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1.
Sports Health ; 13(1): 18-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32716762

RESUMO

BACKGROUND: Current research on concussion incidence in youth athletes (age <18 years) is small and limited by variability in injury reporting and diagnostic methodology. HYPOTHESIS: Concussion injuries commonly occur in high school sports programs. The likelihood of concussion among student-athletes (aged 13-18 years) depends on the sport they are participating in as well as the sex of the athlete. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 4. METHODS: A retrospective analysis of all Hawaii high school athletes aged 13 to 18 years participating in 14 sports from 2011 through 2017 was performed as part of a statewide standardized concussion assessment and management program. RESULTS: A total of 5993 concussions were identified among 92,966 athletes. The overall concussion rate was 0.96 (95% CI, 0.94-0.99). Girls' judo had the highest concussion rate (1.92; 95% CI, 1.68-2.17) followed by football (1.60; 95% CI, 1.53-1.66). The concussion rate for boys (1.0; 95% CI, 0.97-1.03) was higher than that for girls (0.91; 95% CI, 0.87-0.95); however, in 4 of the 5 sports in which both girls and boys participated, girls had a higher rate of concussion injury. CONCLUSION: The likelihood of concussion among student-athletes aged 13 to 18 years may be higher than previously thought and varies depending on sport and sex. CLINICAL RELEVANCE: Epidemiologic data on concussion injury in children and adolescents are useful in accurately determining the relative risks of high school sports participation and may be valuable in determining the appropriate allocation of health care and scholastic resources for student-athletes, as well as the impact of rule and training modifications designed to improve participant safety.


Assuntos
Concussão Encefálica/epidemiologia , Esportes Juvenis/lesões , Adolescente , Feminino , Futebol Americano/lesões , Hawaii/epidemiologia , Humanos , Incidência , Masculino , Artes Marciais/lesões , Estudos Retrospectivos , Instituições Acadêmicas , Distribuição por Sexo , Futebol/lesões
2.
Hawaii J Health Soc Welf ; 79(9): 268-271, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32914093

RESUMO

Infections with the SARS-CoV-2 virus are increasing in Hawai'i at alarming rates. In the absence of a SARS-CoV-2 virus vaccine, the options for control include social distancing, improved hygiene, and face mask use. There is evidence that mask use may decrease the rates of viral transmission. The rate of effective face mask use has not yet been established in Hawai'i. The authors performed an observational study at 2 locations in Honolulu and evaluated outdoor face mask use compliance in 200 people. Simultaneous observations were performed in a downtown Honolulu business area and in Waikiki, an area focusing on tourism. Overall, 77% of all subjects used face masks in an appropriate fashion, covering their nose and mouth, while 23% were either incorrectly masked or not masked. The rate of compliance with correct public mask use in downtown Honolulu (88%) was significantly higher than in Waikiki (66%) (P=.0003, Odds Ratio [95% Confidence Interval]=3.78 [1.82, 7.85]) These findings suggest that there are opportunities for improvement in rates of public face mask use and a potential decrease in the spread of COVID-19 in our population. Four proposed actions are suggested, including a reassessment of the face mask exemption requirements, enhanced mask compliance education, non-threatening communication for non-compliance, and centralization of information of the public compliance with face mask use.


Assuntos
Infecções por Coronavirus/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Política Pública , Infecções por Coronavirus/epidemiologia , Geografia , Hawaii/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
J Perinat Med ; 48(9): 1013-1016, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32692706

RESUMO

COVID-19 pandemic is changing profoundly the obstetrics and gynecology (OB/GYN) academic clinical learning environment in many different ways. Rapid developments affecting our learners, patients, faculty and staff require unprecedented collaboration and quick, deeply consequential readjustments, almost on a daily basis. We summarized here our experiences, opportunities, challenges and lessons learned and outline how to move forward. The COVID-19 pandemic taught us there is a clear need for collaboration in implementing the most current evidence-based medicine, rapidly assess and improve the everchanging healthcare environment by problem solving and "how to" instead of "should we" approach. In addition, as a community with very limited resources we have to rely heavily on internal expertise, ingenuity and innovation. The key points to succeed are efficient and timely communication, transparency in decision making and reengagement. As time continues to pass, it is certain that more lessons will emerge.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ginecologia/educação , Obstetrícia/educação , Pandemias , Pneumonia Viral/epidemiologia , Estágio Clínico , Currículo , Assistência à Saúde/tendências , Medicina Baseada em Evidências , Bolsas de Estudo , Feminino , Hawaii/epidemiologia , Humanos , Internato e Residência , Gravidez , Estudantes de Medicina
7.
Appl Environ Microbiol ; 86(17)2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32591375

RESUMO

Clinical surveillance of enteric pathogens like Salmonella is integral to track outbreaks and endemic disease trends. However, clinic-centered disease monitoring biases toward detection of severe cases and underestimates the incidence of self-limiting gastroenteritis and asymptomatic strains. Monitoring pathogen loads and diversity in municipal wastewater (MW) can provide insight into asymptomatic or subclinical infections which are not reflected in clinical cases. Subclinical infection patterns may explain the unusual observation from a year-long sampling campaign in Hawaii: Salmonella enterica serovar Derby was the most abundant pulsotype in MW but was detected infrequently in clinics over the sampling period. Using whole-genome sequencing data of Salmonella isolates from MW and public databases, we demonstrate that the Derby serovar has lower virulence potential than other clinical serovars, particularly based on its reduced profile of genes linked with immune evasion and symptom production, suggesting its potential as a subclinical salmonellosis agent. Furthermore, MW had high abundance of a rare Derby sequence type (ST), ST-72 (rather than the more common ST-40). ST-72 isolates had higher frequencies of fimbrial adherence genes than ST-40 isolates; these are key virulence factors involved in colonization and persistence of infections. However, ST-72 isolates lack the Derby-specific Salmonella pathogenicity island 23 (SPI-23), which invokes host immune responses. In combination, ST-72's genetic features may lead to appreciable infection rates without obvious symptom production, allowing for subclinical persistence in the community. This study demonstrated wastewater's capability to provide community infectious disease information-such as background infection rates of subclinical enteric illness-which is otherwise inaccessible through clinical approaches.IMPORTANCE Wastewater-based epidemiology (WBE) has been conventionally used to analyze community health via the detection of chemicals, such as legal and illicit drugs; however, municipal wastewater contains microbiological determinants of health and disease as well, including enteric pathogens. Here, we demonstrate that WBE can be used to examine subclinical community salmonellosis patterns. Derby was the most abundant Salmonella serovar detected in Hawaii wastewater over a year-long sampling study, with few corresponding clinical cases. Comparative genomics analyses indicate that the normally rare strain of S Derby found in wastewater has a unique combination of genes which allow it to persist as a subclinical infection without producing symptoms of severe gastroenteritis. This study shows that WBE can be used to explore trends in community infectious disease patterns which may not be reflected in clinical monitoring, shedding light on overall enteric disease burden and rates of asymptomatic cases.


Assuntos
Monitoramento Epidemiológico , Infecções por Salmonella/epidemiologia , Salmonella enterica/isolamento & purificação , Águas Residuárias/microbiologia , Hawaii/epidemiologia , Humanos , Infecções por Salmonella/microbiologia , Sorogrupo
8.
Am J Kidney Dis ; 76(3): 340-349.e1, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32387021

RESUMO

RATIONALE & OBJECTIVE: Native Hawaiians and Pacific Islanders (NHPI) have been reported to have the highest rates of incident end-stage kidney disease (ESKD) compared with other races in the United States. However, these estimates were likely biased upward due to the exclusion of nearly half the NHPI population that reports multiple races in the US Census. We sought to estimate the incidence rate of ESKD, including individuals reporting multiple races, and describe the clinical characteristics of incident cases by race and location. STUDY DESIGN: Health care database study. SETTING & PARTICIPANTS: US residents of the 50 states and 3 Pacific Island territories of the United States whose ESKD was recorded in the US Renal Data System (USRDS) between 2007 and 2016, as well as US residents recorded in the 2010 Census. PREDICTORS: Age, sex, race, body mass index, primary cause of ESKD, comorbid conditions, estimated glomerular filtration rate, pre-ESKD nephrology care, and hemoglobin A1c level among ESKD cases. OUTCOME: Initiation of maintenance dialysis or transplantation for kidney failure. ANALYTICAL APPROACH: Crude ESKD incidence rates (cases/person-years) were estimated using both single- and multiple-race reporting. RESULTS: Even after inclusion of multirace reporting, NHPI had the highest ESKD incidence rate among all races in the 50 states (921 [95% CI, 904-938] per million population per year)-2.7 times greater than whites and 1.2 times greater than blacks. Also using multirace reporting, the NHPI ESKD incident rate in the US territories was 941 (95% CI, 895-987) per million population per year. Diabetes was listed as the primary cause of ESKD most frequently for NHPI and American Indians/Alaska Natives. Sensitivity analysis adjusting for age and sex demonstrated greater differences in rates between NHPI and other races. Diabetes was the primary cause of ESKD in 60% of incident NHPI cases. Patients with ESKD living in the territories had received less pre-ESKD nephrology care than had patients living in the 50 states. LIMITATIONS: Different methods of race classification in the USRDS versus the US Census. CONCLUSIONS: NHPI living in the 50 US states and Pacific territories had the highest rates of ESKD incidence compared with other races. Further research and efforts are required to understand the reasons for and define how best to address this racial disparity.


Assuntos
Falência Renal Crônica/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto , Idoso , Índice de Massa Corporal , Comorbidade , Nefropatias Diabéticas/etnologia , Feminino , Taxa de Filtração Glomerular , Hemoglobina A Glicada/análise , Hawaii/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ilhas do Pacífico/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
9.
Hawaii J Health Soc Welf ; 79(4): 104-111, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32328581

RESUMO

Proactive health behavior change and maintenance are essential for preventing obesity and other lifestyle diseases. Few studies have examined the relationship between eating behavior and physical condition among multiethnic samples. In this study, ethnic differences were examined to obtain basic data on health education for improvement of obesity in Hawai'i. The intake of fruits and vegetables and exercise habits in each of the transtheoretical model stages of change were evaluated in the 4 most populous ethnic groups in Hawai'i in terms of how the participants' health behaviors were associated with obesity. The participants comprised 2795 white, Native Hawaiian, Filipino, and Japanese adults (age range, 18-55 years). There are 4 main findings of this study. First, there were differences in fruit and vegetable intake and exercise habits in each transtheoretical model stage among the ethnic groups. Second, there were differences in attitudes regarding nutrition and healthy food intake and self-efficacy regarding exercise in each ethnic group. Third, items that have the potential to improve obesity in the theory of planned behavior differed, particularly among men, in the 4 ethnic groups. Finally, a low percentage of participants recognized that the recommended number of servings of fruits and vegetables was 5 or more. Education for men may be particularly important. The findings indicate that modified health education approaches may be needed in accordance with the ethnicity of the population.


Assuntos
Dieta Saudável/estatística & dados numéricos , Exercício Físico , Comportamentos Relacionados com a Saúde , Obesidade/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Grupos Étnicos/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Adulto Jovem
10.
South Med J ; 113(3): 125-129, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32123927

RESUMO

OBJECTIVES: There is limited evidence for the use of salt tablets in the treatment of hyponatremia. This retrospective study evaluated the effectiveness of salt tablet administration in euvolemic hyponatremia. METHODS: This was a single-center, retrospective cohort study. Information on patients' demographics, clinical characteristics, and laboratory data were collected for retrospective review. Treatment for hyponatremia, including the amount of salt tablets, fluid restriction, and diuretics was collected. We compared hyponatremic patients with those who received salt tablets versus those who did not receive salt tablets. The primary outcome of interest was the change in serum sodium at 48 hours between the two groups. RESULTS: A total of 1258 medical records were initially screened with inclusion and exclusion criteria. After screening, there were 83 patients included in the study. Forty-two patients received salt tablets and 41 patients were in the group that did not receive salt tablets. Patients treated with salt tablets were older, more often female, and had lower body weight and lower initial serum sodium. The change in serum sodium after 48 hours was higher in the salt tablet group (5.2 mEq/L) than the non-salt tablet group (3.1 mEq/L; P < 0.001). This difference in serum sodium between the two groups remained statistically significant when adjusted for age, sex, weight, and initial serum sodium. CONCLUSIONS: The use of salt tablets in the treatment of euvolemic hyponatremia is associated with a small but significant improvement in serum sodium compared with patients who did not receive such therapy, even after adjusting for age, sex, weight, and initial serum sodium. This study supports the effectiveness of salt tablets in the treatment of euvolemic hyponatremia in medical patients.


Assuntos
Hiponatremia/tratamento farmacológico , Cloreto de Sódio/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hawaii/epidemiologia , Humanos , Hiponatremia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cloreto de Sódio/normas , Resultado do Tratamento
11.
Public Health ; 182: 13-18, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32120066

RESUMO

OBJECTIVES: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. STUDY DESIGN: This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. METHODS: Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. RESULTS: Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. CONCLUSIONS: Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Pequim/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Filipinas/epidemiologia , Prevalência , Estudos Retrospectivos , Tuberculose/microbiologia , Adulto Jovem
12.
Acta Trop ; 204: 105364, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32007445

RESUMO

Haemosporidian parasites of the genera Plasmodium, Leucocytozoon, and Haemoproteus are one of the most prevalent and widely studied groups of parasites infecting birds. Plasmodium is the most well-known haemosporidian as the avian parasite Plasmodium relictum was the original transmission model for human malaria and was also responsible for catastrophic effects on native avifauna when introduced to Hawaii. The past two decades have seen a dramatic increase in research on avian haemosporidian parasites as a model system to understand evolutionary and ecological parasite-host relationships. Despite haemosporidians being one the best studied groups of avian parasites their specialization among avian hosts and variation in prevalence amongst regions and host taxa are not fully understood. In this review we focus on describing the current phylogenetic and morphological diversity of haemosporidian parasites, their specificity among avian and vector hosts, and identifying the determinants of haemosporidian prevalence among avian species. We also discuss how these parasites might spread across regions due to global climate change and the importance of avian migratory behavior in parasite dispersion and subsequent diversification.


Assuntos
Malária Aviária/epidemiologia , Plasmodium/classificação , Animais , Aves/parasitologia , Mudança Climática , Ecologia , Haemosporida/classificação , Hawaii/epidemiologia , Interações Hospedeiro-Parasita , Malária Aviária/parasitologia , Filogenia , Plasmodium/fisiologia , Prevalência
13.
Arch Gerontol Geriatr ; 88: 104015, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32007644

RESUMO

A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.


Assuntos
Ansiedade , Nível de Saúde , Resiliência Psicológica , Idoso , Envelhecimento , Ansiedade/epidemiologia , China/epidemiologia , Hawaii/epidemiologia , Humanos
14.
Public Health Rep ; 135(2): 230-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040922

RESUMO

OBJECTIVES: From September 2015 through March 2016, Hawaii had the largest outbreak of locally transmitted dengue since 1944. We report on the Hawaii Department of Health's (HDOH's) investigation, findings, and response to the outbreak. METHODS: We defined cases of dengue using a modified version of the Council of State and Territorial Epidemiologists' case definition for dengue virus infections. We conducted epidemiologic investigations, including interviews with case-persons, review of medical records, laboratory testing, genetic sequencing of specimens, and geographic information system (GIS) data analysis. Outbreak response included community outreach and vector-control activities. RESULTS: We identified 264 confirmed cases of dengue; illness onset dates ranged from September 11, 2015, to March 17, 2016, all with reported travel to or residence on the Island of Hawaii. Of 264 persons with confirmed dengue, 238 (90.2%) were Hawaii residents. Thirty-seven (14.0%) persons required hospitalization; no cases of severe dengue or death were reported. GIS hot-spot analysis identified a cluster of cases on the western side of the island. Established risk factors for dengue exposure included holes in window or door screens, presence of standing water, and not using insect repellent or wearing protective clothing. CONCLUSIONS: To prevent or mitigate the spread of future arboviral introductions and outbreaks, the public health response should focus on behavioral and cultural attitudes, emphasizing personal mosquito protection and mosquito control at the community level. Outbreak responses can also be enhanced through the use of advanced GIS techniques, such as hot-spot analysis, to provide situational awareness and guide response efforts.


Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dengue/transmissão , Vírus da Dengue/genética , Feminino , Sistemas de Informação Geográfica , Hawaii/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Imunoglobulina M/imunologia , Lactente , Masculino , Pessoa de Meia-Idade , Controle de Mosquitos/métodos , Mosquitos Vetores , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Viagem
15.
Am J Trop Med Hyg ; 102(4): 869-875, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32043443

RESUMO

A dengue outbreak occurred on Hawaii Island between September 2015 and March 2016. Entomological investigations were undertaken between December 2015 and February 2016 to determine which Aedes mosquito species were responsible for the outbreak. A total of 3,259 mosquitoes were collected using a combination of CDC autocidal gravid ovitraps, Biogents BG-Sentinel traps, and hand-nets; immature mosquitoes were collected during environmental surveys. The composition of species was Aedes albopictus (58%), Aedes aegypti (25%), Wyeomyia mitchelli (7%), Aedes vexans (5%), Culex quinquefasciatus (4%), and Aedes japonicus (1%). Adult mosquitoes were analyzed by real-time reverse transcription polymerase chain reaction (PCR) for the presence of dengue virus (DENV) RNA. Of the 185 pools of female mosquitoes tested, 15 containing Ae. albopictus were positive for the presence of DENV type 1 RNA. No virus was detected in pools of the remaining species. Phylogenetic analysis showed the virus strain belonged to genotype I and was closely related to strains that were circulating in the Pacific between 2008 and 2014. This is the first report of detection of DENV in Ae. albopictus from Hawaii.


Assuntos
Aedes/virologia , Vírus da Dengue/classificação , Dengue/epidemiologia , Dengue/virologia , Surtos de Doenças , Animais , Dengue/genética , Feminino , Hawaii/epidemiologia , Humanos , Filogenia
16.
Hawaii J Health Soc Welf ; 79(2): 42-50, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32047874

RESUMO

Breastfeeding provides optimal nutrition for infants, including short- and longterm health benefits for baby and mother. Maternity care practices supporting breastfeeding after delivery increase the likelihood of exclusive breastfeeding. This study explores trends in early infant feeding practices by maternal race and other characteristics in Hawai'i. Data from a linked 2008-2015 Hawai'i Newborn Metabolic Screening and Birth Certificate file for 128 399 singleton term infants were analyzed. Early infant feeding occurring 24-48 hours after delivery and before discharge was categorized: Early formula feeding; early mixed feeding; and early exclusive breastfeeding. Differences were assessed over time by maternal race and other socio-demographic characteristics. Further assessment of maternal race included a generalized logit model adjusting for maternal age, marital status, county of residence, type of birth attendant, and birth year. Statewide, early exclusive breastfeeding increased from 58.8% in 2008 to 79.1% in 2015 (relative increase=+35%); early mixed feeding declined from 31.1% to 16.0% (relative decrease=-49%) and early formula feeding declined from 10.1% to 4.9% (relative decrease=-51%). Most maternal race subgroups experienced increases in early exclusive breastfeeding and decreases in mixed and formula. Japanese mothers were 2.15 (95%CI=1.90-2.42) and Korean mothers were 1.73 (95%CI=1.37-2.18) times more likely to practice early exclusive breastfeeding compared with white mothers. Several subgroups were less likely to practice early exclusive breastfeeding compared with white mothers. Substantial increases in early exclusive breastfeeding in Hawai'i occurred across all subgroups. Development of culturally appropriate hospital practices, particularly in those with persistently lower estimates, could help improve early exclusive breastfeeding.


Assuntos
Alimentação Artificial/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Adulto , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Adulto Jovem
17.
Cancer Epidemiol ; 65: 101685, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32058311

RESUMO

BACKGROUND: This study investigated the association of breast lobular involution status and three inflammatory markers as predictors of survival among breast cancer patients in the Multiethnic Cohort. METHODS: Lobular involution was evaluated in tissue sections of normal breast tissue and COX-2, TNF-α, and TGF-ß proteins were assessed by immunohistochemistry in tumor microarrays. A summary score added the expression levels of the three markers. Cox regression was applied to estimate hazard ratios (HRs) and 95 % confidence intervals (CI) with age as the time metric and adjustment for factors known to affect mortality. RESULTS: Among 254 women (mean age = 61.7 ± 8.7 years) with pathologic blocks and follow-up information, 54 all-cause and 10 breast cancer-specific deaths were identified after a mean follow-up time of 16.0 ± 3.1 years. For 214 participants, an inflammatory score was available and 157 women had information on lobular involution. Lobular involution was not significantly associated with survival. Expression of both COX-2 and TNF-α were significant predictors of lower survival (p = 0.02 and 0.04), while the association for TGF-ß was weaker (p = 0.09). When combined into one overall inflammation score, both intermediate (HR = 2.72; 95 % CI 0.90-8.28) and high (HR = 4.21; 95 % CI 1.51-11.8) scores were associated with higher mortality but only the latter was statistically significant. No significant association with breast cancer-specific mortality was detected. CONCLUSIONS: These results suggest that strong expression of inflammatory markers in breast tissue predicts a poorer prognosis possibly due to a system-wide state of chronic inflammation.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias Inflamatórias Mamárias/mortalidade , Neoplasias Inflamatórias Mamárias/patologia , Neoplasias da Mama/etnologia , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Humanos , Inflamação/patologia , Neoplasias Inflamatórias Mamárias/etnologia , Pessoa de Meia-Idade , Análise de Sobrevida
18.
Obesity (Silver Spring) ; 28(1): 55-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858739

RESUMO

OBJECTIVE: The aim of this study was to examine the association of county-level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program. METHODS: In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross-sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months. RESULTS: A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers' market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (ß = 0.02 visits at 12 months; P = 0.002). CONCLUSIONS: Consideration of a participant's county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs.


Assuntos
Planejamento Ambiental/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Parques Recreativos/provisão & distribução , Recreação/fisiologia , Veteranos/estatística & dados numéricos , Programas de Redução de Peso , Adulto , Idoso , Alaska/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Frutas/provisão & distribução , Hawaii/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Parques Recreativos/estatística & dados numéricos , Filipinas/epidemiologia , Porto Rico/epidemiologia , Características de Residência/estatística & dados numéricos , Verduras/provisão & distribução , Programas de Redução de Peso/estatística & dados numéricos
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