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2.
Artigo em Inglês | MEDLINE | ID: mdl-34199387

RESUMO

Children have been identified as being particularly vulnerable to energy poverty (EP), but little empirical research has addressed the effect of EP on children's health and wellbeing, especially in southern Europe. In this work we aimed to provide an in-depth description of the distribution of EP by sociodemographic, socioeconomic and housing characteristics, as well as to analyse the association between EP and health and wellbeing in children in Barcelona. We performed a cross-sectional study using data from the Barcelona Health Survey for 2016 (n = 481 children under 15 years). We analysed the association between EP and health outcomes through prevalence differences and prevalence ratios (PR) and their 95% confidence interval (CI), using Poisson regression models with robust variance. In Barcelona, 10.6% of children were living in EP and large inequalities were found by sociodemographic, socioeconomic and housing characteristics. EP was strongly associated with poor health in children (PR (95% CI): 7.70 (2.86, 20.72)). Living in EP was also associated with poor mental health (PR (95% CI): 2.46 (1.21, 4.99)) and with more cases of asthma (PR (95% CI): 4.19 (1.47, 11.90)) and overweight (PR (95% CI): 1.50 (1.05, 2.15)) in children. It is urgent to develop specific measures to avoid such serious and unfair health effects on children.


Assuntos
Habitação , Pobreza , Criança , Cidades , Estudos Transversais , Europa (Continente) , Humanos , Fatores Socioeconômicos
4.
Front Public Health ; 9: 566960, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222159

RESUMO

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs. Methods: Data from 12,432 women in the 1921-26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life. Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services. Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.


Assuntos
Habitação , Aposentadoria , Acidentes por Quedas , Idoso , Austrália/epidemiologia , Feminino , Humanos , Estudos Longitudinais
5.
Artigo em Inglês | MEDLINE | ID: mdl-34299714

RESUMO

The pandemic generated by the SARS-CoV-2 virus has led to a forced increase in the number of hours spent at home. In many cases, the lockdown situations, both in social and work terms, have meant that homes have suddenly also become workplaces. Based on all the indicators, this new relational scenario in the labor market displays a clear upward trend and is far from being a temporary situation. It is known that sunlight affects people's circadian rhythm and that its reduction and even absence during this period of isolation has had a psychological impact on the population. This makes it necessary to reconsider the regulations applied in homes, in order to guarantee their habitability, given their recent widespread use as offices, as well as domestic spaces. In historic centers, the comprehensive renovations being carried out include improvements in energy efficiency and thermal comfort, which play a fundamental role. However, the energy consumption linked to artificial lighting and the quality of this lighting itself have remained in the background, as improvement strategies consist mainly in the replacement of incandescent or fluorescent lamps with LED lamps. Prior to the pandemic, the electric consumption of lighting systems accounted for 10-15% of the total, a figure which increased to 40-50% during the lockdown period. Aiming to improve people's well-being while reducing energy expenditure on lighting, this article presents a quantitative approach to improving the levels of natural lighting in residential heritage buildings located in historic centers. According to data obtained from previous surveys of a sector of the population, homes built prior to 1950 were characterized by good natural lighting conditions and a very low incidence of health issues among occupants compared to contemporary homes. The objective was to quantify the circadian stimulus and lighting levels and to identify the areas or work areas in homes in order to optimize consumption related to lighting and to generate healthy and comfortable spaces. Results show that historic homes have enough naturally lit areas to perform office work during business hours. However, in the most unfavorable seasons, winter and autumn, it is necessary to use artificial lighting at the start and end of the working day.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Habitação , Humanos , Iluminação , SARS-CoV-2
6.
Artigo em Inglês | MEDLINE | ID: mdl-34299740

RESUMO

Since the outbreak of COVID-19, many parts of the world have fallen into deep recession. Governments in every country have adopted various measures to restrict social gatherings due to the need to control the pandemic. This includes restrictions on activities in homes and communities. Fundamentally, epidemic prevention relies on the measures individuals take. A community's epidemic prevention measures become more critical as activities are held in houses or communities once again. From the perspective of the theory of planned behavior, this study investigates whether the various epidemic prevention measures and characteristics of a community affect residents' perception of epidemic prevention. We use the truncated regression model as the primary research method. The empirical results show that the community's epidemic prevention measures can change residents' awareness of the importance of epidemic prevention. Moreover, the scale of the community and management committee are also found to have a partial impact.


Assuntos
COVID-19 , Habitação , Humanos , Pandemias , Percepção , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34299781

RESUMO

The COVID-19 pandemic and the precautionary measures applied globally (lockdowns and curfews) have impacted homes, including work. Working from home (WFH) has emerged as a growing trend in the post-pandemic era. The research question was: Are our homes ready for teleworking? To respond, a national prospective mixed approach was launched for Spanish households during the spring 2020 lockdown, using two online questionnaires, one quantitative and the other qualitative. Through a survey, photographs, and narratives, the study evaluates the perceived adequacy of telework spaces and their specific characteristics, the availability of digital resources and the internet. A total of 1800 surveys and over 200 images and texts related to telework environments were obtained. The results suggest that the adequacy of these spaces was insufficient for more than a quarter of the homes. Also, strong relations between the perceived workspace adequacy and a social status or stability of homes were shown and validated, despite other sociodemographic features, the home composition or habitat were not related. Some other variables statistically significant were occupation regime, type and surface of dwellings; their indoor environmental quality; the availability of exclusive spaces for teleworking; quality of digital resources; and the specific space features. The analysis was completed with qualitative insights through photos and texts. Telework, lived in this context as an experiment, needs this reflection from an environmental, resource-availability, and ergonomic point of view.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Habitação , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2
8.
PLoS One ; 16(7): e0254954, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288965

RESUMO

BACKGROUND: Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. METHODS: The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software. RESULTS: The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection. CONCLUSION: Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.


Assuntos
COVID-19/epidemiologia , Insegurança Alimentar , Renda/estatística & dados numéricos , Pandemias/economia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Feminino , Habitação/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Inquéritos e Questionários , Adulto Jovem
9.
J Affect Disord ; 291: 352-358, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34087631

RESUMO

BACKGROUND: Intimate partner violence (IPV) has significant consequences for women's mental health, and it also compromises women's economic security and livelihood, including housing stability. There is a dearth of research, however, on protective factors in the link between housing instability and psychopathology in IPV-exposed women. METHODS: The current study examines the protective role of social support in the association between housing instability and mental health (depression, posttraumatic stress) in a sample of pregnant, IPV-exposed women (N = 137). RESULTS: Overall models for both depression and posttraumatic stress were significant (F = 6.42, p<.001; R2=16.3%; F = 15.09, p<.001; R2=31.0%, respectively). Housing instability was significantly associated with higher levels of depressed mood (ß=0.20, p<.016), but not posttraumatic stress symptoms. Social support was significantly associated with lower levels of depressed mood (ß=-0.17, p<.036) and posttraumatic stress (ß=-0.38, p =0.001). The addition of the interaction term (housing instability*social support) resulted in a significant improvement in variance explained from the main effects model for depression (F = 4.90, p<.028, ∆R2=3.0%) and the interaction term was significant (ß=-0.60, p=.029). An interaction effect of housing instability and social support on posttraumatic stress was not identified. LIMITATIONS: Although the current study is the first to examine protective factors in the relationship between housing instability and psychopathology in IPV-exposed pregnant women, data were cross-sectional and therefore directionality and temporality cannot be inferred. CONCLUSIONS: Results suggest that housing instability may play a greater role in women's depressed mood than in their experience of posttraumatic stress symptoms, and the presence of social support may substantially ameliorate the effect of this adversity.


Assuntos
Habitação , Violência por Parceiro Íntimo , Estudos Transversais , Feminino , Humanos , Saúde Mental , Gravidez , Gestantes
10.
Biol Lett ; 17(6): 20210171, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34186002

RESUMO

Mice are the most commonly used model organism for human biology, and failure to acknowledge fundamental differences in thermal biology between these species has confounded the study of adipose tissue metabolism in mice and its translational relevance to humans. Here, using exercise biochemistry as an example, we highlight the subtle yet detrimental effects sub-thermoneutral housing temperatures can have on the study of adipose tissue metabolism in mice. We encourage academics and publishers to consider ambient housing temperature as a key determinant in the methodological conception and reporting of all research on rodent white adipose tissue metabolism.


Assuntos
Tecido Adiposo Branco , Habitação , Aclimatação , Animais , Camundongos , Camundongos Endogâmicos C57BL , Temperatura
12.
BMC Public Health ; 21(1): 1128, 2021 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118916

RESUMO

BACKGROUND: Youth experiencing homelessness are at high risk for suicide, yet few studies have evaluated risk reduction interventions targeting suicidal ideation in this vulnerable population. A comprehensive approach to risk-reduction is needed that addresses basic needs and provides targeted interventions for those at highest risk. The protocol described builds on the design of the first randomized trial of Housing First (HF) for homeless youth. The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts). Additionally, we will explore mediators of the treatment effect (housing stability and substance use) and determinants of implementation. METHODS: Youth recruited to the HF trial will be randomized to HF + supportive services (n = 120), or supportive services alone (n = 120). The "Suicide Treatment Education and Prevention" (STEP) protocol will additionally screen youth in both arms at baseline and 3 months for suicidal ideation (SSI-W). Those who screen as moderate risk for suicide (SSI-W ≥ 10) will be offered CTSP, which includes up to 9 sessions over the first 6 months following enrollment. CTSP will be delivered in one-on-one sessions by a trained advocate. Research assessments will be collected to assess outcomes (including suicidal ideation) at baseline, 3, 6, 9 and 12 months. Qualitative interviews with subjects receiving CTSP and other stakeholders will explore implementation determinants. DISCUSSION: The study will fill an important gap in the literature about the added benefit of HF combined with supportive services including suicide screening and treatment for reducing suicidal ideation in homeless youth. With the urgent need to address both homelessness and suicide risk, evidence is needed about services that can be integrated into delivery settings for youth experiencing homelessness. TRIAL REGISTRATION: NCT04135703 . Date of registration: October 23, 2019.


Assuntos
Terapia Cognitivo-Comportamental , Pessoas em Situação de Rua , Adolescente , Habitação , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ideação Suicida , Tentativa de Suicídio
13.
AIDS ; 35(8): 1241-1246, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076613

RESUMO

OBJECTIVE: Homelessness is the greatest risk factor for HIV viremia in San Francisco. Innovative care models for people with HIV (PWH) with homelessness or unstable housing (HUH) are needed to address this inequity. We developed a novel low-barrier clinic-based program for PWH-HUH in an urban safety-net clinic ('POP-UP') and report outcomes on care engagement and viral suppression. DESIGN: A prospective cohort study. SETTING: San Francisco General Hospital HIV Clinic (Ward 86). PARTICIPANTS: We enrolled PWH who are HUH, viraemic and for whom usual care is not working (at least one missed primary care appointment and at least two drop-in visits at Ward 86 in the last year). INTERVENTION: POP-UP provides drop-in comprehensive primary care, housing assistance and case management, financial incentives and patient navigation with frequent contact. MAIN OUTCOME MEASURES: We describe uptake of eligible patients into POP-UP, and cumulative incidence of antiretroviral therapy (ART) initiation, return to care and virologic suppression 6 months post-enrolment, estimated via Kaplan--Meier. RESULTS: Out of 192 referred patients, 152 were eligible, and 75 enrolled. All 75 were off ART and viraemic; 100% had a substance use disorder; and 77% had a mental health diagnosis. Over three-quarters restarted ART within 7 days of enrolment, and 91% returned for follow-up within 90 days. The cumulative incidence of viral suppression at 6 months was 55% (95% confidence interval 43-68). CONCLUSION: A novel care model for PWH-HUH demonstrates early success in engaging viraemic patients in care and improving viral suppression. Low-barrier, high-contact primary care programmes offering comprehensive services and incentives may improve outcomes for this vulnerable population.


Assuntos
Infecções por HIV , Pessoas em Situação de Rua , Infecções por HIV/tratamento farmacológico , Habitação , Humanos , Estudos Prospectivos , São Francisco/epidemiologia , Carga Viral
14.
Soc Sci Med ; 281: 114096, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34126293

RESUMO

RATIONALE: Mental health and substance use disorders are strong risk factors for homelessness. Understanding the role of transdiagnostic factors could help inform efforts to reduce homelessness among veterans with a range of disorders. Homeless veterans have high rates of trauma exposure, which can result in the depletion of social and emotional resources that may contribute to housing and employment stability. In this study, we evaluated the role of problems with emotional lability and interpersonal closeness as transdiagnostic socio-emotional factors that might interfere with efforts to achieve housing and employment stability. METHODS: The sample consisted of 346 homeless veterans with co-occurring disorders that were admitted to a U.S. Department of Veterans Affairs (VA) residential treatment program between 2004 and 2009. Assessments were conducted at treatment entry (baseline) and two follow-up timepoints (6- and 12-months). Variables used in the current analyses included history of interpersonal trauma exposure, emotional lability and interpersonal closeness at baseline and 6-months, and homelessness and employment problems during follow-up. Data were analyzed using structural equation modeling and counterfactually-defined mediation effects. RESULTS: Veterans exposed to more trauma types experienced more baseline impairment and less improvement during treatment in emotional lability and interpersonal closeness. Problems with interpersonal closeness mediated 73% of the relationship between exposure to multiple traumas and homelessness, and 32%-61% of the relationship between trauma exposure and employment problems. Emotional lability mediated 36% of the relationship between exposure to multiple traumas and employment problems. Decomposition of indirect pathways revealed that indirect effects were primarily transmitted through changes during treatment, and not baseline levels. CONCLUSION: Findings support a cumulative effect of trauma on persistence of socio-emotional deficits across treatment, which increased risk of homelessness and employment problems during follow-up. Greater attention and more targeted efforts should be directed at helping trauma-exposed veterans build socio-emotional resources during treatment.


Assuntos
Pessoas em Situação de Rua , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Emprego , Habitação , Humanos , Tratamento Domiciliar , Estados Unidos/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34069214

RESUMO

Young adults are prone to psychological stress and anxiety induced by major transitions to adulthood. While employment has predominated in previous research on the social determinants of young people's mental health, this study examines the association between young people's housing problems and mental health in the context of an unaffordable housing market. Using the Survey on the Living Conditions and Welfare Needs of Youths (n = 1308) in Korea, the study found that perceived poor housing quality and material hardship are negatively associated with the mental health of young adults living independently. Specifically, while poor housing quality and material hardship induced by housing cost burden were negatively associated with single-person households' mental health, only poor housing quality was associated with non-single-person households' mental health. This study is one of the few studies examining the linkage between housing problems and mental health of young adults and informs the interventions aimed at promoting the psychological well-being of young adults in the transition from parents' homes to independent living.


Assuntos
Habitação , Saúde Mental , Adolescente , Adulto , Emprego , Humanos , Vida Independente , República da Coreia/epidemiologia , Adulto Jovem
16.
Trop Anim Health Prod ; 53(3): 348, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34095974

RESUMO

There are several factors that can directly or indirectly influence wool quality and quantity in sheep, the main elements being genetic and environmental factors. An experiment was conducted to assess the effect of different management/housing interventions during winter on wool quality and yield in Corriedale ewes. Forty healthy pregnant ewes were selected and divided into four groups (G1, G2, G3, G4) based on their body weight and parity. Throughout the study period, the groups G1 and G3 were reared inside the shed, while G2 and G4 were reared in an open shed with four-sided wire fencing and a roof shelter for direct rain/snow protection. The basic ration of all the four groups consisted of 1.25 kg roughage/head/day and 500 g concentrate/head/day. G3 and G4 were fed additional concentrate @ 100 g/head/day. Significant differences were observed in the crimp frequency, fibre diameter, fibre length and medullation percentage. G2 and G4 showed significantly (P < 0.05) higher fibre diameter but lower crimp frequency. Also, medullation percentage was significantly (P < 0.05) higher for G2. However, the studied rearing systems showed no significant differences for wool yield, staple length, scouring yield and burr content. The study concludes that the wool quality parameters observed in sheep, exposed to cold environment, meet most of the requirements of textile sector and thus can be reared in open houses without any adverse effects.


Assuntos
Habitação , , Animais , Peso Corporal , Feminino , Gravidez , Estações do Ano , Ovinos , Carneiro Doméstico
17.
J Environ Manage ; 293: 112818, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34087645

RESUMO

One of the essential environmental goods is water, thus, some governments have implemented policies that allow regulating and protecting this valuable resource. Additionally, it is necessary to understand the behaviour of people to its consumption. The objective of this paper is to determine which socioeconomic factors have a greater influence on water-saving practices in households in Ecuador and thus be able to recommend policy formulations that help to conserve it. The database for the Monitoring Survey for the National Development Plan applied by the National Institute of Statistics and Censuses [INEC] (December 2019) was used. The sections of the survey that were used to obtain the variables were: education, environmental information, housing, and household data. Furthermore, the econometric logit model was used to identify the factors that influence water-saving practices in the home and five main dependent variables were taken into account: closing the taps while soaping the dishes or doing other activities, showering for less than 10 min, using a bucket and not a hose for certain activities, checking pipes regularly and water reuse while the independent variables were grouped into two groups: socio-economic and environmental awareness and responsibility. The results show that the most significant determinant variables of water-saving practices for households in Ecuador are gender, marital status, homeownership, and the main finding is the variable of perception of environmental problems, which is significant in most of the proposed models. Finally, as a policy implication, in addition to the tax burden on water consumption, governments can implement campaigns that promote awareness, saving, and the proper use of this resource; laws can also be established that sanction the misuse of water.


Assuntos
Características da Família , Água , Equador , Habitação , Humanos , Fatores Socioeconômicos
18.
JAMA Netw Open ; 4(6): e2112862, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100935

RESUMO

Importance: Although there is evidence of more severe COVID-19 outcomes, there is no information describing the risk factors for COVID-19 diagnosis and/or mortality among people with intellectual and developmental disabilities (IDD) receiving residential support services in the US. Objective: To identify associations between demographic characteristics, residential characteristics, and/or preexisting health conditions and COVID-19 diagnosis and mortality for people with IDD receiving residential support services. Design, Setting, and Participants: This cohort study tracked COVID-19 outcomes for 543 individuals with IDD. Participants were receiving support services from a single organization providing residential services in the 5 boroughs of New York City from March 1 to October 1, 2020. Statistical analysis was performed from December 2020 to February 2021. Exposures: Resident-level characteristics, including age, sex, race/ethnicity, disability status, residential characteristics, and preexisting medical conditions. Main Outcomes and Measures: COVID-19 diagnosis was confirmed by laboratory test. COVID-19 mortality indicated that the individual died from COVID-19 during the course of the study. Logistic regression models were used to evaluate associations between demographic characteristics, residential characteristics, and preexisting health conditions and COVID-19 diagnosis and mortality. Results: Among the 543 individuals with IDD in the study, the median (interquartile range) age was 57.0 (45-65) years; 217 (40.0%) were female, and 274 (50.5%) were Black, Asian/Pacific Islander, American Indian or Alaskan Native, or Hispanic. The case rate was 16 759 (95% CI, 13 853-20 131) per 100 000; the mortality rate was 6446 (95% CI, 4671-8832) per 100 000; and the case-fatality rate was 38.5% (95% CI, 29.1%-48.7%). Increased age (odds ratio [OR], 1.04; 95% CI, 1.02-1.06), Down syndrome (OR, 2.91; 95% CI, 1.49-5.69), an increased number of residents (OR, 1.07; 95% CI, 1.00-1.14), and chronic kidney disease (OR, 4.17; 95% CI, 1.90-9.15) were associated with COVID-19 diagnosis. Heart disease (OR, 10.60; 95% CI, 2.68-41.90) was associated with COVID-19 mortality. Conclusions and Relevance: This study found that, similar to the general population, increased age and preexisting health conditions were associated with COVID-19 outcomes for people with IDD receiving residential support services in New York City. As with older adults living in nursing homes, number of residents was also associated with more severe COVID-19 outcomes. Unique to people with IDD was an increased risk of COVID-19 diagnosis for people with Down syndrome.


Assuntos
COVID-19/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Deficiência Intelectual/epidemiologia , Pandemias , Instituições Residenciais , Fatores Etários , Idoso , COVID-19/mortalidade , Causas de Morte , Estudos de Coortes , Comorbidade , Síndrome de Down , Grupos Étnicos , Feminino , Habitação , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Razão de Chances , Fatores de Risco , SARS-CoV-2
19.
JAMA Netw Open ; 4(6): e2113031, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34106264

RESUMO

Importance: The US Department of Veterans Affairs (VA) offers programs that reduce barriers to care for veterans and those with housing instability, poverty, and substance use disorder. In this setting, however, the role that social and behavioral risk factors play in COVID-19 outcomes is unclear. Objective: To examine whether social and behavioral risk factors were associated with mortality among US veterans with COVID-19 and whether this association might be modified by race/ethnicity. Design, Setting, and Participants: This cohort study obtained data from the VA Corporate Data Warehouse to form a cohort of veterans who received a positive COVID-19 test result between March 2 and September 30, 2020, in a VA health care facility. All veterans who met the inclusion criteria were eligible to participate in the study, and participants were followed up for 30 days after the first SARS-CoV-2 or COVID-19 diagnosis. The final follow-up date was October 31, 2020. Exposures: Social risk factors included housing problems and financial hardship. Behavioral risk factors included current tobacco use, alcohol use, and substance use. Main Outcomes and Measures: The primary outcome was all-cause mortality in the 30-day period after the SARS-CoV-2 or COVID-19 diagnosis date. Multivariable logistic regression was used to estimate odds ratios, clustering for health care facilities and adjusting for age, sex, race, ethnicity, marital status, clinical factors, and month of COVID-19 diagnosis. Results: Among 27 640 veterans with COVID-19 who were included in the analysis, 24 496 were men (88.6%) and the mean (SD) age was 57.2 (16.6) years. A total of 3090 veterans (11.2%) had housing problems, 4450 (16.1%) had financial hardship, 5358 (19.4%) used alcohol, and 3569 (12.9%) reported substance use. Hospitalization occurred in 7663 veterans (27.7%), and 1230 veterans (4.5%) died. Housing problems (adjusted odds ratio [AOR], 0.96; 95% CI, 0.77-1.19; P = .70), financial hardship (AOR, 1.13; 95% CI, 0.97-1.31; P = .11), alcohol use (AOR, 0.82; 95% CI, 0.68-1.01; P = .06), current tobacco use (AOR, 0.85; 95% CI, 0.68-1.06; P = .14), and substance use (AOR, 0.90; 95% CI, 0.71-1.15; P = .41) were not associated with higher mortality. Interaction analyses by race/ethnicity did not find associations between mortality and social and behavioral risk factors. Conclusions and Relevance: Results of this study showed that, in an integrated health system such as the VA, social and behavioral risk factors were not associated with mortality from COVID-19. Further research is needed to substantiate the potential of an integrated health system to be a model of support services for households with COVID-19 and populations who are at risk for the disease.


Assuntos
COVID-19/mortalidade , Habitação , Pandemias , Pobreza , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Adulto , Idoso , Consumo de Bebidas Alcoólicas , COVID-19/etnologia , Estudos de Coortes , Grupos de Populações Continentais , Grupos Étnicos , Feminino , Pessoas em Situação de Rua , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , SARS-CoV-2 , Uso de Tabaco , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
20.
PLoS One ; 16(6): e0251580, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34181650

RESUMO

This mixed-method study examined the experiences of college students during the COVID-19 pandemic through surveys, experience sampling data collected over two academic quarters (Spring 2019 n1 = 253; Spring 2020 n2 = 147), and semi-structured interviews with 27 undergraduate students. There were no marked changes in mean levels of depressive symptoms, anxiety, stress, or loneliness between 2019 and 2020, or over the course of the Spring 2020 term. Students in both the 2019 and 2020 cohort who indicated psychosocial vulnerability at the initial assessment showed worse psychosocial functioning throughout the entire Spring term relative to other students. However, rates of distress increased faster in 2020 than in 2019 for these individuals. Across individuals, homogeneity of variance tests and multi-level models revealed significant heterogeneity, suggesting the need to examine not just means but the variations in individuals' experiences. Thematic analysis of interviews characterizes these varied experiences, describing the contexts for students' challenges and strategies. This analysis highlights the interweaving of psychosocial and academic distress: Challenges such as isolation from peers, lack of interactivity with instructors, and difficulty adjusting to family needs had both an emotional and academic toll. Strategies for adjusting to this new context included initiating remote study and hangout sessions with peers, as well as self-learning. In these and other strategies, students used technologies in different ways and for different purposes than they had previously. Supporting qualitative insight about adaptive responses were quantitative findings that students who used more problem-focused forms of coping reported fewer mental health symptoms over the course of the pandemic, even though they perceived their stress as more severe. These findings underline the need for interventions oriented towards problem-focused coping and suggest opportunities for peer role modeling.


Assuntos
COVID-19/psicologia , Habitação , Estudantes/psicologia , Universidades/estatística & dados numéricos , Adolescente , Adulto , Ansiedade/epidemiologia , COVID-19/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Educação à Distância/estatística & dados numéricos , Feminino , Humanos , Solidão , Masculino , Angústia Psicológica , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
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