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1.
Science ; 371(6530): 677-678, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33574200
2.
Infect Dis Poverty ; 10(1): 3, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397470

RESUMO

BACKGROUND: The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood. METHODS: Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis. RESULTS: A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties. CONCLUSIONS: The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19.


Assuntos
/mortalidade , Idoso , /virologia , Análise por Conglomerados , Feminino , Humanos , Masculino , Mortalidade , Pandemias , Prevalência , Saúde Pública , Fatores Raciais , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Estatísticas não Paramétricas , Estados Unidos/epidemiologia
3.
PLoS One ; 15(10): e0238871, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33021978

RESUMO

BACKGROUND: Age-period-cohort (APC) models are often used to decompose health trends into period- and cohort-based sources, but their use in epidemiology and population sciences remains contentious. Central to the contention are researchers' failures to 1) clearly state their analytic assumptions and/or 2) thoroughly evaluate model results. These failures often produce varying conclusions across APC studies and generate confusion about APC methods. Consequently, scholarly exchanges about APC methods usually result in strong disagreements that rarely offer practical advice to users or readers of APC methods. METHODS: We use research guidelines to help practitioners of APC methods articulate their analytic assumptions and validate their results. To demonstrate the usefulness of the guidelines, we apply them to a 2015 American Journal of Epidemiology study about trends in black-white differences in U.S. heart disease mortality. RESULTS: The application of the guidelines highlights two important findings. On the one hand, some APC methods produce inconsistent results that are highly sensitive to researcher manipulation. On the other hand, other APC methods estimate results that are robust to researcher manipulation and consistent across APC models. CONCLUSIONS: The exercise shows the simplicity and effectiveness of the guidelines in resolving disagreements over APC results. The cautious use of APC models can generate results that are consistent across methods and robust to researcher manipulation. If followed, the guidelines can likely reduce the chance of publishing variable and conflicting results across APC studies.


Assuntos
Estudos de Coortes , Modelos Estatísticos , Projetos de Pesquisa , Adulto , Afro-Americanos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Projetos de Pesquisa Epidemiológica , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores Raciais/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Estados Unidos/epidemiologia
5.
RECIIS (Online) ; 14(3): 681-691, jul.-set. 2020.
Artigo em Português | LILACS | ID: biblio-1121856

RESUMO

A doença falciforme é a afecção genética mais prevalente no Brasil; de acordo com o Programa Nacional de Triagem Neonatal (PNTN), nascem cerca de 3.500 (três mil e quinhentas) crianças por ano com hemoglobina S, uma das responsáveis pela doença, ou seja, 1/1.000 nascidos vivos no Brasil. Considerando o grau de sua incidência, é necessário observar o acesso à saúde possibilitado aos portadores dessa enfermidade, devendose analisar as dificuldades que afligem esse segmento populacional e a efetividade das políticas públicas existentes para enfrentamento dessa hemoglobinopatia. Por meio de metodologia descritiva e explicativa, constatou-se que o segmento social acometido por essa doença se encontra historicamente associado aos afrodescendentes, dada sua origem mutante no continente africano em resposta à disseminação da malária, fato que conjuga a enfermidade com os fatores raciais de discriminação histórica da população negra. A falciforme foi utilizada, em certos casos, como fundamento para exclusão dos negros da sociedade, como argumento para segregação racial nos Estados Unidos e como fundamento para ideia de embranquecimento da população brasileira.


Sickle cell disease is the most prevalent genetic disorder in Brazil; according to the PNTN ­ Programa Nacional de Triagem Neonatal (National Neonatal Screening Program), approximately 3,500 (three thousand, five hundred) babies with haemoglobin disorders are born each year that is to say 1/1,000 live-born in Brazil. Since the high degree of its incidence, it is necessary to observe how the access to the health is given to patients with this disease, and the difficulties that afflict this population segment and the effectiveness of existing public policies to confront this kind of genetic hemoglobinopath should be analyzed. Through descriptive and explanatory methodology, it was found that the social segment affected by this disease is historically associated with people of African descent, due to its mutant origin in the African continent in response to the spread of malaria, fact that combines the disease with the factors of historical discrimination against the Black population. Sickle cell disease, in certain cases, was used as a basis for exclusion of Black people from society, as an argument for racial segregation in the United States and as a basis for the idea of whitening the Brazilian population.


La anemia de células falciformes es el trastorno genético que prevalece en Brasil; según el PNTN ­ Programa Nacional de Triagem Neonatal (Programa Nacional de Detección Neonatal), aproximadamente 3 500 (tres mil quinientos) niños nacen por año con una alteración de la sangre que causa esa enfermedad, o sea 1/1.000 nacidos vivos en Brasil. Teniendo en cuenta el grado de su incidencia, es necesario observar el acceso a la salud posibilitado a los portadores de la enfermedad, y se deben analizar las dificultades que afligen ese segmento de la población y la efectividad de las políticas públicas existentes para enfrentar esa hemoglobinoptía genética. A través de una metodología descriptiva y explicativa, se descubrió que el segmento social afectado por la enfermedad está históricamente asociado con los afrodescendientes, debido a su origen cambiante en el continente africano en respuesta a la propagación de la malaria, un hecho que combina la enfermedad con los factores de discriminación histórica de la población negra. La célula falciforme, en ciertos casos, ha sido utilizada como base para la exclusión de los negros de la sociedad, como argumento para la segregación racial en los Estados Unidos y como base para la idea de blanquear la población brasileña.


Assuntos
Humanos , Hemoglobina Falciforme , Grupo com Ancestrais do Continente Africano , Nascimento Vivo , Fatores Raciais , Anemia Falciforme , Política Pública , Brasil , Direito à Saúde , Programas Nacionais de Saúde
6.
J Stroke Cerebrovasc Dis ; 29(9): 104954, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807414

RESUMO

BACKGROUND/PURPOSE: Racial/ethnic and sex disparity may occur in stroke throughout the continuum of care. Endovascular therapy (EVT) became standard of care in 2015 for eligible patients with acute ischemic stroke (AIS). We evaluated for racial and sex differences in t-PA and EVT utilization and outcomes in 2016 in the National Inpatient Sample. METHODS: Treatment rates for t-PA, EVT, and t-PA+EVT and outcomes including home discharge, in-hospital mortality and prolonged length of stay (pLOS) were evaluated by sex and race. Multivariate survey-logistic regression was performed to evaluate outcomes. RESULTS: The study had 468,630 patients - 49.3% men, 50.7% women; 69.3% whites, and 30.7% non-whites. There was no difference in treatment utilization by sex, women vs men for t-PA (7.65% vs 7.76%; aOR:1.02; 95% CI:0.97-1.07), EVT (1.74% vs 1.67%; aOR:1.09; 95% CI:0.99-1.20) and t-PA+EVT (0.57% vs 0.57%; aOR:1.01; 95% CI:0.85-1.21); and by race, non-white vs white for t-PA (7.62% vs 7.74%; aOR:0.98; 95% CI:0.93-1.05), EVT (1.62% vs 1.74%; aOR:0.91; 95% CI:0.78-1.07), and t-PA+EVT(0.59% vs 0.56%; aOR:1.05; 95% CI:0.84-1.30). Compared to men, women treated with t-PA had less home discharge (37.2% vs 46.3%; aOR:0.81; 95% CI:0.72-0.90), more in-hospital mortality (5.7% vs 3.9%; aOR:1.37; 95% CI:1.06-1.77) and less pLOS (8.3% vs 9.6%; aOR:0.82; 95% CI:0.69-0.98); women treated with EVT had less home discharge (15.8% vs 23.7%; aOR:0.69; 95% CI:0.52-0.91). Compared to whites, non-whites treated with t-PA had lower odds of home discharge (42.1% vs 41.6%; aOR:0.79; 95% CI:0.69-0.90), less in-hospital mortality (3.7% vs 5.3%; aOR:0.65; 95% CI:0.49-0.87), and higher pLOS (11.4% vs 7.9%; aOR:1.3; 95% CI:1.07-1.56); non-whites treated with EVT had less home discharge (18%vs 20.2%; aOR:0.70; 95% CI:0.51-0.97) and higher pLOS (35.1% vs 24%; aOR:1.52; 95% CI:1.16-1.99). CONCLUSION: Sex and racial disparity exists for outcomes of t-PA and EVT despite no difference in utilization rates.


Assuntos
Isquemia Encefálica/terapia , Fibrinolíticos/administração & dosagem , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Acidente Vascular Cerebral/terapia , Trombectomia/tendências , Terapia Trombolítica/tendências , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , Isquemia Encefálica/mortalidade , Bases de Dados Factuais , Feminino , Fibrinolíticos/efeitos adversos , Disparidades em Assistência à Saúde/etnologia , Mortalidade Hospitalar/tendências , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Complicações Pós-Operatórias/etnologia , Prevalência , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/mortalidade , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
BMJ Open ; 10(8): e039849, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784264

RESUMO

INTRODUCTION: Data on race and ethnic disparities for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We analysed sociodemographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race and ethnic disparities in the SARS-CoV-2 pandemic. METHODS: This is a cross-sectional analysis of the COVID-19 Surveillance and Outcomes Registry, which captures data for a large healthcare system, comprising one central tertiary care hospital, seven large community hospitals and an expansive ambulatory/emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analysed sociodemographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (Charlson Comorbidity Index, hypertension, diabetes, obesity) factors. Multivariable logistic regression models were fitted to provide adjusted OR (aOR) and 95% CI for likelihood of a positive SARS-CoV-2 test. Structural equation modelling (SEM) framework was used to explore three mediation pathways (low income, high population density, high comorbidity burden) for the association between non-Hispanic black (NHB) race, Hispanic ethnicity and SARS-CoV-2 infection. RESULTS: Among 20 228 tested individuals, 1551 (7.7%) tested positive. The overall mean (SD) age was 51.1 (19.0) years, 62% were females, 22% were black and 18% were Hispanic. NHB and Hispanic ethnicity were associated with lower socioeconomic status and higher population density residence. In the fully adjusted model, NHB (vs non-Hispanic white; aOR, 2.23, CI 1.90 to 2.60) and Hispanic ethnicity (vs non-Hispanic; aOR, 1.95, CI 1.72 to 2.20) had a higher likelihood of infection. Older individuals and males were also at higher risk of infection. The SEM framework demonstrated a significant indirect effect of NHB and Hispanic ethnicity on SARS-CoV-2 infection mediated via a pathway including residence in densely populated zip code. CONCLUSIONS: There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic that are potentially mediated through unique social determinants of health.


Assuntos
Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Pandemias , Pneumonia Viral/etnologia , Fatores Raciais , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Betacoronavirus , Comorbidade , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Densidade Demográfica , Vigilância da População , Sistema de Registros , Fatores Socioeconômicos , Texas/epidemiologia
8.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32759379

RESUMO

OBJECTIVES: To evaluate racial and/or ethnic and socioeconomic differences in rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children. METHODS: We performed a cross-sectional study of children tested for SARS-CoV-2 at an exclusively pediatric drive-through and walk-up SARS-CoV-2 testing site from March 21, 2020, to April 28, 2020. We performed bivariable and multivariable logistic regression to measure the association of patient race and/or ethnicity and estimated median family income (based on census block group estimates) with (1) SARS-CoV-2 infection and (2) reported exposure to SARS-CoV-2. RESULTS: Of 1000 children tested for SARS-CoV-2 infection, 20.7% tested positive for SARS-CoV-2. In comparison with non-Hispanic white children (7.3%), minority children had higher rates of infection (non-Hispanic Black: 30.0%, adjusted odds ratio [aOR] 2.3 [95% confidence interval (CI) 1.2-4.4]; Hispanic: 46.4%, aOR 6.3 [95% CI 3.3-11.9]). In comparison with children in the highest median family income quartile (8.7%), infection rates were higher among children in quartile 3 (23.7%; aOR 2.6 [95% CI 1.4-4.9]), quartile 2 (27.1%; aOR 2.3 [95% CI 1.2-4.3]), and quartile 1 (37.7%; aOR 2.4 [95% CI 1.3-4.6]). Rates of reported exposure to SARS-CoV-2 also differed by race and/or ethnicity and socioeconomic status. CONCLUSIONS: In this large cohort of children tested for SARS-CoV-2 through a community-based testing site, racial and/or ethnic minorities and socioeconomically disadvantaged children carry the highest burden of infection. Understanding and addressing the causes of these differences are needed to mitigate disparities and limit the spread of infection.


Assuntos
Infecções por Coronavirus/etnologia , Epidemias , Pneumonia Viral/etnologia , Fatores Raciais/estatística & dados numéricos , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
10.
Int J Cardiovasc Imaging ; 36(11): 2139-2144, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32767023

RESUMO

Use of echocardiography to evaluate the characteristics of right heart and pulmonary artery of Tibetans with hepatic hydatidosis living in a high plateau area. We recruited 222 Tibetan adults diagnosed with hydatidosis from June 2016 to June 2017 in Shiqu and Seda areas of Tibet; 40 healthy control from the same area, denoted as the high plateau group. We also include 755 Healthy adults of Han nationality living in the plain from the EMINCA study as the low altitude group. Compared to high plateau group, hydatidosis individuals showed decreased RVADed, RVTDed, increased E(T)/A(T) and reduced RVFAC and TAPSE (p < 0.05). The 2 groups did not differ in the incidence rate of tricuspid regurgitation (TR) and pulmonary regurgitation (PR) (63.9% vs. 55.0%, p = 0.281 and 15.3% vs. 5.0%, p = 0.135, respectively) or incidence of pulmonary hypertension (PH) (13.9% vs. 20.5%, p = 0.167). PH risk did not differ between hydatidosis individuals and high plateau controls (OR 0.559, 95% CI 0.243-1.287). The RVADed and TAPSE were higher and E(T)/A(T) was lower for high plateau group than low altitude group (p < 0.05). The decreased right ventricular size and reduced diastolic and systolic function were found in Tibetans with hydatidosis. Hepatic hydatidosis had no significant effect on the incidence of pulmonary hypertension in Tibetans. Healthy Tibetans showed increased right ventricular size, decreased diastolic function, and increased systolic function compared to the Han counterparts.


Assuntos
Aclimatação , Altitude , Equinococose Hepática/diagnóstico , Ecocardiografia Doppler em Cores , Hipertensão Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Pressão Arterial , Grupo com Ancestrais do Continente Asiático , Cateterismo Cardíaco , Estudos de Casos e Controles , Equinococose Hepática/etnologia , Equinococose Hepática/fisiopatologia , Feminino , Humanos , Hipertensão Pulmonar/etnologia , Hipertensão Pulmonar/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores Raciais , Tibet/epidemiologia , Função Ventricular Direita , Remodelação Ventricular , Adulto Jovem
12.
Curr Atheroscler Rep ; 22(9): 48, 2020 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-32710255

RESUMO

PURPOSE OF REVIEW: The COVID-19 pandemic has infected over > 11 million as of today people worldwide and is associated with significant cardiovascular manifestations, particularly in subjects with preexisting comorbidities and cardiovascular risk factors. Recently, a predisposition for arterial and venous thromboses has been reported in COVID-19 infection. We hypothesize that besides conventional risk factors, subjects with elevated lipoprotein(a) (Lp(a)) may have a particularly high risk of developing cardiovascular complications. RECENT FINDINGS: The Lp(a) molecule has the propensity for inhibiting endogenous fibrinolysis through its apolipoprotein(a) component and for enhancing proinflammatory effects such as through its content of oxidized phospholipids. The LPA gene contains an interleukin-6 (IL-6) response element that may induce an acute phase-type increase in Lp(a) levels following a cytokine storm from COVID-19. Thus, subjects with either baseline elevated Lp(a) or those who have an increase following COVID-19 infection, or both, may be at very high risk of developing thromboses. Elevated Lp(a) may also lead to acute destabilization of preexisting but quiescent atherosclerotic plaques, which might induce acute myocardial infarction and stroke. Ongoing studies with IL-6 antagonists may be informative in understanding this relationship, and registries are being initiated to measure Lp(a) in subjects infected with COVID-19. If indeed an association is suggestive of being causal, consideration can be given to systematic testing of Lp(a) and prophylactic systemic anticoagulation in infected inpatients. Therapeutic lipid apheresis and pharmacotherapy for the reduction of Lp(a) levels may minimize thrombogenic potential and proinflammatory effects. We propose studies to test the hypothesis that Lp(a) may contribute to cardiovascular complications of COVID-19.


Assuntos
Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Inflamação/etiologia , Lipoproteína(a)/sangue , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Trombose/etiologia , Proteínas da Fase Aguda/análise , Proteínas da Fase Aguda/genética , Anticoagulantes/uso terapêutico , Apolipoproteína E4/genética , Aterosclerose/etiologia , Betacoronavirus , Biomarcadores/sangue , Pesquisa Biomédica , Remoção de Componentes Sanguíneos , Grupos de Populações Continentais/genética , Infecções por Coronavirus/epidemiologia , Genótipo , Humanos , Inflamação/prevenção & controle , Interleucina-6/antagonistas & inibidores , Interleucina-6/sangue , Lipoproteína(a)/genética , Pandemias , Pneumonia Viral/epidemiologia , Fatores Raciais , Fatores de Risco , Índice de Gravidade de Doença , Trombose/prevenção & controle
13.
J Stroke Cerebrovasc Dis ; 29(8): 104987, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689593

RESUMO

BACKGROUND AND PURPOSE: Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. METHODS: Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal-Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). RESULTS: Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65-3.15), CHF (OR 2.17, 1.06-4.46), and DM II 1.92 (1.25-2.94) while HIS had higher odds of DM II (OR 2.52, 1.55-4.10) and lower odds of smoking (OR 0.56, 0.35-0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31-0.78)) and HIS (OR 0.37 CI (0.21-0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. CONCLUSIONS: In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.


Assuntos
Afro-Americanos , Isquemia Encefálica/etnologia , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Hispano-Americanos , Acidente Vascular Cerebral/etnologia , Adolescente , Adulto , Fatores Etários , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Avaliação da Deficiência , Feminino , Humanos , Hipertensão/etnologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores Raciais , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Texas/epidemiologia , Fatores de Tempo , Adulto Jovem
14.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32690805

RESUMO

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.


Assuntos
Preservativos Femininos , Preservativos , Comportamento Sexual , Adolescente , Fatores Etários , Preservativos/estatística & dados numéricos , Preservativos Femininos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interpessoais , Profilaxia Pré-Exposição , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Gravidez não Planejada , Fatores Raciais , Sexo Seguro , Autoimagem , Educação Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Apoio Social
15.
Medicine (Baltimore) ; 99(27): e20913, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629686

RESUMO

BACKGROUND: Novel coronavirus pneumonia (COVID-19) is a very serious and urgent infectious disease. With the development of global economy and the improvement of living standard, the incidence of diabetes is increasing year by year. And it is more common in the elderly. COVID-19 is associated with much chronic disease, especially diabetes. At present, there is no systematic review and meta-analysis of mortality based on large scale of data between diabetes and COVID-19 all over the world. METHODS AND ANALYSIS: The databases of PubMed, the Cochrane Library, EMBASE, Wanfang Data, China National Knowledge Infrastructure database (CNKI) and VIP were searched by computer, and the researches related to diabetes mellitus and mortality of COVID-19 were collected. The searching time was from the establishment of the database to April 30 2020. The meta-analysis was carried out by Review Manager Version 5.3 and stata 14.0 software for Mac software after 2 researchers independently selected literature, extracted data and evaluated the bias risk. The main outcome was the mortality of COVID-19 which was included in meta-analysis and subgroup analysis. The bias of the study was evaluated independently by NOS scale, and published by funnel chart. The sensitivity was analyzed row by row. RESULTS: The results will be published at a peer-reviewed journal.Registration number: INPLASY202040158.


Assuntos
Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Pneumonia Viral/mortalidade , Fatores Etários , Betacoronavirus , Glicemia/metabolismo , Proteína C-Reativa/metabolismo , Comorbidade , Infecções por Coronavirus/complicações , Complicações do Diabetes , Diabetes Mellitus/sangue , Hemoglobina A Glicada/metabolismo , Humanos , Metanálise como Assunto , Pandemias , Pneumonia Viral/complicações , Fatores Raciais , Índice de Gravidade de Doença , Fatores Sexuais , Revisões Sistemáticas como Assunto
17.
J Public Health (Oxf) ; 42(3): 470-478, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32490519

RESUMO

BACKGROUND: Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. METHODS: We analyzed data from 1216 adults in the March 2020 Kaiser Family Foundation 'Coronavirus Poll', to determine levels of KAPs across different groups. Univariate and multivariate regression analysis was used to identify predictors of KAPs. RESULTS: In contrast to White respondents, Non-White respondents were more likely to have low knowledge (58% versus 30%; P < 0.001) and low attitude scores (52% versus 27%; P < 0.001), but high practice scores (81% versus 59%; P < 0.001). By multivariate regression, White race (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.70-5.50), higher level of education (OR 1.80; 95% CI: 1.46-2.23) and higher income (OR 2.06; 95% CI: 1.58-2.70) were associated with high knowledge of COVID-19. Race, sex, education, income, health insurance status and political views were all associated with KAPs. CONCLUSIONS: Racial and socioeconomic disparity exists in the levels of KAPs related to COVID-19. More work is needed to identify educational tools that tailor to specific racial and socioeconomic groups.


Assuntos
Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Infecções por Coronavirus/psicologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Fatores Raciais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
Am J Physiol Heart Circ Physiol ; 319(2): H271-H281, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32559139

RESUMO

The purpose of this study was to investigate the effect of race and subclinical elevations in blood pressure (i.e., prehypertension) on cutaneous sensory nerve-mediated and nitric oxide (NO)-dependent vasodilation. We recruited participants who self-identified as either non-Hispanic black (n = 16) or non-Hispanic white (n = 16). Within each group, participants were subdivided as either normotensive (n = 8 per group) or prehypertensive (n = 8 per group). Each participant was instrumented with four intradermal microdialysis fibers: 1) control (lactated Ringer's), 2) 5% lidocaine (sensory nerve inhibition), 3) 20 mM Nω-nitro-l-arginine methyl ester (l-NAME) (NO synthase inhibition), and 4) lidocaine + l-NAME. Skin blood flow was assessed via laser-Doppler flowmetry, and each site underwent local heating from 33°C to 39°C. At the plateau, 20 mM l-NAME were infused at control and lidocaine sites to quantify NO-dependent vasodilation. Maximal vasodilation was induced via 54 mM sodium nitroprusside and local heating to 43°C. Data are means ± SD. Sensory nerve-mediated cutaneous vasodilation was reduced in prehypertensive non-Hispanic white (34 ± 7%) and both non-Hispanic black groups (normotensive, 20 ± 9%, prehypertensive, 24 ± 15%) relative to normotensive non-Hispanic whites (54 ± 12%). NO-dependent vasodilation was also reduced in prehypertensive non-Hispanic white (41 ± 7%) and both non-Hispanic black groups (normotensive, 44 ± 7%, prehypertensive, 19 ± 7%) relative to normotensive non-Hispanic whites (60 ± 11%). The decrease in NO-dependent vasodilation in prehypertensive non-Hispanic blacks was further reduced relative to all other groups. These data suggest subclinical increases in blood pressure adversely affect sensory-mediated and NO-dependent vasodilation in both non-Hispanic blacks and whites.NEW & NOTEWORTHY Overt hypertension is known to reduce cutaneous sensory nerve-mediated and nitric oxide (NO)-dependent vasodilation, but the effect of subclinical increases in blood pressure (i.e., prehypertension) is unknown. The combined effect of race and prehypertension is also unknown. In this study, we found that prehypertension reduces cutaneous sensory nerve-mediated and NO-dependent vasodilation in both non-Hispanic white and black populations, with the greatest reductions observed in prehypertensive non-Hispanic blacks.


Assuntos
Pressão Sanguínea , Vasos Sanguíneos/inervação , Vasos Sanguíneos/metabolismo , Células Endoteliais/metabolismo , Óxido Nítrico/metabolismo , Pré-Hipertensão/fisiopatologia , Células Receptoras Sensoriais , Pele/irrigação sanguínea , Vasodilatação , Administração Cutânea , Adolescente , Adulto , Afro-Americanos , Anestésicos Locais/administração & dosagem , Vasos Sanguíneos/efeitos dos fármacos , Estudos de Casos e Controles , Células Endoteliais/efeitos dos fármacos , Inibidores Enzimáticos/administração & dosagem , Grupo com Ancestrais do Continente Europeu , Feminino , Georgia/epidemiologia , Humanos , Masculino , Microdiálise , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico Sintase/metabolismo , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/etnologia , Pré-Hipertensão/metabolismo , Fatores Raciais , Células Receptoras Sensoriais/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Adulto Jovem
19.
Head Neck ; 42(7): 1555-1559, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32562325

RESUMO

The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Pneumonia Viral/epidemiologia , Coleta de Dados , Neoplasias de Cabeça e Pescoço/epidemiologia , Prioridades em Saúde , Humanos , Cobertura do Seguro , Seguro Saúde , Pandemias , Fatores Raciais , Medição de Risco , Telemedicina , Triagem , Desemprego , Estados Unidos/epidemiologia
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