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1.
Multimedia | Recursos Multimídia | ID: multimedia-9689

RESUMO

Com o objetivo de apoiar a prática do cuidado individual na Atenção Primária à Saúde, o Ministério da Saúde vêm desenvolvendo uma série de iniciativas para a qualificação do pré-natal e produziu um fascículo do Protocolo de Uso do Guia Alimentar para a População Brasileira na Orientação Alimentar de Gestantes. Nessa fase é particularmente relevante o consumo de uma grande variedade de alimentos in natura e minimamente processados além de muita água, para suprir a necessidade de nutrientes fundamentais para esse evento da vida. A alimentação saudável na gestação favorece o bom desenvolvimento fetal, a saúde e o bem-estar da gestante, além de prevenir o surgimento de agravos, como diabetes gestacional, hipertensão e ganho de peso excessivo. Para uma orientação alimentar mais adequada, é essencial que o profissional de saúde esteja atento a aspectos relacionados à vulnerabilidade social e renda, à rede de apoio, à idade da gestante e às condições de trabalho da pessoa gestante atendida. Outros fatores que necessitam de atenção no período gestacional são as alterações fisiológicas e sintomatologias que podem influenciar o consumo alimentar nesse evento da vida. Além disso, o acompanhamento do cenário alimentar e nutricional realizado por meio das consultas de pré-natal e acompanhamento do ganho de peso é uma ação preventiva de agravos relacionados à má nutrição e a curva de ganho de peso gestacional, disponível na caderneta de saúde da gestante é uma importante ferramenta na rotina de trabalho dos profissionais e equipes de saúde.


Assuntos
Atenção Primária à Saúde/estatística & dados numéricos , Guias Alimentares , Alimentos para Gestantes e Nutrizes , Dieta Saudável , Serviços de Saúde Materno-Infantil/normas , Segurança Alimentar , Sistemas Locais de Saúde , Desnutrição/prevenção & controle , Manejo da Obesidade/provisão & distribuição , Sobrepeso/prevenção & controle , Fatores Raciais , Cuidado Pré-Natal , Cuidado Pós-Natal , Ácido Fólico/uso terapêutico , Suplementos Nutricionais , Insegurança Alimentar , Brasil , Promoção da Saúde , Exercício Físico
2.
Front Public Health ; 10: 859113, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685754

RESUMO

Objective: Real-world data characterizing differences between African American (AA) and White women with metastatic triple-negative breast cancer (mTNBC) are limited. Using 9 years of data collected from community practices throughout the United States, we assessed racial differences in the proportion of patients with mTNBC, and their characteristics, treatment, and overall survival (OS). Methods: This retrospective study analyzed de-identified data from 2,116 patients with mTNBC in the Flatiron Health database (January 2011 to March 2020). Characteristics and treatment patterns between AA and White patients with mTNBC were compared using descriptive statistics. OS was examined using Kaplan-Meier analysis and a multivariate Cox proportional hazards regression model. Results: Among patients with metastatic breast cancer, more AA patients (23%) had mTNBC than White patients (12%). This difference was particularly pronounced in patients who lived in the Northeast, were aged 45-65, had commercial insurance, and had initial diagnosis at stage II. AA patients were younger and more likely to have Medicaid. Clinical characteristics and first-line treatments were similar between AA and White patients. Unadjusted median OS (months) was shorter in AA (10.3; 95% confidence interval [CI]: 9.1, 11.7) vs. White patients (11.9; 95% CI: 10.9, 12.8) but not significantly different. After adjusting for potential confounders, the hazard ratio for OS was 1.09 (95% CI: 0.95, 1.25) for AA vs. White patients. Conclusions: The proportion of patients with mTNBC was higher in AA than White mBC patients treated in community practices. Race did not show an association with OS. Both AA and White patients with mTNBC received similar treatments. OS was similarly poor in both groups, particularly in patients who had not received any documented anti-cancer treatment. Effective treatment remains a substantial unmet need for all patients with mTNBC.


Assuntos
Neoplasias de Mama Triplo Negativas , Feminino , Humanos , Estimativa de Kaplan-Meier , Fatores Raciais , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Estados Unidos/epidemiologia
3.
PLoS One ; 17(6): e0268689, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35657918

RESUMO

Telomere length (TL) is widely studied as a possible biomarker for stress-related cellular aging and decreased longevity. There have been conflicting findings about the relationship between family caregiving stress and TL. Several initial cross-sectional studies have found associations between longer duration of caregiving or perceived stressfulness of caregiving and shortened TL, suggesting that caregiving poses grave risks to health. Previous reviews have suggested the need for longitudinal methods to investigate this topic. This study examined the association between the transition to family caregiving and change in TL across ~9 years. Data was utilized from the Caregiving Transitions Study, an ancillary study to the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. TL was assayed using qPCR and analyzed as the telomere-to-single copy gene ratio for each participant at baseline and follow-up. General linear models examined the association between caregiving status and the change in TL for 208 incident caregivers and 205 controls, as well as associations between perceived stress and TL among caregivers. No association was found between TL change and caregiving (p = 0.494), and fully adjusted models controlling for health and socioeconomic factors did not change the null relationship (p = 0.305). Among caregivers, no association was found between perceived caregiving stress and change in TL (p = 0.336). In contrast to earlier cross-sectional studies, this longitudinal, population-based study did not detect a significant relationship between the transition into a family caregiving role and changes in TL over time. Given the widespread citation of previous findings suggesting that caregiving shortens telomeres and places caregivers at risk of early mortality, these results demonstrate the potential need of a more balanced narrative about caregiving.


Assuntos
Acidente Vascular Cerebral , Encurtamento do Telômero , Estudos Transversais , Humanos , Fatores Raciais , Estresse Psicológico/genética , Acidente Vascular Cerebral/genética , Telômero/genética
4.
J Bone Joint Surg Am ; 104(11): 949-958, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35648063

RESUMO

BACKGROUND: There is a paucity of literature on racial differences across a full total joint arthroplasty (TJA) "episode of care" and beyond. Given various incentives, the Comprehensive Care for Joint Replacement (CJR) program in the U.S. may have impacted preexisting racial differences across this care continuum. The purposes of the present study were (1) to assess trends in racial differences in care/outcome characteristics before, during, and after TJA surgery and (2) to assess if the CJR program coincided with reductions in these racial differences. METHODS: This retrospective cohort study includes data on 1,483,221 TJAs (based on Medicare claims data, 2013 to 2018). Racial differences between Black and White patients were assessed for (1) preoperative characteristics (Deyo-Charlson comorbidity index, patient sex, and age), (2) characteristics during hospitalization (length of stay, blood transfusions, and combined complications), and (3) postoperative characteristics (90 and 180-day readmission rates and institutional post-acute care). Additionally, Medicare payments for each period were assessed. Racial differences (Black versus White patients) were expressed in terms of odds ratios (ORs) and 95% confidence intervals (CIs) per year. A "difference-in-differences" analysis (comparing before and after CJR implementation, with non-CJR hospitals being used as controls) estimated the association of the CJR program with changes in racial differences. RESULTS: In both 2013 and 2018, Black patients (n = 74,390; 5.0%) were more likely than White patients to have a higher Deyo-Charlson comorbidity index (score of >0) (OR = 1.32 [95% CI = 1.28 to 1.36] and OR = 1.32 [95% CI = 1.28 to 1.37]), to require more transfusions (OR = 1.55 [95% CI = 1.49 to 1.62] and OR = 1.77 [95% CI = 1.56 to 2.01]), to be discharged to institutional post-acute care (OR = 1.40 [95% CI = 1.36 to 1.44] and OR = 1.49 [95% CI = 1.43 to 1.56]), and to be readmitted within 90 days (OR = 1.38 [95% CI = 1.32 to 1.44] and OR = 1.21 [95% CI = 1.13 to 1.29]) (p < 0.05 for all). Adjusted difference-in-differences analyses demonstrated that the CJR program coincided with reductions in racial differences in 90-day readmission (-1.24%; 95% CI, -2.46% to -0.03%) and 180-day readmission (-1.28%; 95% CI, -2.52% to -0.03%) (p = 0.044 for both). CONCLUSIONS: Racial differences persist among patients managed with TJA. The CJR program coincided with reductions in some racial differences, thus identifying bundle design as a potential novel strategy to target racial disparities. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Idoso , Humanos , Medicare , Fatores Raciais , Estudos Retrospectivos , Estados Unidos
6.
Sleep ; 45(5)2022 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-35554593

RESUMO

STUDY OBJECTIVES: Insomnia is common among older adults and associated with an increased risk for falls. Determining if falls are more strongly associated with insomnia or prescribed hypnotic medications could be used to guide interventions to reduce falls risk. METHODS: We examined the prospective association of a diagnosis of insomnia and/or prescribed hypnotic medication use with the risk for serious fall injuries among 9087 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants aged 65 years or older with Medicare fee-for-service health insurance at baseline (2003-2007). A diagnosis of insomnia was based on ICD-9 codes in Medicare claims and prescribed hypnotic medication use was determined through a pill bottle review. Serious fall injuries were identified by Medicare claims between baseline and December 31, 2018. RESULTS: Over a median of 6.8 years, 1660 (18.3%) participants had a serious fall injury. The incidence rates for a serious fall injury per 1000 person-years were 24.8 (95%CI: 23.5, 26.1), 28.8 (95%CI: 18.6, 38.9), 32.6 (95%CI: 28.2, 37.0), and 46.6 (95%CI: 26.7, 66.5) for participants without insomnia or taking prescribed hypnotic medication (-insomnia/-hypnotics), with insomnia only (+insomnia/-hypnotics), taking prescribed hypnotic medication only (-insomnia/+hypnotics), and with insomnia and taking prescribed hypnotic medication (+insomnia/+hypnotics), respectively. Compared with the -insomnia/-hypnotic group, the multivariable-adjusted hazard ratios for a serious fall injury were 1.13 (95%CI: 0.79, 1.61), 1.29 (95%CI: 1.11, 1.50), and 1.60 (95%CI: 1.01, 2.56) for +insomnia/-hypnotics, -insomnia/+hypnotics, and +insomnia/+hypnotics, respectively. CONCLUSIONS: The risk for serious fall injuries was higher for those taking prescribed hypnotic medications but not with an insomnia diagnosis.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Acidente Vascular Cerebral , Acidentes por Quedas , Idoso , Humanos , Hipnóticos e Sedativos/efeitos adversos , Medicare , Fatores Raciais , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
7.
J Am Heart Assoc ; 11(10): e024199, 2022 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-35506534

RESUMO

Background Acute myocardial infarctions are increasingly common among young adults. We investigated sex and racial differences in the evaluation of chest pain (CP) among young adults presenting to the emergency department. Methods and Results Emergency department visits for adults aged 18 to 55 years presenting with CP were identified in the National Hospital Ambulatory Medical Care Survey 2014 to 2018, which uses stratified sampling to produce national estimates. We evaluated associations between sex, race, and CP management before and after multivariable adjustment. We identified 4152 records representing 29 730 145 visits for CP among young adults. Women were less likely than men to be triaged as emergent (19.1% versus 23.3%, respectively, P<0.001), to undergo electrocardiography (74.2% versus 78.8%, respectively, P=0.024), or to be admitted to the hospital or observation unit (12.4% versus 17.9%, respectively, P<0.001), but ordering of cardiac biomarkers was similar. After multivariable adjustment, men were seen more quickly (hazard ratio [HR], 1.15 [95% CI, 1.05-1.26]) and were more likely to be admitted (adjusted odds ratio, 1.40 [95% CI, 1.08-1.81]; P=0.011). People of color waited longer for physician evaluation (HR, 0.82 [95% CI, 0.73-0.93]; P<0.001) than White adults after multivariable adjustment, but there were no racial differences in hospital admission, triage level, electrocardiography, or cardiac biomarker testing. Acute myocardial infarction was diagnosed in 1.4% of adults in the emergency department and 6.5% of admitted adults. Conclusions Women and people of color with CP waited longer to be seen by physicians, independent of clinical features. Women were independently less likely to be admitted when presenting with CP. These differences could impact downstream treatment and outcomes.


Assuntos
Dor no Peito , Infarto do Miocárdio , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Fatores Raciais , Triagem/métodos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-35564878

RESUMO

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999-2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24-1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.


Assuntos
Alostase , Afro-Americanos , Escolaridade , Humanos , Masculino , Inquéritos Nutricionais , Fatores Raciais
9.
Am J Cardiol ; 175: 110-118, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35589425

RESUMO

As advancements in care improve longevity in patients with congenital heart disease (CHD), it is crucial to further characterize this rapidly growing adult population. It is also essential that equitable care is offered across demographic groups. Hospitalizations for adults with CHD in the National Inpatient Sample were identified to describe trends in overall and cause-specific rates of admission per 1,000 adults with CHD from 2000 to 2018. Primary admission causes were then analyzed and stratified by race. An aggregate rate of left-ventricular assist device placements and heart transplants was calculated for each group and trended over the years. A total of 1,562,001 weighted hospitalizations were identified. Overall, annual rates of hospital admissions increased from 39 per 1,000 adults with CHD in 2000 to 74 per 1,000 in 2018, as did rates of cardiovascular admissions (16 of 1,000 to 34 of 1,000, p <0.001 for both). Transient ischemic attack/stroke (2.5 of 1,000 to 10.7 of 1,000), coronary artery disease (4.1 of 1,000 to 5.6 of 1,000), arrhythmias (2.8 of 1,000 to 4.6 of 1,000), and heart failure (2.8 of 1,000 to 5.0 of 1,000) were the most common cardiovascular primary causes of admission (other than CHD itself), and each significantly increased over time (p <0.001 for each). Mean age at all-cause and primary heart failure hospitalization increased for all races but remained 7 to 9 years younger for Black and Hispanic adults than White adults. In conclusion, hospitalization rates of adults with CHD in the United States increased from 2000 to 2018, largely driven by an increase in adults ≥55 years. Although the age at hospitalization increased overall, Black and Hispanic patients were substantially younger at presentation for advanced heart failure. Anticoagulation guidelines in this population may need revisiting as transient ischemic attack/stroke hospitalizations were frequent.


Assuntos
Cardiopatias Congênitas , Insuficiência Cardíaca , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Cardiopatias Congênitas/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Fatores Raciais , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
10.
Prev Chronic Dis ; 19: E20, 2022 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-35446759

RESUMO

INTRODUCTION: The objective of this study was to describe how the relationship between waist circumference and incident coronary heart disease (CHD) is influenced by individual and neighborhood factors in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. METHODS: REGARDS is a cohort study of 30,239 US adults. The primary exposure was sex-specific quartiles of waist circumference. Individual covariates included sociodemographic characteristics, health status, health behavior, and usual source of care. Neighborhood (ie, zip code-level) covariates included access to primary care, poverty, rurality, and racial segregation. The main outcome was incident CHD from baseline (2003) through 2017. We used descriptive statistics, Kaplan-Meier curves, and Cox proportional hazard models to analyze the overall sample and race-sex subgroups. RESULTS: During the study period, 23,042 study participants had 1,499 CHD events. We found a higher risk of incident CHD in the upper quartile of waist circumference compared with the first quartile in all 4 race-sex subgroups except African American men, among whom we found no relationship between waist circumference and incident CHD. Covariates did not attenuate these relationships. CONCLUSION: In all groups except African American men, waist circumference in the highest quartile was associated with increased risk of incident CHD. Individual and neighborhood factors did not influence the relationship between waist circumference and development of CHD but differentially influenced incident CHD among race-sex subgroups.


Assuntos
Doença das Coronárias , Acidente Vascular Cerebral , Adulto , Estudos de Coortes , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Fatores Raciais , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Circunferência da Cintura
11.
JAMA Cardiol ; 7(6): 623-631, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35476049

RESUMO

Importance: Sex- and race-based differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are poorly understood. Clinical decisions are often informed by absolute-as opposed to relative-risk, but absolute risk of incident heart failure (HF) associated with NT-proBNP concentration across these important demographic categories is unclear. Objective: To determine whether physiologic determinants of NT-proBNP concentrations account for sex and race differences, and to more uniformly predict HF risk using NT-proBNP in these demographic subgroups. Design, Setting, and Participants: In the longitudinal Atherosclerosis Risk in Communities epidemiologic prospective community-based cohort study, the association of NT-proBNP concentration with relative and absolute risk of HF by sex- and race-based categories was assessed at study visit 2 (1990-1992) and study visit 5 (2011-2013) using Cox and Poisson regression. These data were analyzed from June 2018 to October 2021. The contribution of clinical, anthropometric, echocardiographic, and laboratory parameters to sex- and race-based differences in NT-proBNP concentration was assessed at visit 5 using linear regression. Participants included were free of HF in midlife (visit 2; a total of 12 750 participants) and late life (visit 5; a total of 5191 participants). Exposures: NT-proBNP concentration. Main Outcomes and Measures: Incident HF or death. Results: Among the 5191 HF-free participants at visit 5, the mean (SD) age was 76.0 (5.2) years, 2104 (41%) were male, 1043 (20%) were Black, and the median (IQR) NT-proBNP concentration was 124 (64-239) pg/. In both midlife and late life, NT-proBNP concentration was lowest in Black men (median [IQR] concentration: visit 2, 30 [14-67] pg/mL; visit 5, 74 [34-153] pg/mL) and highest in White women (median [IQR] concentration: visit 2, 70 [42-111] pg/mL; visit, 5, 154 [82-268] pg/mL). Sex and race differences in NT-proBNP concentration persisted after accounting for age, income, education, area deprivation index, cardiovascular diseases, left ventricular structure (LV), LV function, LV wall stress, weight and fat mass, and estimated glomerular filtration rate. Substantial differences in the absolute risk of incident HF or death existed across the sex- and race-based categories at any NT-proBNP concentration (eg, 7-fold [rate ratio, 6.7; 95% CI, 4.6-9.9] and 3-fold [rate ratio, 2.7; 95% CI, 1.7-4.1] difference at visit 2 and visit 5, respectively, at guideline-recommended thresholds) with higher risk consistently observed among Black men and lower risk in White women. Results were replicated in a cohort of participants from the Cardiovascular Health Study. Conclusions and Relevance: In this study, sex- and race-based differences in NT-proBNP persisted after accounting for known physiologic determinants. Absolute risk associated with a given value of NT-proBNP varied substantially by sex and race. Consideration of NT-proBNP values in the context of sex and race allows for more uniform prediction of absolute risk across important demographic subgroups.


Assuntos
Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Idoso , Biomarcadores , Estudos de Coortes , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Fragmentos de Peptídeos , Estudos Prospectivos , Fatores Raciais , Fatores de Risco
12.
Arq. bras. cardiol ; 118(3): 614-622, mar. 2022. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1364355

RESUMO

Resumo Fundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.


Abstract Background It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. Objectives This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. Methods The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. Results Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. Conclusions Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.


Assuntos
Humanos , Adulto , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/farmacologia , Estados Unidos , Pressão Sanguínea , Brasil , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Estudos Transversais , Estudos Longitudinais , Antagonistas de Receptores de Angiotensina/uso terapêutico , Fatores Raciais
13.
J Drugs Dermatol ; 21(3): 270-275, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35254766

RESUMO

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic disease that causes inflammatory lesions typically found in the axillary, inguinal, and perineal regions that can result in permanent scarring, fibrosis, and sinus tract formation. Although HS is more prevalent in patients with skin of color, research in HS has historically been performed in European and White populations. We aimed to explore management differences in skin of color HS patients compared to White patients. METHODS: We performed a cross-sectional retrospective review of HS-associated outpatient encounters in the Medical University of South Carolina’s Research Data Warehouse from 1/2017–12/2020. We performed descriptive statistics and chi-square analyses. RESULTS: We found that Black HS patients were more likely to receive metformin and nonsteroidal anti-inflammatory drugs (NSAIDs) during HS-associated visits. We also found that Black patients were less likely to see dermatology and primary care and more likely to see surgery for their HS-associated visits. Lastly, skin of color HS patients were more likely to have a complex excision (P<0.001). DISCUSSION: We found differences in the medical and procedural care provided to Black HS patients compared to White patients. A limitation of our study is the lack of information concerning efficacy of treatment interventions and clinical outcomes. Future studies should include a representative population of HS patients with a higher proportion of skin of color HS patients and include race as a variable when investigating medical and surgical outcomes to understand mechanisms that could explain differences in disease profiles across racial groups. J Drugs Dermatol. 2022;21(3):270-275. doi:10.36849/JDD.6446.


Assuntos
Hidradenite Supurativa , Estudos Transversais , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/terapia , Humanos , Fatores Raciais , Estudos Retrospectivos
15.
Clin Spine Surg ; 35(4): 176-180, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35344526

RESUMO

STUDY DESIGN: This was a retrospective chart review. OBJECTIVE: The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS). SUMMARY OF BACKGROUND DATA: There are previously described racial disparities in spinal surgery outcomes and quality metrics. METHODS: A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient's LOS was related to their self-identified race, demographics, and perioperative clinical data. RESULTS: Of the 278 patients who received an ACDF, 71.6% (199) self-identified as White and 28.4% (79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P=0.001). AA patients had longer LOS by an average of half a day (P=0.001) and experienced a larger percentage of extended stays (P=0.002). AA patients experienced longer overall operation times on average (P=0.001) across all different levels of fusion. AA race was not an independent driver of LOS (ß=0.186; P=0.246). CONCLUSIONS: As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study's results. LEVEL OF EVIDENCE: Level III.


Assuntos
Doenças da Medula Espinal , Fusão Vertebral , Vértebras Cervicais/cirurgia , Discotomia/métodos , Humanos , Complicações Pós-Operatórias/cirurgia , Fatores Raciais , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Resultado do Tratamento
16.
Cancer ; 128(12): 2320-2338, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35289926

RESUMO

BACKGROUND: The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. METHODS: Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aerobic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. RESULTS: The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI, -0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. CONCLUSIONS: Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Afro-Americanos , Idoso , Neoplasias da Mama/terapia , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Fatores Raciais
17.
Cancer Epidemiol Biomarkers Prev ; 31(5): 1006-1016, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35244678

RESUMO

BACKGROUND: Tumor-infiltrating lymphocytes (TIL) confer a survival benefit among patients with ovarian cancer; however, little work has been conducted in racially diverse cohorts. METHODS: The current study investigated racial differences in the tumor immune landscape and survival of age- and stage-matched non-Hispanic Black and non-Hispanic White women with high-grade serous ovarian carcinoma (HGSOC) enrolled in two population-based studies (n = 121 in each racial group). We measured TILs (CD3+), cytotoxic T cells (CD3+CD8+), regulatory T cells (CD3+FoxP3+), myeloid cells (CD11b+), and neutrophils (CD11b+CD15+) via multiplex immunofluorescence. Multivariable Cox proportional hazard regression was used to estimate the association between immune cell abundance and survival overall and by race. RESULTS: Overall, higher levels of TILs, cytotoxic T cells, myeloid cells, and neutrophils were associated with better survival in the intratumoral and peritumoral region, irrespective of tissue compartment (tumor, stroma). Improved survival was noted for T-regulatory cells in the peritumoral region and in the stroma of the intratumoral region, but no association for intratumoral T-regulatory cells. Despite similar abundance of immune cells across racial groups, associations with survival among non-Hispanic White women were consistent with the overall findings, but among non-Hispanic Black women, most associations were attenuated and not statistically significant. CONCLUSIONS: Our results add to the existing evidence that a robust immune infiltrate confers a survival advantage among women with HGSOC; however, non-Hispanic Black women may not experience the same survival benefit as non-Hispanic White women with HGSOC. IMPACT: This study contributes to our understanding of the immunoepidemiology of HGSOC in diverse populations.


Assuntos
Neoplasias Ovarianas , Feminino , Humanos , Linfócitos do Interstício Tumoral , Masculino , Fatores Raciais
18.
Cancer Epidemiol Biomarkers Prev ; 31(5): 991-998, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35247880

RESUMO

BACKGROUND: Telomere shortening is linked to aging and may be associated with increased risk for cancer. Most cancer studies have used telomere length in leukocytes rather than in the target tissue of cancer origin. METHODS: A case-control study of 524 case-control pairs with a benign prostate biopsy nested within a historical cohort of 10,478 men was conducted to determine whether premalignant prostate telomere length (assessed using a modified qRT-PCR) is associated with prostate cancer risk. RESULTS: Telomere lengths in benign prostate biopsies of cases versus controls were similar (1.46 ± 0.38 vs. 1.45 ± 0.42; P = 0.49). African American (AA) men had significantly shorter telomeres compared with White men (1.51 ± 0.38 vs. 1.63 ± 0.39; P < 0.0001). In race-stratified analyses, increasing telomere length was more strongly associated with prostate cancer risk in White men, wherein those with telomere length in the highest quartile had 1.9-fold greater adjusted risk of prostate cancer compared with men with prostate telomere lengths in the lowest quartile [OR = 1.90; 95% confidence interval (CI) = 1.08-3.36]. Men in the highest telomere length quartile also had a greater risk of aggressive prostate cancer compared with men with telomere lengths in the lowest quartile (OR = 2.78; 95% CI = 1.25-6.19). CONCLUSIONS: White men have longer telomeres in benign prostate tissue compared with AA men, and those with the longest telomeres may be at increased risk for prostate cancer, particularly the more aggressive form of the disease. IMPACT: Race-specific telomere length measures may be an early biomarker of aggressive prostate cancer.


Assuntos
Próstata , Neoplasias da Próstata , Biópsia , Estudos de Casos e Controles , Humanos , Leucócitos , Masculino , Neoplasias da Próstata/genética , Fatores Raciais , Fatores de Risco , Telômero/genética
19.
Child Abuse Negl ; 127: 105579, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35299132

RESUMO

BACKGROUND: A wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making. OBJECTIVE: This study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence. PARTICIPANTS AND SETTING: 258 professionals (133 current staff and 125 trainees) from Colorado participated in the study. METHODS: The study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied. RESULTS: A SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (ß = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (ß = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (ß = 0.26). Lastly, negative perceptions of morality increased supervision order scores (ß = -0.55 to -0.36). CONCLUSIONS: Evidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.


Assuntos
Serviços de Proteção Infantil , Estereotipagem , Criança , Maus-Tratos Infantis/psicologia , Feminino , Humanos , Mães , Pais , Fatores Raciais , Fatores Sexuais
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