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2.
mSphere ; 5(5)2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999084

RESUMO

The inaugural Black In Microbiology Week (#BlackInMicro) is 28 September 2020 through 4 October 2020. Its mission is to "showcase the presence and accomplishments of Black microbiologists from around the globe, connect Black microbiologists with one another and foster a sense of community among them, and provide a forum for the discussion of racial disparities in microbiology and its subfields." Participation in this event will happen primarily over Twitter through the hashtag #BlackInMicro and over Zoom through registration on the website https://blackinmicrobiology.org/ An additional mission of Black In Microbiology Week is to amplify black scientists. Today, mSphere does this by presenting two mSphere of Influence commentaries from Black In Microbiology co-lead organizers Ariangela J. Kozik ("mSphere of Influence: frameshift-a vision for human microbiome research" [mSphere 5:e00944-20, 2020, https://doi.org/10.1128/mSphere.00944-20]) and Kishana Taylor ("mSphere of Influence: that's racist-COVID-19, biological determinism, and the limits of hypotheses" [mSphere 5:e00945-20, 2020, https://doi.org/10.1128/mSphere.00945-20]).


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Determinismo Genético , Racismo/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Microbiologia , Microbiota , Pandemias , Pneumonia Viral/epidemiologia
3.
Cien Saude Colet ; 25(suppl 2): 4211-4224, 2020 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027358

RESUMO

This study discusses to what extent the inclusion, or not, of the race/color variable in epidemiological analysis of the COVID-19 pandemic can work as an external manifestation of necropolitics and as a producer of health inequities. We conducted a literature review on 09 articles, and on Scientific Electronic Library, PubMed and Virtual Health Library databases. We also conducted a documental analysis on 27 epidemiological reports from all the federal states and the Federal District of Brazil. We did not see much information regarding race/color, which can be interpreted as an intentional omission in order to hide those who the epidemics affects the most. The denial of basic and fundamental rights is the element that characterizes the larger racist structure of Brazil's COVID-19 policies.


Assuntos
Grupo com Ancestrais do Continente Africano , Infecções por Coronavirus/epidemiologia , Coleta de Dados/estatística & dados numéricos , Equidade em Saúde , Pneumonia Viral/epidemiologia , Betacoronavirus , Brasil/epidemiologia , Monitoramento Epidemiológico , Disparidades nos Níveis de Saúde , Humanos , Pandemias , Racismo
4.
Rev Med Suisse ; 16(709): 1849-1852, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026726

RESUMO

For safe procedures, the surgeon performing thyroid gland surgeries must know precisely the anatomical relationships of the inferior laryngeal nerve with other cervical structures, in particular the inferior laryngeal artery and its branches. Classic descriptions of these relationships are based almost exclusively on the observation of Caucasian populations. However, this study shows that there are important differences between Caucasian and Sub-Saharian ethnic group, differences that any surgeon having the opportunity to operate in Africa should know to limit the risk of iatrogenic nerve damage and its morbid consequences.


Assuntos
Grupo com Ancestrais do Continente Africano , Artérias/cirurgia , Grupos Étnicos , Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/cirurgia , África/etnologia , Grupo com Ancestrais do Continente Europeu , Humanos , Laringe/irrigação sanguínea , Laringe/cirurgia
5.
S Afr Med J ; 110(7): 678-685, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880347

RESUMO

BACKGROUND: The outcome and response of idiopathic nephrotic syndrome (NS) to steroids have been linked to race. OBJECTIVES: To determine the age of presentation, sex, race, histopathology, kidney function and disease status at the last hospital visit and correlate these with steroid response in Indian and black African children with idiopathic NS. METHODS: This is a retrospective review of 231 children aged 1 - 14 years, who were seen at Inkosi Albert Luthuli Central Hospital, Durban, South Africa (SA) from 2003 to 2018. RESULTS: The mean (standard deviation (SD)) age of presentation was 6.2 (3.4) years, with the majority of children (n=107; 46.3%) presenting at an early age (1 - 3 years) with a mean (SD) follow-up of 3.0 (2.4) years. One-hundred and twenty-one (52.4%) were males and 110 (47.6%) were females, with a male/female ratio of 1.1:1. There were 166 (71.9%) black African and 65 (28.1%) Indian children. The latter presented at a younger age than black African children (p<0.001). Seventy-six (32.9%) children were steroid sensitive (SS) and 155 (67.1%) were steroid resistant (SR). Black African children were more likely to be SR (odds ratio (OR) 2.0; p=0.02; 95% confidence interval (CI) 1.1 - 3.7). A kidney biopsy was performed in 209 (90.5%) children. Minimal change disease (MCD) was observed in 32 (13.9%) children and 162 (70.1%) had focal segmental glomerulosclerosis (FSGS). Black African children were slightly more likely to have FSGS; this, however, did not reach statistical significance (122/166 (73.5%) v. 40/65 (61.5%); OR 1.73; p=0.08; 95% CI 0.94 - 3.18). On comparing disease status at last hospital visit by race, 49/65 (75.4%) Indian and 94/166 (56.6%) black African children were in remission. At last hospital visit, black African children were less likely to be in remission than Indian children (OR 0.47; p=0.02; 95% CI 0.2 - 0.9), while 15/65 (23.1%) Indian and 47/166 (28.3%) black African children had relapsed, with no significant difference between the two groups. One (1.5%) Indian child and 25 (15.1%) black African children had end-stage kidney disease (ESKD) (OR 9.27; p=0.03; 95% CI 1.2 - 70.4) ‒ the majority had FSGS. Sixteen (61.5%) received renal replacement therapy. CONCLUSIONS: Our study shows a rising incidence of FSGS, with the majority of patients having SRNS, particularly black African children. This highlights the need for alternative efficacious therapy in the management of this disease. Also, a higher percentage of black African children with both MCD and FSGS were SS on histopathological examination, which was in keeping with reports from other regions in SA. There are still major challenges for the inclusion of all children into a chronic dialysis and transplant programme.


Assuntos
Síndrome Nefrótica/epidemiologia , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Criança , Pré-Escolar , Resistência a Medicamentos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Glomerulosclerose Segmentar e Focal/epidemiologia , Glucocorticoides/farmacologia , Humanos , Lactente , Falência Renal Crônica/epidemiologia , Masculino , Nefrose Lipoide/epidemiologia , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , África do Sul/epidemiologia
8.
Am J Hum Genet ; 107(3): 379-380, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32888506

RESUMO

It is imperative for participation in genetics and genomics research to reflect humanity's diversity so that all people can enjoy its benefits. This will take a concerted effort by the research community and must include greater engagement with individuals and communities underrepresented in research. In engaging with vulnerable populations, it is essential that researchers guard against harm resulting from their participation.


Assuntos
Pesquisa Biomédica , Variação Genética/genética , Populações Vulneráveis , Grupo com Ancestrais do Continente Africano/genética , Grupo com Ancestrais do Continente Europeu/genética , Genoma Humano , Genômica , Genética Humana , Humanos
10.
J Am Soc Nephrol ; 31(9): 2117-2121, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32817310

RESUMO

BACKGROUND: Racial and ethnic disparities in vaccination rates for seasonal influenza exist. Whether such disparities extend to patients with ESKD, who simultaneously are at risk for complications of infection and have extensive contact with health care providers, has not been investigated. METHODS: To determine whether the proportion of patients vaccinated at a dialysis facility differs according to the facility's racial and ethnic composition, we examined dialysis facility data reported to the Centers for Medicare and Medicaid Services. The main outcome was the proportion of facility patients vaccinated for influenza among 6735 Medicare-certified facilities operating between 2014 and 2017. RESULTS: Among dialysis facilities, the mean percentage of patients vaccinated during the influenza season was 72.1%. Facilities with higher proportions of Black and Hispanic patients had significantly lower vaccination percentages than less diverse facilities. The average proportion of patients vaccinated at each facility decreased significantly from 2014 to 2017 (a decrease of 1.05% vaccinated per year) and decreased significantly more so among facilities with higher minority proportions. The share of vaccinated patients in facilities in the quartile with the highest proportion of Black patients decreased 1.21% per year compared with a decrease of 0.88% per year in facilities in the quartile with the lowest proportion of Black patients. We found similar trends for Hispanic patients. CONCLUSIONS: Rates of seasonal influenza vaccination are modestly but significantly lower among dialysis facilities with larger proportions of minority patients, and the gap seems to be widening over time. As wide-scale vaccination efforts grow more urgent amid the current COVID-19 pandemic, these disparities must be addressed to protect patients and communities equitably.


Assuntos
Disparidades em Assistência à Saúde , Vacinas contra Influenza/imunologia , Diálise Renal , Vacinação/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estações do Ano
11.
Womens Health (Lond) ; 16: 1745506520949419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842917

RESUMO

BACKGROUND: Breast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support. OBJECTIVE: This article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa. METHODS: We interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2-3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension. RESULTS: We found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication. CONCLUSIONS: These findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Mastectomia/psicologia , Adaptação Psicológica , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Comorbidade , Diagnóstico Tardio/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Apoio Social , África do Sul , Estresse Psicológico
12.
Pediatrics ; 146(Suppl 1): S86-S92, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737239

RESUMO

Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.


Assuntos
Bem-Estar da Criança , Coerção , Saúde da Família , Tratamento Involuntário/legislação & jurisprudência , Complicações na Gravidez/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Grupo com Ancestrais do Continente Africano , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/etnologia , Gestantes/etnologia , Cuidado Pré-Natal , Classe Social , Sociedades Médicas , South Carolina , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos
13.
Acute Med ; 19(2): 110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32840263

RESUMO

We write this letter as doctors and proud members of the Black, Asian and Minority Ethnic (BAME) community from a South Asian background. Recent Office for National Statistics (ONS) data suggest that the BAME population is disproportionately affected by Covid-19. Observations and experiences from within our family and wider community led us to explore how cultural aspects may account for these figures. Both intrinsic and extrinsic factors are likely to contribute to this unfortunate statistic.


Assuntos
Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Infecções por Coronavirus/mortalidade , Decepção , Meios de Comunicação de Massa , Pneumonia Viral/mortalidade , Betacoronavirus , Grupos Étnicos , Humanos , Grupos Minoritários , Pandemias , Reino Unido/epidemiologia
15.
Ann Hematol ; 99(10): 2323-2328, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32808105

RESUMO

Infection with SARS-CoV-2 (COVID-19) can cause prothrombotic complications. We aim to study the frequency of thrombotic complications and impact of anticoagulation on outcomes in hospitalized patients. We conducted a retrospective chart review of 921 consecutive patients admitted to our hospital with COVID-19. Patients were divided into four groups depending on whether they were on anticoagulation prior to admission, started anticoagulation during the admission, received prophylactic anticoagulation, or did not receive any anticoagulation. At the time of analysis, 325 patients (35.3%) had died, while 544 patients (59%) had been discharged resulting in inpatient mortality of 37.3%. Male sex, age > 65 years, and high D-dimer at admission were associated with higher mortality. Sixteen patients (1.7%) had venous thromboembolism confirmed with imaging, 11 patients had a stroke, and 2 patients developed limb ischemia. Treatment with therapeutic anticoagulation was associated with improved inpatient mortality compared with prophylactic anticoagulation alone (63% vs 86.2%, p < 0.0001) in patients requiring mechanical ventilation. Other outcomes such as rates of liberation from mechanical ventilation and duration of mechanical ventilation were not significantly impacted by the type of anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Trombose/prevenção & controle , Trombose/virologia , Grupo com Ancestrais do Continente Africano , Idoso , Anticoagulantes/administração & dosagem , Infecções por Coronavirus/terapia , Feminino , Hemorragia/epidemiologia , Hispano-Americanos , Hospitais Comunitários , Hospitais Urbanos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/terapia , Respiração Artificial , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Trombose/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
16.
J Racial Ethn Health Disparities ; 7(5): 822-828, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32789564

RESUMO

During the COVID-19 pandemic, the data of Department of Health in United Kingdom (UK) showed an increase mortality and morbidity among the Black and Minority Ethnic (BAME) population. This high mortality can be due to social factors, genetic and immunological factors. Metabolic factors like high prevalence of diabetes, obesity, metabolic syndrome and hypertension were also found to contribute to the increased risk of COVID-19 infection in BAME population. In addition, a large number of BAME population are working in jobs that involve regular and daily contact with public, and this may increase risk of encountering COVID-19 infection. Therefore, future research should address all these factors and generate the correct health policy that will allow us to combat the danger of COVID-19. We recommend the establishment of BAME alliance against COVID-19 in order to improve occupational risks and hazards, adequate income protection, culturally and linguistically appropriate public health communications and decreasing barriers in accessing healthcare. The BAME alliance will initially focus on (i) development of central system to record data about COVID-19 patients from BAME population (ii) involvement of healthcare professionals and researchers from ethnic minorities and (iii) multidisciplinary and inter-institution collaboration; for example, civil engineers and architects need to think about house design and ventilation that decrease risk of COVID-19 especially in BAME populations.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Humanos , Fatores de Risco , Reino Unido/epidemiologia
17.
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
20.
Artigo em Inglês | MEDLINE | ID: mdl-32796518

RESUMO

The study explored how older adults experience an HIV diagnosis, deal with issues of stigma and disclosure, and navigate the healthcare system. Descriptive phenomenology was used to collect data from 20 older adults receiving antiretroviral treatment in health facilities in Gauteng Province, South Africa. Data analysis was inductive and followed the thematic approach. After diagnosis with HIV, the older adults experienced shock and disbelief, internalized their new reality of being HIV-positive, and found it difficult to disclose their HIV status. Stigma was embedded in their patterns of disclosure, and they chose not to disclose in order to manage stigma, protect their status, and maintain their privacy. Moreover, nondisclosure allowed them to achieve some normality in their lives without the fear of rejection. The older adults adopted various survival skills that aided them to accept their HIV status. Self-acceptance was important for the older adults who did not want to feel cheated out of life by the HIV diagnosis. The positive supportive attitudes of the healthcare professionals provided the much-needed support network for the older adults immediately after they had received their HIV test results. This was instrumental in their acceptance of their HIV status, their adherence to clinic visits, and their ability to live a healthy, positive life.


Assuntos
Infecções por HIV , Estigma Social , Grupo com Ancestrais do Continente Africano , Idoso , Antirretrovirais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul
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