elucidate the molecular mechanism of the effects of coffee, we analyzed molecular response upon exposure to coffee extract using cellular and animal models of these diseases. As obesity is recognized as a major risk factor for these chronic diseases, we investigated the effect of coffee on adipogenesis using mouse preadipocyte 3T3-L1 cells. We found that coffee induced proteasomal degradation of IRS-1, leading to reduction of PPARγ expression, a master transcription factor for adipogenesis. Reduction in weight as well as in IRS-1 expression was detected in the fat tissues of the high fat-diet-fed mice when reared with 60% coffee for 7 weeks. As for Alzheimer's disease, we analyzed the effect of coffee on amyloid ß (Aß) production in human neuronal SH-SY5Y cells. We found a 20% reduction in Aß production when treated with 2.5% coffee for 2 d. This reduction was due to proteasomal degradation of BACE1 (ß-secretase), which was activated by protein kinase A. In addition, coffee ameliorates LPS-induced inflammatory responses in RAW264.7 macrophages by reducing NFκB activity and Nrf2 activation. Roasted coffee prevents selenite-induced cataractogenesis by ameliorating antioxidant loss. Pyrocatechol, a component of roasted coffee, also reduced Aß production and exhibits anti-inflammatory effects by a similar mechanism as coffee. Our results suggest that roasting coffee beans to generate pyrocatechol is necessary for the preventive effects of coffee intake on the chronic diseases.


Assuntos
Doença de Alzheimer/prevenção & controle , Catarata/prevenção & controle , Doença Crônica/prevenção & controle , Café , Ingestão de Líquidos/fisiologia , Adipogenia , Doença de Alzheimer/metabolismo , Secretases da Proteína Precursora do Amiloide/metabolismo , Peptídeos beta-Amiloides/metabolismo , Animais , Ácido Aspártico Endopeptidases/metabolismo , Catecóis , Células Cultivadas , Café/química , Modelos Animais de Doenças , Manipulação de Alimentos , Temperatura Alta , Humanos , Proteínas Substratos do Receptor de Insulina/metabolismo , Camundongos , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , PPAR gama/metabolismo , Complexo de Endopeptidases do Proteassoma/metabolismo , Células RAW 264.7
2.
Am J Clin Nutr ; 112(4): 926-930, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889521

RESUMO

The consumption of animal products exposes humans to saturated fat, cholesterol, lactose, estrogens, and pathogenic microorganisms, while displacing fiber, complex carbohydrates, antioxidants, and other components needed for health. In the process, consumption of animal products increases the risk for cardiovascular disease, cancer, diabetes, obesity, and other disorders. This dietary pattern also promotes the growth of unhealthful gut bacteria, fostering, among other things, the production of trimethylamine N-oxide, a proinflammatory compound associated with cardiovascular and neurological diseases. When omnivorous individuals change to a plant-based diet, diet quality as measured by the Alternate Healthy Eating Index improves, and the risk of these health problems diminishes. Planning for nutrient adequacy is important with any diet. However, a diet based on vegetables, fruits, whole grains, and legumes, supplemented with vitamin B-12, is nutritionally superior to diets including animal products and is healthful for children and adults.


Assuntos
Doença Crônica/prevenção & controle , Dieta Saudável , Dieta Vegetariana , Comportamento Alimentar , Adulto , Animais , Criança , Fibras na Dieta , Frutas , Humanos , Risco , Verduras
3.
Am J Clin Nutr ; 112(4): 931-936, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889537

RESUMO

Excessive attention to the animal versus plant binary food choice reflects society's moral views on eating right. To claim that avoidance of animal products is required to prevent chronic disease is not supported by evidence, makes little sense from an evolutionary perspective, and distracts policy makers from common-sense approaches to achieve adequate nutrition. Animal products provide highly bioavailable nutrients, some of which are not easily obtained from plants, and can play a key role in meeting the nutritional challenges of populations in both high- and low-income countries. This role goes beyond the need for protein and relates to vitamins, minerals, and numerous often-overlooked nutrients, such as long-chain fatty acids, taurine, and choline. Restrictive dietary prescriptions that exclude animal products complicate the quest for optimal nutrition by undermining dietary diversity and flexibility, and by introducing a dependency on fortification and supplementation. Thus, a vegan diet may put the general population at increased risk of poor nutrition, a problem of particular concern for those with special nutritional requirements.


Assuntos
Doença Crônica/prevenção & controle , Dieta Vegetariana , Comportamento Alimentar , Adulto , Animais , Criança , Humanos , Necessidades Nutricionais , Valor Nutritivo , Risco
4.
Am J Clin Nutr ; 112(4): 937-940, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889545

RESUMO

The present debate outlined opposing views regarding the role of animal products in human diets. The YES position argues that the health benefits and safety of plant-based diets have been clearly established by consistent findings of randomized trials and observational studies; that animal products skew the diet toward saturated fat, excess protein, cholesterol, lactose, and exogenous hormones; and that vulnerable populations are better nourished by vegetables, fruits, legumes, and whole grains than by striated muscle and cow milk. In contrast, the NO position asserts that animal foods are not only benign but are also key elements of the human omnivore diet, facilitating the global challenge of adequate essential nutrition. This view holds that the portrayal of animal foods as unhealthy is not supported by the evidence and that a restrictive vegan diet decreases nutritional flexibility and robustness, increasing risk for vulnerable population groups. Points of agreement and controversy were identified, as well as opportunities for further studies.


Assuntos
Doença Crônica/prevenção & controle , Dieta Vegetariana , Comportamento Alimentar , Adulto , Animais , Criança , Consenso , Humanos , Risco
5.
Stroke ; 51(10): 2910-2917, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912091

RESUMO

BACKGROUND AND PURPOSE: Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. METHODS: From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. RESULTS: Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01-1.12]), severe (IRR, 2.34 [95% CI, 1.65-3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07-2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08-1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95-0.99]). CONCLUSIONS: Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01763203.


Assuntos
Ataque Isquêmico Transitório/prevenção & controle , Qualidade de Vida , Autogestão , Acidente Vascular Cerebral/prevenção & controle , Idoso , Doença Crônica/prevenção & controle , Doença Crônica/psicologia , Feminino , Humanos , Ataque Isquêmico Transitório/psicologia , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Autoeficácia , Acidente Vascular Cerebral/psicologia
6.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1129415

RESUMO

Objetivo: Apresentar o impacto da pandemia de COVID-19 em pacientes com doenças crônicas e a sua correlação ao acesso a serviços de saúde durante este período. Casuística e Métodos: Trata-se de um estudo transversal descritivo-analítico, cujos dados foram obtidos por meio da pesquisa ConVid ­ Pesquisa de Comportamentos. A ConVid utilizou um questionário virtual, disponível entre 24 de abril a 24 de maio de 2020. A obtenção da amostra foi realizada por um procedimento de amostragem em cadeia, obedecendo a uma estratificação por sexo, faixa de idade (18 a 39 anos, 40 a 59 anos, 60 anos e mais) e grau de escolaridade. Neste estudo, foram selecionados para análise alguns dos tópicos presentes no questionário, sendo os dados coletados e apresentados em forma de tabelas. A pesquisa realizada pelo ConVid foi aprovada pelo Comitê de Ética em Pesquisa da Fiocruz (CEP/Fiocruz) e pela Comissão Nacional de Ética em Pesquisa (CONEP). Em virtude de utilizar dados secundários, neste estudo não foi necessário a submissão do projeto ao Comitê de Ética em Pesquisa. Resultados: A pesquisa obteve amostra de 45.161 indivíduos, na qual houve maior prevalência de indivíduos que consideram que o seu estado de saúde permaneceu igual. A maioria dos respondentes que buscaram os serviços de saúde conseguiram atendimento. O transtorno depressivo maior obteve o maior impacto durante a pandemia. Houve impacto no acesso a serviços de saúde. Conclusão: Ressalta-se a importância de estudos que avaliem as influências da COVID-19 na vida dos brasileiros


Objective: To present the impact of the COVID-19 pandemic on patients with chronic diseases and its correlation with access to health services during this period. Casuistry and Methods: It is a descriptive-analytical cross-section, whose data were obtained through the research ConVid -Research on Behaviors. ConVid used a virtual questionnaire, available from April 24th to May 24th, 2020. The sample was obtained by one by one chain sampling procedure, obeying a stratification by sex, age range (18 to 39 years old, 40 to 59 years, 60 years and over) and educational level. In this study, some of the topics present in the questionnaire were selected for analysis, the data obtained being presented in tables. The research carried out by ConVid was approved by the Fiocruz Research Ethics Committee (CEP/Fiocruz) and the National Research Ethics Commission (CONEP). Due to the use of secondary data, in this study it was not necessary to submit the project to the Research Ethics Committee. Results: The survey obtained a sample of 45,161 individuals, in which there was a higher prevalence of individuals who consider that their health status remained the same. Most respondents who sought health services were able to receive care. Major depressive disorder had the greatest impact during the pandemic. There was an impact on access to health services. Conclusion: The importance of studies that assess the influences of COVID-19 in the lives of Brazilians is emphasized


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Doença Crônica/prevenção & controle , Infecções por Coronavirus , Pandemias
9.
Life Sci ; 260: 118182, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32781063

RESUMO

BACKGROUND: Chronic diseases are a major cause of mortality worldwide, and despite the recent development in treatment modalities, synthetic drugs have continued to show toxic side effects and development of chemoresistance, thereby limiting their application. The use of phytochemicals has gained attention as they show minimal side effects. Diosgenin is one such phytochemical which has gained importance for its efficacy against the life-threatening diseases, such as cardiovascular diseases, cancer, nervous system disorders, asthma, arthritis, diabetes, and many more. AIM: To evaluate the literature available on the potential of diosgenin and its analogs in modulating different molecular targets leading to the prevention and treatment of chronic diseases. METHOD: A detailed literature search has been carried out on PubMed for gathering information related to the sources, biosynthesis, physicochemical properties, biological activities, pharmacokinetics, bioavailability and toxicity of diosgenin and its analogs. KEY FINDINGS: The literature search resulted in many in vitro, in vivo and clinical trials that reported the efficacy of diosgenin and its analogs in modulating important molecular targets and signaling pathways such as PI3K/AKT/mTOR, JAK/STAT, NF-κB, MAPK, etc., which play a crucial role in the development of most of the diseases. Reports have also revealed the safety of the compound and the adaptation of nanotechnological approaches for enhancing its bioavailability and pharmacokinetic properties. SIGNIFICANCE: Thus, the review summarizes the efficacy of diosgenin and its analogs for developing as a potent drug against several chronic diseases.


Assuntos
Doença Crônica/tratamento farmacológico , Diosgenina/uso terapêutico , Animais , Disponibilidade Biológica , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Fenômenos Químicos , Doença Crônica/prevenção & controle , Diosgenina/análogos & derivados , Diosgenina/farmacocinética , Humanos , Inflamação/tratamento farmacológico , Neoplasias/tratamento farmacológico , Doenças do Sistema Nervoso/tratamento farmacológico , Fitoterapia , PubMed , Sementes/química , Transdução de Sinais/efeitos dos fármacos , Trigonella
10.
Emerg Top Life Sci ; 4(2): 179-190, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32832978

RESUMO

Fremanezumab is a fully humanized monoclonal antibody (IgG2Δa) that targets calcitonin gene-related peptide (CGRP), a key neuropeptide involved in the pathophysiology of migraine. Fremanezumab is approved for quarterly and monthly subcutaneous dosing for the preventive treatment of migraine in adults. The phase 3 clinical development program for fremanezumab aimed to evaluate the efficacy of this preventive treatment across different patient populations, including those with difficult-to-treat migraine. Two pivotal 12-week, phase 3, placebo-controlled studies investigated quarterly and monthly dosing of fremanezumab in participants with chronic migraine (HALO CM) and episodic migraine (HALO EM). The efficacy of fremanezumab was further explored in individuals with difficult-to-treat chronic or episodic migraine in the 12-week FOCUS study, which enrolled participants who had previously experienced an inadequate response to 2-4 pharmacological classes of migraine preventive medications. The long-term efficacy of fremanezumab was assessed in a 12-month long-term study (HALO LTS), which enrolled participants completing the 12-week HALO studies and new participants. Across these studies, treatment with fremanezumab dosed quarterly or monthly provided significant reductions in the frequency of migraine days, headache days of at least moderate severity, and migraine- and headache-related disability compared with placebo. Sustained improvements were seen with long-term fremanezumab treatment. Subgroup analyses of participants with difficult-to-treat migraine (those with comorbid depression, overuse of acute headache medications, and concomitant use of other migraine preventive medications) demonstrated the effectiveness of quarterly or monthly fremanezumab in these populations. Ongoing studies are further exploring the potential benefits of fremanezumab in difficult-to-treat migraine and other headache and pain disorders.


Assuntos
Anticorpos Monoclonais/farmacologia , Doença Crônica/tratamento farmacológico , Doença Crônica/prevenção & controle , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Peptídeo Relacionado com Gene de Calcitonina/farmacologia , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , Cefaleia/tratamento farmacológico , Humanos , Imunoglobulina G/farmacologia , Assistência de Longa Duração , Conformação Proteica , Transtornos Somatoformes/tratamento farmacológico , Resultado do Tratamento
11.
PLoS One ; 15(8): e0234733, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822350

RESUMO

PURPOSE: To investigate the knowledge and practices regarding diabetic retinopathy (DR) among diabetic patients included in a community-based primary health system (CBPHS) in China. METHODS: Diabetic patients aged 18 years and above registered in the CBPHS in Yueqing city, Zhejiang province were recruited. Information obtained by questionnaire included: demographic and socioeconomic status, knowledge about DR, and ocular and medical history. The primary outcome was whether the participant knew that DM can affect the eyes, defined according to the question: "Do you know diabetes mellitus (DM) can affect eyes? (yes or no)". A knowledge score was calculated based on the responses to seven questions, with 1 point awarded for a correct response and 0 points for an incorrect or uncertain answer. RESULTS: A total of 1972 diabetic patients were included in the study with an average age of 65.2±10.8 years, 45.7% were male. One thousand two hundred and nineteen patients (61.8%) knew that DM can affect the eyes. Significant differences in age, education, income status, insurance covering eye care, fasting blood glucose, duration of DM, history of hypertension existed between subjects who knew and those who did not know that DM can affect the eyes (P<0.05 for all). The proportion of correct answers to the DR knowledge questions ranged from 33.3% to 61.8%, with an average score of 3.65±2.47. In the multiple regression analysis, the knowledge score was significantly associated with age, education, income, history of hypertension, duration of DM, being told that regular examinations should be performed and concern about vision loss (P <0.01 for all). CONCLUSIONS: The knowledge toward DR among DM patients were still low within the chronic disease management system in eastern China. Routine ophthalmic screening, health care promotions, and educational programs should be emphasized and implemented for better DR prevention and management.


Assuntos
Retinopatia Diabética/epidemiologia , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Retinopatia Diabética/prevenção & controle , Retinopatia Diabética/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política Pública , Sistema de Registros/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
12.
PLoS One ; 15(8): e0236573, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756595

RESUMO

BACKGROUND: South Asians are one of the fastest growing ethnic groups in western countries with a high incidence of chronic diseases like metabolic syndrome and cardiovascular disease occurring at younger ages and lower body weight compared with white Europeans. Physically active lifestyle and reduced sedentary time are modifiable risk factors that can decrease burden of chronic diseases. Population-level surveys based on self-report show South Asians engage in low levels of physical activity. Because of known limitations with self-report data, we aimed to synthesize available evidence to generate a physical activity /sedentary time profile of South Asians from studies using accelerometry. METHODS: We systematically searched Medline, EMBASE, CINAHL, PsycINFO, and SportDiscus. We included studies applying accelerometry to measure physical activity /sedentary time under free-living. Studies with an exclusive focus on drugs or including participants with health conditions/physical disability, and special populations (athletes/pregnant women) were excluded. Two authors independently adjudicated inclusion of citations at title/abstract and full text. We applied a standardized data abstraction form to extract relevant data. We evaluated methodological quality using Newcastle Ottawa Quality Assessment Scale. Due to variability and inconsistencies in measurement and reporting of physical activity /sedentary time, we only provide a narrative synthesis. FINDINGS: We identified only 14 studies(n = 1,338). Despite using similar accelerometry assumptions, we noted variability in reported outcomes for physical activity and sedentary time. Sedentary time ranged from 482(98) to 587 min/day. Mean light physical activity ranged from 211.69(67. 38) to 574(227) min/day. Moderate to vigorous physical activity among South Asian women ranged from 17-41 min/day and among men, 32-43 min/day. CONCLUSION: South Asians exhibited higher levels of physical activity when compared to the Canadian population level survey but not when compared to the American population level survey. Overall, fewer studies, and small sample sizes led to considerable variability limiting any effective comparisons. Results highlight the importance of conducting methodologically robust studies based on random sampling to advance the field, and to capture true levels of sedentary time and physical activity in the South Asian population.


Assuntos
Acelerometria/métodos , Doença Crônica/prevenção & controle , Exercício Físico/fisiologia , Comportamento Sedentário , Adulto , Grupo com Ancestrais do Continente Asiático , Atletas , Canadá/epidemiologia , Doença Crônica/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Estilo de Vida , Masculino , Gravidez , Fatores de Risco , Autorrelato
13.
Int J Behav Nutr Phys Act ; 17(1): 99, 2020 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771018

RESUMO

BACKGROUND: Technological progress has enabled the provision of personalised feedback across multiple dimensions of physical activity that are important for health. Whether this multidimensional approach supports physical activity behaviour change has not yet been examined. Our objective was to examine the effectiveness of a novel digital system and app that provided multidimensional physical activity feedback combined with health trainer support in primary care patients identified as at risk of chronic disease. METHODS: MIPACT was a parallel-group, randomised controlled trial that recruited patients at medium (≥10 and < 20%) or high (≥20%) risk of cardiovascular disease and/or type II diabetes from six primary care practices in the United Kingdom. Intervention group participants (n = 120) received personal multidimensional physical activity feedback using a customised digital system and web-app for 3 months plus five health trainer-led sessions. All participants received standardised information regarding physical activity. Control group participants (n = 84) received no further intervention. The primary outcome was device-based assessment of physical activity at 12 months. RESULTS: Mean intervention effects were: moderate-vigorous physical activity: -1.1 (95% CI, - 17.9 to 15.7) min/day; moderate-vigorous physical activity in ≥10-min bouts: 0.2 (- 14.2 to 14.6) min/day; Physical Activity Level (PAL): 0.00 (- 0.036 to 0.054); vigorous physical activity: 1.8 (- 0.8 to 4.2) min/day; and sedentary time: 10 (- 19.3 to 39.3) min/day. For all of these outcomes, the results showed that the groups were practically equivalent and statistically ruled out meaningful positive or negative effects (>minimum clinically important difference, MCID). However, there was profound physical activity multidimensionality, and only a small proportion (5%) of patients had consistently low physical activity across all dimensions. CONCLUSION: In patients at risk of cardiovascular disease and/or type II diabetes, MIPACT did not increase mean physical activity. Using a sophisticated multidimensional digital approach revealed enormous heterogeneity in baseline physical activity in primary care patients, and practitioners may need to screen for low physical activity across dimensions rather than rely on disease-risk algorithms that are heavily influenced by age. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry ( ISRCTN18008011 ; registration date 31 July 2013).


Assuntos
Biorretroalimentação Psicológica , Tecnologia Biomédica/instrumentação , Exercício Físico , Doenças Cardiovasculares/prevenção & controle , Doença Crônica/prevenção & controle , Diabetes Mellitus Tipo 2/prevenção & controle , Metabolismo Energético , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Monitorização Ambulatorial/métodos , Motivação , Reino Unido/epidemiologia , Dispositivos Eletrônicos Vestíveis
15.
Medicine (Baltimore) ; 99(28): e20884, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664080

RESUMO

The objective of this work is to verify the relationship between the self-perception of health and the self-concept of physical appearance in adolescents, in order to check their influence on the physical activity they perform with the aim of preventing chronic illnesses. To this end, an observational, cross-sectional descriptive study with analytical components was carried out. Opportunistic activity, in which young people, between the ages of 16 and 22, were recruited from 5 secondary schools of the municipality of San Cristóbal de La Laguna, on the island of Tenerife (Spain). Data were collected through the General Health Questionnaire, the Rosemberg Self-esteem Scale, and the physical exercise habits test physical activity questionnaire for adolescents-A, revealing the first 2 that most percentage of responses were grouped on the positive side. The physical exercise habits test physical activity questionnaire for adolescents-A described that the most commonly performed physical activity was walking (75%).


Assuntos
Doença Crônica/prevenção & controle , Exercício Físico/psicologia , Aparência Física/fisiologia , Adolescente , Atitude Frente a Saúde , Doença Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Autoimagem , Espanha/epidemiologia , Inquéritos e Questionários , Caminhada/fisiologia , Caminhada/estatística & dados numéricos , Adulto Jovem
16.
BMC Fam Pract ; 21(1): 147, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698768

RESUMO

BACKGROUND: Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. METHOD: This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors. RESULT: A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = - 0.284, P = 0.007), implement (b = - 0.292, P = 0.004), and maintain (b = - 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = - 0.150, P = 0.047), implementation (b = - 0.171, P = 0.029), and maintenance (b = - 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university. CONCLUSIONS: This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.


Assuntos
Atitude do Pessoal de Saúde , Doença Crônica/prevenção & controle , Tomada de Decisão Clínica , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Adulto , China , Centros Comunitários de Saúde , Estudos Transversais , Feminino , Humanos , Ciência da Implementação , Renda , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Percepção
17.
Nat Rev Endocrinol ; 16(9): 495-505, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32632275

RESUMO

Exercise is fundamental for good health, whereas physical inactivity underpins many chronic diseases of modern society. It is well appreciated that regular exercise improves metabolism and the metabolic phenotype in a number of tissues. The phenotypic alterations observed in skeletal muscle are partly mediated by transcriptional responses that occur following each individual bout of exercise. This adaptive response increases oxidative capacity and influences the function of myokines and extracellular vesicles that signal to other tissues. Our understanding of the epigenetic and transcriptional mechanisms that mediate the skeletal muscle gene expression response to exercise as well as of their upstream signalling pathways has advanced substantially in the past 10 years. With this knowledge also comes the opportunity to design new therapeutic strategies based on the biology of exercise for a variety of chronic conditions where regular exercise might be a challenge. This Review provides an overview of the beneficial adaptive responses to exercise and details the molecular mechanisms involved. The possibility of designing therapeutic interventions based on these molecular mechanisms is addressed, using relevant examples that have exploited this approach.


Assuntos
Doença Crônica/prevenção & controle , Exercício Físico/fisiologia , Promoção da Saúde , Proteínas Quinases Ativadas por AMP/metabolismo , Adaptação Fisiológica , Animais , Glândulas Endócrinas/fisiologia , Epigênese Genética , Expressão Gênica , Histona Desacetilases/metabolismo , Humanos , Músculo Esquelético/fisiologia , Condicionamento Físico Animal/fisiologia , Transdução de Sinais/fisiologia , Transcrição Genética/fisiologia
19.
BMC Public Health ; 20(1): 821, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487118

RESUMO

BACKGROUND: Epidemiological transition in high HIV-burden settings is resulting in a rise in HIV/NCD multimorbidity. The majority of NCD risk behaviours start during adolescence, making this an important target group for NCD prevention and multimorbidity prevention in adolescents with a chronic condition such as HIV. However, there is data paucity on NCD risk and prevention in adolescents with HIV in high HIV-burden settings. The aim of this study was to investigate the extent to which NCD comorbidity (prevention, diagnosis, and management) is incorporated within existing adolescent HIV primary healthcare services in Cape Town, South Africa. METHODS: We reviewed medical records of 491 adolescents and youth living with HIV (AYLHIV) aged 10-24 years across nine primary care facilities in Cape Town from November 2018-March 2019. Folders were systematically sampled from a master list of all AYLHIV per facility and information on HIV management and care, NCDs, NCD risk and NCD-related health promotion extracted. RESULTS: The median age was 20 years (IQR: 14-23); median age at ART initiation 18 years (IQR: 6-21) and median duration on ART 3 years (IQR: 1.1-8.9). Fifty five percent of participants had a documented comorbidity, of which 11% had an NCD diagnosis with chronic respiratory diseases (60%) and mental disorders (37%) most common. Of those with documented anthropometrics (62%), 48% were overweight or obese. Fifty nine percent of participants had a documented blood pressure, of which 27% were abnormal. Twenty-six percent had a documented health promoting intervention, 42% of which were NCD-related; ranging from alcohol or substance abuse (13%); smoking (9%); healthy weight or diet (9%) and mental health counselling (10%). CONCLUSIONS: Our study demonstrates limited NCD screening and health promotion in AYLHIV accessing healthcare services. Where documented, our data demonstrates existing NCD comorbidity and NCD risk factors highlighting a missed opportunity for multimorbidity prevention through NCD screening and health promotion. Addressing this missed opportunity requires an integrated health system and intersectoral action on upstream NCD determinants to turn the tide on the rising NCD and multimorbidity epidemic.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Programas de Rastreamento/organização & administração , Multimorbidade , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , Adolescente , Adulto , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Feminino , Humanos , Masculino , Fatores de Risco , África do Sul/epidemiologia , Adulto Jovem
20.
PLoS One ; 15(6): e0233565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484817

RESUMO

OBJECTIVE: Lifestyle is considered as a key factor that affects one's health and quality of life, and it has become the focus of increasing research interest worldwide. Research has shown that lifestyle is an important health determinant in preventive health care. However, lifestyle is a multifaceted construct and there is limited evidence regarding lifestyle assessment, which evaluates individuals' multi-domain lifestyle factors. This study developed evaluation items for measuring the multifaceted lifestyle profile of community-dwelling older adult to prevent chronic disease and improve their health and quality of life. METHODS: Opinions from 21 experts with experience in older adults and lifestyle research were collected from December 2019 to January 2020. Three Delphi surveys were carried out, based on previous research. The first survey gathered opinions using a mix of open- and closed-ended questions regarding items of the older adults' multifaceted lifestyle profile. The second was conducted after adding and modifying several items based on the first Delphi survey. In the third survey, after the results of the second one were presented to the expert panels, final opinions from the experts were converged. RESULTS: In total, 59 items were selected as the first Delphi results; 62 items were selected as the second results after adding and modifying the values below a content validity ratio of .42; and 62 items were selected as the third Delphi results. The average content validity ratio of the final Delphi survey was .92, the stability was .18, and the consensus was .80, which were all high. CONCLUSIONS: This study verified the content validity of the evaluation items for community-dwelling older adults' multifaceted lifestyle profile. In the future, it is expected that after verifying the validity and reliability, this will be used as a standardized assessment tool in clinical environments.


Assuntos
Doença Crônica/prevenção & controle , Avaliação Geriátrica/métodos , Estilo de Vida , Qualidade de Vida , Idoso , Consenso , Técnica Delfos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Vida Independente , Estudos Interdisciplinares , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos
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