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2.
Aust N Z J Public Health ; 45(1): 34-38, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33522685

RESUMO

OBJECTIVE: To examine the supply of smoking cessation medicines to Aboriginal and Torres Strait Islander smokers compared to non-Indigenous smokers across Australia. METHODS: We analysed the total number of smoking cessation prescriptions dispensed over three years through the Pharmaceutical Benefits Scheme (PBS) compared to those supplied nationally through the Closing the Gap (CTG) measure and also in the Northern Territory through the Remote Area Aboriginal Health Service (RAAHS) program. RESULTS: Aboriginal and Torres Strait Islander smokers were supplied with fewer smoking cessation medicines per smoker under the CTG measure compared to non-Indigenous smokers under general PBS benefits. Supply of medicines though the RAAHS program complicated the use of CTG data where higher proportions of Aboriginal and Torres Strait Islander people live in remote areas and use of the CTG measure is lower. CONCLUSIONS: Fewer smoking cessation medicines are being prescribed and then dispensed to Aboriginal and Torres Strait Islander smokers than to non-Indigenous smokers. Implications for public health: CTG and RAAHS data may be useful to monitor and evaluate the effectiveness of interventions to improve the use of smoking cessation medicines by Aboriginal and Torres Strait Islander smokers. However, there are limitations and current obstacles to accessing RAAHS data would need to be removed.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/organização & administração , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/efeitos adversos , Adulto , Idoso , Austrália/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Northern Territory/epidemiologia , Grupo com Ancestrais Oceânicos , Estudos Prospectivos , Fumantes/psicologia , Fumar/epidemiologia , Fumar/etnologia , Abandono do Hábito de Fumar/etnologia
3.
Medicine (Baltimore) ; 100(4): e24159, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530206

RESUMO

BACKGROUND: The incidence of non-small cell lung cancer (NSCLC) in Uygur population is gradually increasing recently. In view of the great diagnostic and prognostic values of cell-free DNAs (cfDNA) detection, this study focus on a liquid biopsy to explore the value of cfDNA mutation in healthy and NSCLC patients in 2 ethnicities. METHODS: The concentration and sequencing of cfDNA in NSCLC and healthy subjects was assessed with a standard information analysis procedure, including detection, annotation, and statistical analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to analyze the function of mutant genes and related pathways. Totally, 133 subjects, including 35 Uygur NSCLC patients, 10 Uygur healthy subjects, 63 cases of Han NSCLC patients and 25 Han health control, were admitted to the hospital. RESULTS: There were a lower proportion of adenocarcinoma and higher percentage of smoking rate for Uygur patients. For cfDNA level between NSCLC and healthy subjects, Han patients exhibited sharp increase while there was no statistical difference in Uygur population. In addition, the mutation frequency of cfDNA in Han patients (72.6%) was significantly higher than Uygur patients (45.7%). There were 5 gene mutations only found in Han patients and ABCC11 showed a higher mutation frequency in Uygur population as a common one. Finally, Go and Kyoto Encyclopedia of Genes and Genomes analysis showed apprent functional enrichments and pathway changes between 2 ethnicities. CONCLUSION: There existed distinct distributions of cancer subtypes, smoking proportion, cfDNA level, and mutation patterns between Han and Uygur patients. The results may be a useful tool in NSCLC patients' diagnosis as well as individualized therapy between ethnicities in future.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Carcinoma Pulmonar de Células não Pequenas/etnologia , DNA Tumoral Circulante/sangue , Neoplasias Pulmonares/etnologia , Transportadores de Cassetes de Ligação de ATP/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , China/epidemiologia , Bases de Dados Genéticas , Grupos Étnicos , Feminino , Ontologia Genética , Genótipo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Fumar/etnologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33348723

RESUMO

(1) Background: To explore the function of smoking in Aboriginal women's lives from a trauma-informed, women-centred approach in order to inform the design of a culturally meaningful smoking cessation program for women living in the Pilbara, Western Australia; (2) Methods: Qualitative and Community Based Participatory Action Research (CBPAR) was used to discover what Aboriginal women know about smoking, the specific contextual issues that influence their smoking, and what community supports are available to help them quit smoking. Inductive analysis was used to determine key themes; (3) Results: 25 Aboriginal women (smokers, non-smokers, and ex-smokers) participated in focus groups or individual interviews. Women smoked to deal with stress, trauma and for maintaining social connections. Women who stopped smoking did so on their own when the reason was important enough or when they saw alternative ways of living. Creating safe places to bring women together to yarn about women's business and link with health services was identified as critical to support women to stop smoking. Conclusions: Strategies to address smoking need to bring community, culture and health together in a meaningful way for women and their families; build on existing community strengths; and educate communities about the effects of smoking, and health professionals about how to support women to stop smoking.


Assuntos
Assistência à Saúde Culturalmente Competente , Comportamentos Relacionados com a Saúde/etnologia , Saúde Materna , Grupo com Ancestrais Oceânicos/psicologia , Abandono do Hábito de Fumar/psicologia , Fumar/etnologia , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Pesquisa sobre Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fumar/psicologia , Abandono do Hábito de Fumar/etnologia , Austrália Ocidental
5.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
6.
Adv Ther ; 37(12): 4981-4995, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33044691

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can present as a range of symptoms, from mild to critical; lower pulmonary involvement, including pneumonia, is often associated with severe and critical cases. Understanding the baseline characteristics of patients hospitalized with COVID-19 illness is essential for effectively targeting clinical care and allocating resources. This study aimed to describe baseline demographics and clinical characteristics of US patients hospitalized with COVID-19 and pulmonary involvement. METHODS: US patients with COVID-19 and pulmonary involvement during an inpatient admission from December 1, 2019, to May 20, 2020, were identified using the IBM Explorys® electronic health records database. Baseline (up to 12 months prior to first COVID-19 hospitalization) demographics and clinical characteristics and preadmission (14 days to 1 day prior to admission) pulmonary diagnoses were assessed. Patients were stratified by sex, age, race, and geographic region. RESULTS: Overall, 3471 US patients hospitalized with COVID-19 and pulmonary involvement were included. The mean (SD) age was 63.5 (16.3) years; 51.2% of patients were female, 55.0% African American, 81.6% from the South, and 16.8% from the Midwest. The most common comorbidities included hypertension (27.7%), diabetes (17.3%), hyperlipidemia (16.3%), and obesity (9.7%). Cough (27.3%) and dyspnea (15.2%) were the most common preadmission pulmonary symptoms. African American patients were younger (mean [SD], 62.5 [15.4] vs. 67.8 [6.2]) with higher mean (SD) body mass index (33.66 [9.46] vs. 30.42 [7.86]) and prevalence of diabetes (19.8% vs. 16.7%) and lower prevalence of chronic obstructive pulmonary disease (5.6% vs. 8.2%) and smoking/tobacco use (28.1% vs. 37.2%) than White patients. CONCLUSIONS: Among US patients primarily from the South and Midwest hospitalized with COVID-19 and pulmonary involvement, the most common comorbidities were hypertension, diabetes, hyperlipidemia, and obesity. Differences observed between African American and White patients should be considered in the context of the complex factors underlying racial disparities in COVID-19.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por Coronavirus , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Pneumopatias , Doenças não Transmissíveis/epidemiologia , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Demografia , Feminino , Disparidades nos Níveis de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pneumopatias/diagnóstico , Pneumopatias/etnologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/etnologia , Estados Unidos/epidemiologia
7.
BMC Public Health ; 20(1): 1068, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631296

RESUMO

BACKGROUND: Cardiovascular disease (CVD) prevalence has increased continuously over the last 30 years in China. Dyslipidemia is an important modifiable risk factor in CVD. We aimed to collect current data on the prevalence of dyslipidemia in northern China and explore potential influencing factors. METHODS: In this cross-sectional study, we selected a representative sample of 65,128 participants aged ≥35 years in Inner Mongolia during 2015-2017. All participants completed a questionnaire and were examined for risk factors. Dyslipidemia was defined according to 2016 Chinese guidelines for adults. The associated factors for dyslipidemia were estimated by multivariate logistic regression analysis. RESULTS: The age-standardized prevalence of dyslipidemia was 31.2% overall, with 4.3, 2.4, 14.7, and 17.4% for high total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C), respectively. The dyslipidemia prevalence was significantly higher in men than women (37.9% vs. 27.5%, P < 0.001), but postmenopausal women had a higher prevalence of dyslipidemia components (except low HDL-C). Compared with Han participants, Mongol participants had a lower prevalence of dyslipidemia (29.1% vs. 31.4%, P < 0.001). Male sex, living in urban areas, Han ethnicity, smoking, obesity, central obesity, hypertension, and diabetes were all positively correlated with dyslipidemia; alcohol consumption was linked to lower risk of dyslipidemia. CONCLUSIONS: Our study revealed that dyslipidemia is a health problem in northern China. Greater efforts to prevent and manage dyslipidemia, especially in men under age 55 years, postmenopausal women, and people with unhealthy lifestyles or chronic diseases.


Assuntos
Fatores Etários , Dislipidemias/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Fatores Sexuais , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/etnologia , China/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Dislipidemias/etiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/etnologia , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/etnologia
8.
J Adolesc Health ; 67(3): 362-368, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32674964

RESUMO

PURPOSE: COVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring vulnerability to severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. METHODS: A young adult subsample (aged 18-25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016-2018. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention medical indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. RESULTS: Medical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7-.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2-1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples-full sample: white (31%) versus Hispanic (24%; 95% CI: .6-.9) and Asian (18%; 95% CI: .4-.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06-.9) and Asian (10%; 95% CI: .3-.8). CONCLUSIONS: Notably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Fumar/epidemiologia , Fumar/psicologia , Populações Vulneráveis , Adolescente , Adulto , Infecções por Coronavirus/etnologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pandemias , Pneumonia Viral/etnologia , Índice de Gravidade de Doença , Fumar/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
9.
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
10.
South Med J ; 113(6): 311-319, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483642

RESUMO

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Assuntos
Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Doenças Vasculares Periféricas/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etnologia , Americanos Asiáticos/estatística & dados numéricos , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Obesidade/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Doenças Vasculares Periféricas/etnologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/etnologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etnologia , Adulto Jovem
11.
Natl Vital Stat Rep ; 69(3): 1-11, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32510315

RESUMO

Objectives-This report presents data on recent trends for three sexually transmitted infections (STIs)-chlamydia, gonorrhea, and syphilis-reported among women giving birth in the United States from 2016 through 2018, and rates by selected characteristics for 2018. Methods-Data are from birth certificates and are based on 100% of births registered in the United States for 2016, 2017, and 2018. Birth certificate data on infections during pregnancy are recommended to be collected from the mother's medical records (1). Mothers are to be reported as having an infection if there is a confirmed diagnosis or documented treatment for the infection in their medical record (2). Results-Among women giving birth in 2018, the overall rates of chlamydia, gonorrhea, and syphilis were 1,843.9, 310.2, and 116.7 per 100,000 births, respectively. The rates for these STIs increased 2% (chlamydia), 16% (gonorrhea), and 34% (syphilis) from 2016 through 2018. In 2018, rates of chlamydia and gonorrhea decreased with advancing maternal age, whereas those for syphilis decreased with maternal age through 30-34 years and then increased for women aged 35 and over. In 2018, rates of all three STIs were highest for non-Hispanic black women, women who smoked during pregnancy, women who received late or no prenatal care, and women for whom Medicaid was the principal source of payment for the delivery. Among women aged 25 and over, rates of each of the STIs decreased with increasing maternal education.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Declaração de Nascimento , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Parto Obstétrico/economia , Escolaridade , Feminino , Gonorreia/epidemiologia , Gonorreia/etnologia , Humanos , Idade Materna , Medicaid/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/etnologia , Fumar/epidemiologia , Fumar/etnologia , Sífilis/epidemiologia , Sífilis/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
12.
N Z Med J ; 133(1514): 33-40, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379737

RESUMO

BACKGROUND: Aortic dissection is a life-threatening condition frequently requiring emergency surgery. Key risk factors include hypertension and aortopathy syndromes; however, possible ethnic associations and differences in presentation and outcomes are less well established. We compared characteristics and outcomes of type A aortic dissection surgery by ethnicity. METHODS: Consecutive patients having type A aortic dissection surgery at Auckland City Hospital March 2003-March 2017 were divided into three ethnic groups: Maori, Pasifika and 'other', and analysed for characteristics, presentation and outcomes. RESULTS: Among 327 patients, 45 (14%) were Maori, 91 (28%) were Pasifika Islander and 191 (58%) were other ethnicities. Mean age was lowest for Maori 51+/-12 years, then Pasifika 56+/-12 and other ethnicities 63+/-13 (P<0.001). Maori and Pasifika ethnicities had higher body mass index, more hypertension, dyslipidaemia and smoking, but lower proportion presenting in critical pre-operative state. Operative mortality occurred in 5 (11%), 18 (20%) and 42 (22%) for Maori, Pasifika and other ethnicities (P=0.258). Pasifika had higher age-standardised operative mortality standardised mortality ratio 6.00, 95% confidence interval 3.67-9.30 than 'other' ethnicities, while Maori had higher age-standardised late mortality 5.71, 2.90-10.2 respectively, and the latter association persisted in multivariable analysis. Critical pre-operative state and malperfusion syndrome independently predicted operative mortality. CONCLUSION: Maori and Pasifika patients were younger and present less unwell with type A aortic dissection, but had higher prevalence of cardiovascular risk factors. They had higher age-standardised late and operative mortality respectively, suggesting that aggressive management and risk factor control are critical for these patients.


Assuntos
Aneurisma Dissecante/etnologia , Aneurisma Dissecante/cirurgia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto , Idoso , Índice de Massa Corporal , Dislipidemias/etnologia , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Gravidade do Paciente , Fatores de Risco , Fumar/etnologia , Resultado do Tratamento
13.
Aust N Z J Public Health ; 44(3): 186-192, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459387

RESUMO

OBJECTIVE: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. METHODS: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) and the 759 who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health: Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.


Assuntos
Alcoolismo/psicologia , Depressão/psicologia , Satisfação Pessoal , Fumantes/psicologia , Fumar/efeitos adversos , Estresse Psicológico/psicologia , Adulto , Alcoolismo/etnologia , Austrália/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Depressão/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fumar/epidemiologia , Fumar/etnologia , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Estresse Psicológico/etnologia
15.
Curr Opin Endocrinol Diabetes Obes ; 27(2): 87-94, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32073427

RESUMO

PURPOSE OF REVIEW: It is only over the last few decades that the impact of coronary artery disease (CAD) in very young South Asian population has been recognized. There has been a tremendous interest in elucidating the causes behind this phenomenon and these efforts have uncovered several mechanisms that might explain the early onset of CAD in this population. The complete risk profile of very young South Asians being affected by premature CAD still remains unknown. RECENT FINDINGS: The existing data fail to completely explain the burden of premature occurrence of CAD in South Asians especially in very young individuals. Results from some studies identified nine risk factors, including low consumption of fruits and vegetables, smoking, alcohol, diabetes, psychosocial factors, sedentary lifestyle, abdominal obesity, hypertension and dyslipidemia as the cause of myocardial infarction in 90% of the patients in this population. Recent large genome-wide association studies have discovered the association of several novel genetic loci with CAD in South Asians. Nonetheless, continued scientific efforts are required to further our understanding of the causal risk factors of CAD in South Asians to address the rising burden of CVD in this vulnerable population. SUMMARY: In this review, we discuss established and emerging risk factors of CAD in this population.


Assuntos
Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Adulto , Idade de Início , Ásia/epidemiologia , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/etiologia , Humanos , Estilo de Vida/etnologia , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/etnologia
16.
Diabetes Res Clin Pract ; 161: 108028, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31962087

RESUMO

BACKGROUND: Australian Indigenous women experience high rates of social disadvantage and type 2 diabetes (T2D) in pregnancy, but it is not known how social factors and maternal behaviours impact neonatal adiposity in offspring of women with hyperglycaemia in pregnancy. METHODS: Participants were Indigenous (n = 404) and Europid (n = 240) women with gestational diabetes mellitus (GDM) or T2D in pregnancy and their offspring in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Social, economic factors, and maternal behaviours were measured in pregnancy and six neonatal anthropometric outcomes were examined after birth. RESULTS: On univariate analysis, maternal education < 12 years (p = 0.03), unemployment (p = 0.001), welfare income vs no welfare income (p = 0.001), lower area based socio-economic score (p < 0.001), and fast food intake > 2 times/week (p = 0.002) were associated with increased sum of skinfolds (SSF) in offspring. Smoking was significantly associated with a reduction in anthropometric measures, except SSF. In multivariable models adjusted for ethnicity, BMI and hyperglycaemia, social and economic factors were no longer significant predictors of neonatal outcomes. Smoking was independently associated with a reduction in length, head circumference and fat free mass. Frequent fast food intake remained independently associated with SSF (ß-coefficient 1.08 mm, p = 0.02). CONCLUSION: In women with hyperglycaemia in pregnancy, social factors were associated with neonatal adiposity, particularly skinfold measures. Promoting smoking cessation and limited intake of energy-dense, nutrient-poor foods in pregnancy are important to improve neonatal adiposity and lean mass outcomes. Addressing inequities in social and economic factors are likely to be important, particularly for Indigenous women or women experiencing social disadvantage.


Assuntos
Adiposidade/fisiologia , Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Recém-Nascido/metabolismo , Comportamento Materno/fisiologia , Gravidez em Diabéticas , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Adiposidade/etnologia , Adulto , Austrália/epidemiologia , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/metabolismo , Feminino , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Hiperglicemia/metabolismo , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/metabolismo , Grupos Populacionais/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/etnologia , Gravidez em Diabéticas/epidemiologia , Gravidez em Diabéticas/metabolismo , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/etnologia , Fatores Socioeconômicos , Adulto Jovem
17.
J Perinat Med ; 48(2): 168-172, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-31926099

RESUMO

Background Our aim was to determine the prevalence of tobacco smoking and e-cigarettes and cannabis use during pregnancy, whether these were influenced by ethnicity, and their relationship to perinatal outcomes. Methods A study was carried out in 4465 infants whose mothers delivered during 2017 and 2018. Self-reported maternal smoking, e-cigarette and cannabis use at booking were recorded. Outcome measures were birthweight and head circumference z-scores and admission to the neonatal intensive care unit (NICU). Results Two hundred and five women reported smoking cigarettes (4.7%), five were using e-cigarettes (0.11%) and 106 were using cannabis (2.43%). Women were most likely to smoke if young (15-19 years old) or from a mixed-race or White background. Cigarette smoking was associated with a lower mean z-score for birthweight (-0.587 vs. -0.064) and head circumference (-0.782 vs. -0.157) (both outcomes P < 0.0001). Young, mixed-race women were most likely to be both smoking and using cannabis during pregnancy and their infants had a lower birthweight mean z score (-0.989 vs. -0.587, P = 0.028) and head circumference z score (-1.33 vs. 0.782, P = 0.025) than cigarette use alone. Conclusion Young, mixed-race women were most likely to be both smoking and using cannabis during pregnancy and should be targeted for cessation programmes.


Assuntos
Peso ao Nascer , Resultado da Gravidez/epidemiologia , Fumar/etnologia , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
18.
Am J Prev Med ; 58(1): e21-e29, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31862106

RESUMO

INTRODUCTION: Alcohol misuse, cigarette smoking, poor diet, and physical inactivity, known as the "big four" contributors to chronic conditions and mortality, typically co-occur or cluster together, with their synergistic effect more detrimental to health than their cumulative individual effects. Little research has been reported on race/ethnicity-specific analyses of the clustering of these behaviors in the U.S. This study identified clustered risk behaviors among whites, blacks, and Hispanics and examined whether unhealthy clusters were associated with lower SES (assessed by education level and family income) and poor health status. METHODS: A nationally representative sample of U.S. adults aged 30-69 years (n=9,761) from the 2010 and 2015 National Alcohol Surveys was used to perform latent class analysis and multinomial and logistic regression modeling in 2018-2019. Obesity was used as a proxy for unhealthy diet. RESULTS: Three lifestyle classes were identified in each group. The relatively healthy lifestyle class was identified among whites and Hispanics. The nonsmoking and low risky drinking class among blacks, though showing a healthier lifestyle than the other 2 classes, still had relatively high prevalence of inactivity and obesity. The inactive and obese class was found in all 3 groups. Also identified were the smoking and risky drinking class among whites; the smoking and inactive class among blacks; and the smoking, inactive, and risky drinking class among Hispanics. For all 3 groups, unhealthy lifestyle classes mostly were associated with lower SES. Unhealthy lifestyle classes were also associated with poorer health status. CONCLUSIONS: Multi-behavior interventions are warranted to address inactivity and obesity in all 3 groups and unhealthy clusters involving smoking in each group.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Nível de Saúde , Assunção de Riscos , Fatores Socioeconômicos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Comportamento Sedentário/etnologia , Fumar/etnologia , Inquéritos e Questionários , Estados Unidos
19.
Int J Epidemiol ; 49(1): 45-55, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31650183

RESUMO

BACKGROUND: Harmful substances in solid fuel and tobacco smoke are believed to enter the bloodstream via inhalation and to be metabolized in the liver, leading to chronic liver damage. However, little is known about the independent and joint effects of solid fuel use and smoking on risks of chronic liver disease (CLD) mortality. METHODS: During 2004-08, ∼0.5 million adults aged 30-79 years were recruited from 10 areas across China. During a 10-year median follow-up, 2461 CLD deaths were recorded. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the individual associations of self-reported long-term cooking fuel and tobacco use with major CLD death. RESULTS: Overall, 49% reported solid fuel use and 26% smoked regularly. Long-term solid fuel use for cooking and current smoking were associated with higher risks of CLD deaths, with adjusted HRs of 1.26 (95% CI, 1.02-1.56) and 1.28 (1.13-1.44), respectively. Compared with never-smoking clean fuel users, the HRs were 1.41 (1.10-1.82) in never-smoking solid fuel users, 1.55 (1.17-2.06) in regular-smoking clean fuel users and 1.71 (1.32-2.20) in regular-smoking solid fuels users. Individuals who had switched from solid to clean fuels (1.07, 0.90-1.29; for median 14 years) and ex-regular smokers who stopped for non-medical reasons (1.16, 0.95-1.43; for median 10 years) had no evidence of excess risk of CLD deaths compared with clean fuel users and never-regular smokers, respectively. CONCLUSIONS: Among Chinese adults, long-term solid fuel use for cooking and smoking were each independently associated with higher risks of CLD deaths. Individuals who had stopped using solid fuels or smoking had lower risks.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Carvão Mineral , Culinária , Hepatopatias/mortalidade , Uso de Tabaco/efeitos adversos , Madeira , Adulto , China/epidemiologia , Doença Crônica , Carvão Mineral/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Uso de Tabaco/etnologia , Madeira/efeitos adversos
20.
Nicotine Tob Res ; 22(4): 583-587, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-31013341

RESUMO

INTRODUCTION: Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. METHODS: Data were drawn from the 2002-2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. RESULTS: In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). CONCLUSIONS: Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. IMPLICATIONS: This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Fumar/tendências , Produtos do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Prevalência , Fumar/etnologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
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