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1.
Am J Phys Anthropol ; 170(1): 116-130, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31194271

RESUMO

OBJECTIVES: Intersectionality theory argues that various categories of identity and forms of systemic oppression interact and produce inequalities in resource access, economic opportunities, and health outcomes. However, there has been little explicit engagement with this theory by bioarchaeologists examining disparate health outcomes in the past. This study examines the associations among frailty, age at death, sex, and socioeconomic status (SES) in 18th- and 19th-century England. MATERIALS AND METHODS: The sample for this study comes from four industrial-era cemeteries from England, ca. 1711-1857. The associations among adult age (18+ years), SES, sex, and three skeletal indicators of stress (dental enamel hypoplasia [DEH, n = 293], cribra orbitalia [CO, n = 457], periosteal lesions [PNB, n = 436]) are examined using hierarchical log-linear analysis. RESULTS: Significant interactions existed among the variables examined for two skeletal indicators: high SES females had lower frequencies of CO relative to other groups and males between ages 30-45 years exhibited higher frequencies of PNB compared to females or males of older or younger ages, regardless of SES. Additionally, sex and SES were consistently associated with age at death. CONCLUSIONS: These results suggest that patterns of stress indicators cannot be examined solely across unilateral axes of age, SES, or sex. Intersecting axes of privilege, marginalization, and structural oppression may have buffered high SES females from some negative health outcomes (CO) while predisposing them to others (risk of maternal mortality). Likewise, the hazardous working conditions relegated to adult males may have heightened the risk of injury, infection, and death for middle-aged men in industrial-era England.


Assuntos
Fragilidade , Desenvolvimento Industrial/história , Paleopatologia , Adolescente , Adulto , Determinação da Idade pelo Esqueleto , Idoso , Doenças Ósseas Metabólicas/patologia , Osso e Ossos/patologia , Hipoplasia do Esmalte Dentário/patologia , Inglaterra/etnologia , Feminino , Fragilidade/etnologia , Fragilidade/história , Fragilidade/patologia , História do Século XVIII , História do Século XIX , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Dente/patologia , Adulto Jovem
2.
Am J Phys Anthropol ; 169(1): 104-121, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30851130

RESUMO

OBJECTIVE: Stark health inequalities exist in the present day between the North and South of England, with people in the South, overall, experiencing better health across a range of parameters (e.g., life expectancy and number of years spent in good health). Bioarchaeological studies of skeletal remains from cemeteries across this geographical divide have the ability to provide a temporal perspective on the etiology, longevity, and nature of this disparity. METHODS: In total 574 non-adults (0-17 years) from six urban sites (c. AD 1711-1856) were analyzed from the North and South of England. Measurements of long bone length, cortical thickness, and vertebral dimensions were analyzed alongside both skeletal and dental palaeopathological data to assess patterns of disease and growth disruption between skeletal samples. RESULTS: There were few significant differences in growth parameters between the six sites in relation to geographical location. However, the northern-based sample Coach Lane (North Shields) demonstrated some of the highest rates of pathology, with metabolic disease being particularly prevalent. DISCUSSION: Northern and southern populations suffered alike from the detrimental environmental conditions associated with urban centers of the 18th-19th centuries. However, the elevated prevalence of vitamin D deficiency seen within the Coach Lane sample is indicative of a regionally specific risk that may be related to latitude, and/or the influence of particular industries operating in the North-East.


Assuntos
Estatura/etnologia , Desenvolvimento Infantil/fisiologia , Saúde da Criança , Adolescente , Criança , Saúde da Criança/etnologia , Saúde da Criança/história , Pré-Escolar , Hipoplasia do Esmalte Dentário , Inglaterra/etnologia , Fêmur/anatomia & histologia , História do Século XVIII , História do Século XIX , Humanos , Indústrias/história , Lactente , Paleopatologia , Coluna Vertebral/anatomia & histologia , Estresse Fisiológico , Dente/anatomia & histologia , Deficiência de Vitamina D
3.
BMC Infect Dis ; 19(1): 26, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616539

RESUMO

BACKGROUND: Transmission patterns in high tuberculosis incidence areas in England are poorly understood but need elucidating to focus contact tracing. We study transmission within and between age, ethnic and immigrant groups using molecular data from the high incidence West Midlands region. METHODS: Isolates from culture-confirmed tuberculosis cases during 2007-2011 were typed using 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats (MIRU-VNTR). We estimated the proportion of disease attributable to recent transmission, calculated the proportion of isolates matching those from the two preceding years ("retrospectively clustered"), and identified risk factors for retrospective clustering using multivariate analyses. We calculated the ratio (RCR) between the observed and expected proportion clustered retrospectively within or between age, ethnic and immigrant groups. RESULTS: Of the 2159 available genotypes (79% of culture-confirmed cases), 34% were attributed to recent transmission. The percentage retrospectively clustered decreased from 50 to 24% for 0-14 and ≥ 65 year olds respectively (p = 0.01) and was significantly lower for immigrants than the UK-born. Higher than expected clustering occurred within 15-24 year olds (RCR: 1.4 (95% CI: 1.1-1.8)), several ethnic groups, and between UK-born or long-term immigrants with the UK-born (RCR: 1.8 (95% CI: 1.1-2.4) and 1.6 (95% CI: 1.2-1.9) respectively). CONCLUSIONS: This study is the first to consider "who clusters with whom" in a high incidence area in England, laying the foundation for future whole-genome sequencing work. The higher than expected clustering seen here suggests that preferential mixing between some age, ethnic and immigrant groups occurs; prioritising contact tracing to groups with which cases are most likely to cluster retrospectively could improve TB control.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Emigrantes e Imigrantes , Inglaterra/epidemiologia , Inglaterra/etnologia , Grupos Étnicos , Feminino , Genótipo , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Epidemiologia Molecular , Análise Multivariada , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Tuberculose/microbiologia
4.
Aging Ment Health ; 23(2): 173-182, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29206481

RESUMO

BACKGROUND: South Asian older adults are represented less frequently in mainstream mental health services or those for people with dementia. This study aimed to explore in detail the perceptions of dementia (symptoms, causes, consequences, treatments) held by South Asians and to discern how these understandings vary by age and by the self-recognition of memory problems, as these influence help-seeking behaviour. METHODS: Participants were allocated to three groups: younger adults; older adults; and older adults with subjective memory problems. They completed the semi-structured Barts Explanatory Model Inventory for Dementia schedule, whilst older adults also completed measures of cognition (MMSE), and depression (GDS). Interviews were conducted in English, Gujarati or Urdu. RESULTS: Groups were similar in identifying unusual forgetting and confusion as the most frequent symptoms; stress and age as the most frequent causes; and talking to your GP/nurse, taking medication, and talking to family and friends as the most frequent treatments. Younger adults more often knew about risk factors and reported practical consequences more than older adults. Older adults with subjective memory problems were more likely to describe sleep related problems or symptoms commonly associated with depression. They more often cited as causes of dementia lack of sleep, side effects of medication and medical reasons, and mentioned religion as a means to cope. CONCLUSIONS: Findings highlight variability in perceptions of dementia across the South Asian Community and identify specific areas where dementia awareness could be raised in South Asian sub-groups to improve timely diagnosis, treatment outcomes and service access.


Assuntos
Demência/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Transtornos da Memória/etnologia , Adulto , Idoso , Inglaterra/etnologia , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Paquistão/etnologia , Fatores de Risco
5.
Ethn Dis ; 28(Suppl 2): 485-492, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30202202

RESUMO

Objective: To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families. Design: Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders. Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK. Participants: African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7). Results: According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes. Conclusions: Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.


Assuntos
Assistência à Saúde Culturalmente Competente , Saúde da Família/etnologia , Serviços de Saúde Mental , Melhoria de Qualidade/organização & administração , Esquizofrenia , Atitude do Pessoal de Saúde , Região do Caribe , Assistência à Saúde Culturalmente Competente/métodos , Assistência à Saúde Culturalmente Competente/organização & administração , Assistência à Saúde Culturalmente Competente/normas , Inglaterra/etnologia , Família/psicologia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Saúde das Minorias/normas , Religião , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Estereotipagem , Adulto Jovem
6.
HIV Med ; 19(9): 585-596, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29963766

RESUMO

OBJECTIVES: The aim of the study was to determine whether behaviourally informed short message service (SMS) primer and reminder messages could increase the return rate of HIV self-sampling kits ordered online. METHODS: The study was a 2 × 2 factorial design randomized control trial. A total of 9585 individuals who ordered a self-sampling kit from www.freetesting.hiv different SMS combinations: 1) standard reminders sent days 3 and 7 after dispatch (control); 2) primer sent 1 day after dispatch plus standard reminders; 3) behavioural insights (BI) reminders (no primer); or 4) primer plus BI reminders. The analysis was restricted to individuals who received all messages (n = 8999). We used logistic regression to investigate independent effects of the primer and BI reminders and their interaction. We explored the impact of sociodemographic characteristics on kit return as a secondary analysis. RESULTS: Those who received the primer and BI reminders had a return rate 4% higher than that of those who received the standard messages. We found strong evidence of a positive effect of the BI reminders (odds ratio 1.13; 95% confidence interval 1.04-1.23; P = 0.003) but no evidence for an effect of the primer, or for an interaction between the two interventions. Odds of kit return increased with age, with those aged ≥ 65 years being almost 2.5 times more likely to return the kit than those aged 25-34 years. Men who have sex with men were 1.5-4.5 times more likely to return the kit compared with other sexual behaviour and gender identity groups. Non-African black clients were 25% less likely to return the kit compared with other ethnicities. CONCLUSIONS: Adding BI to reminder messages was successful in improving return rates at no additional cost.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Sistemas de Alerta/instrumentação , Adolescente , Adulto , Fatores Etários , Idoso , Comportamento , Inglaterra/etnologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Kit de Reagentes para Diagnóstico , Minorias Sexuais e de Gênero , Envio de Mensagens de Texto , Adulto Jovem
7.
PLoS One ; 13(6): e0197939, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29924799

RESUMO

INTRODUCTION: The HIV epidemic in England is largely concentrated among heterosexuals who are predominately black African and men who have sex with men (MSM). We present for the first time trends in annual HIV incidence for adults attending sexual health clinics, where 80% of all HIV diagnoses are made. METHODS: We identified newly diagnosed incident HIV using a recent infection testing algorithm (RITA) consisting of a biomarker (AxSYM assay, modified to determine antibody avidity), epidemiological and clinical information. We estimated HIV incidence using the WHO RITA formula for cross-sectional studies, with HIV testing data from sexual health clinics as the denominator. RESULTS: From 2009 to 2013, each year, between 9,700 and 26,000 black African heterosexuals (of between 161,000 and 231,000 heterosexuals overall) were included in analyses. For the same period, annually between 19,000 and 55,000 MSM were included. Estimates of HIV incidence among black Africans increased slightly (although non-significantly) from 0.15% (95% C.I.0.05%-0.26%) in 2009 to 0.19% (95% C.I.0.04%-0.34%) in 2013 and was 4-5-fold higher than among all heterosexuals among which it remained stable between 0.03% (95% C.I.0.02%-0.05%) and 0.05% (95% C.I.0.03%-0.07%) over the period. Among MSM incidence was highest and increased (non-significantly) from 1.24% (95%C.I 0.96-1.52%) to 1.46% (95% C.I 1.23%-1.70%) after a peak of 1.52% (95%C.I 1.30%-1.75%) in 2012. CONCLUSION: These are the first nationwide estimates for trends in HIV incidence among black African and heterosexual populations in England which show black Africans, alongside MSM, remain disproportionately at risk of infection. Although people attending sexual health clinics may not be representative of the general population, nearly half of black Africans and MSM had attended in the previous 5 years. Timely and accurate incidence estimates will be critical in monitoring the impact of the reconfiguration of sexual health services in England, and any prevention programmes such as pre-exposure prophylaxis.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/epidemiologia , Heterossexualidade , Saúde Sexual , Adolescente , Adulto , Biomarcadores/metabolismo , Inglaterra/epidemiologia , Inglaterra/etnologia , Feminino , Humanos , Incidência , Masculino , Adulto Jovem
8.
PLoS One ; 13(4): e0195178, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29608588

RESUMO

BACKGROUND: This study explored spatial-temporal variation in diagnoses of gonorrhoea to identify and quantify endemic areas and clusters in relation to patient characteristics and outcomes of partner notification (PN) across England, UK. METHODS: Endemic areas and clusters were identified using a two-stage analysis with Kulldorff's scan statistics (SaTScan). RESULTS: Of 2,571,838 tests, 53,547 diagnoses were gonorrhoea positive (positivity = 2.08%). The proportion of diagnoses in heterosexual males was 1.5 times that in heterosexual females. Among index cases, men who have sex with men (MSM) were 8 times more likely to be diagnosed with gonorrhoea than heterosexual males (p<0.0001). After controlling for age, gender, ethnicity and deprivation rank, 4 endemic areas were identified including 11,047 diagnoses, 86% of which occurred in London. 33 clusters included 17,629 diagnoses (34% of total diagnoses in 2012 and 2013) and spanned 21 locations, some of which were dominated by heterosexually acquired infection, whilst others were MSM focused. Of the 53,547 diagnoses, 14.5% (7,775) were the result of PN. The proportion of patients who attended services as a result of PN varied from 0% to 61% within different age, gender and sexual orientation cohorts. A third of tests resulting from PN were positive for gonorrhoea. 25% of Local Authorities (n = 81, 95% CI: 20.2, 29.5) had a higher than expected proportion for female PN diagnoses as compared to 16% for males (n = 52, 95% CI: 12.0, 19.9). CONCLUSIONS: The English gonorrhoea epidemic is characterised by spatial-temporal variation. PN success varied between endemic areas and clusters. Greater emphasis should be placed on the role of PN in the control of gonorrhoea to reduce the risk of onward transmission, re-infection, and complications of infection.


Assuntos
Gonorreia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Análise por Conglomerados , Ligas Dentárias , Inglaterra/epidemiologia , Inglaterra/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Geografia Médica , Gonorreia/diagnóstico , Gonorreia/história , Infecções por HIV , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Comportamento Sexual , Análise Espaço-Temporal , Adulto Jovem
9.
Transcult Psychiatry ; 55(2): 178-197, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29411686

RESUMO

This article applies the framework of moral experience to examine the cultural experience of stigma with Indian-Australians and Anglo-Australians living with depression in Melbourne, Australia. To date few studies have examined this dynamic in relation to mental illness and culture, and no studies have applied this framework in a culturally comparative way. Based on 58 in-depth interviews with people with depression recruited from the community, we explicate how stigma modulates what is at stake upon disclosure of depression, participants' lived experience following that disclosure, and how practices of health-seeking become stigmatised. Findings show that the social acceptance of depression jars against participants' experience of living with it. Denialism and fear of disclosure were overwhelming themes to emerge from our analysis with significant cultural differences; the Anglo-Australians disclosed their depression to family and friends and encountered significant resistance about the legitimacy of their illness. In contrast, many Indian-Australians, especially men, did not disclose their illness for fear of a damaged reputation and damaged social relations. For Indian-Australians, social relations in the community were at stake, whereas for Anglo-Australians workplace relations (but not community relations) were at stake. Participants' experiences in these settings also influenced their patterns of health-seeking behaviors and age and inter-generational relationships were important mediators of stigma and social support. These findings illuminate how stigma, culture, and setting are linked and they provide critical information necessary to identify and develop customised strategies to mitigate the harmful effects of stigma in particular cultural groups.


Assuntos
Depressão/etnologia , Transtorno Depressivo/etnologia , Relações Interpessoais , Estigma Social , Adulto , Austrália/etnologia , Inglaterra/etnologia , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade
10.
Nature ; 551(7679): 223-226, 2017 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-29088703

RESUMO

Both language and genes evolve by transmission over generations with opportunity for differential replication of forms. The understanding that gene frequencies change at random by genetic drift, even in the absence of natural selection, was a seminal advance in evolutionary biology. Stochastic drift must also occur in language as a result of randomness in how linguistic forms are copied between speakers. Here we quantify the strength of selection relative to stochastic drift in language evolution. We use time series derived from large corpora of annotated texts dating from the 12th to 21st centuries to analyse three well-known grammatical changes in English: the regularization of past-tense verbs, the introduction of the periphrastic 'do', and variation in verbal negation. We reject stochastic drift in favour of selection in some cases but not in others. In particular, we infer selection towards the irregular forms of some past-tense verbs, which is likely driven by changing frequencies of rhyming patterns over time. We show that stochastic drift is stronger for rare words, which may explain why rare forms are more prone to replacement than common ones. This work provides a method for testing selective theories of language change against a null model and reveals an underappreciated role for stochasticity in language evolution.


Assuntos
Evolução Cultural , Idioma , Inglaterra/etnologia , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Medieval , Humanos , Linguística , Fala , Processos Estocásticos
11.
BMC Cancer ; 17(1): 570, 2017 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-28841853

RESUMO

BACKGROUND: After the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers. METHODS: We obtained data for all cancer registrations for children (aged 0-14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups - leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation. RESULTS: The majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01-1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02-1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08-1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13-2.63) and South Asian children (RR = 1.51, 99% CI: 1.10-2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54-0.95). CONCLUSIONS: In the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.


Assuntos
Neoplasias/etnologia , Neoplasias/epidemiologia , Adolescente , Criança , Pré-Escolar , Inglaterra/epidemiologia , Inglaterra/etnologia , Estudos Epidemiológicos , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores Sexuais
12.
Stroke ; 48(6): 1470-1477, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28495831

RESUMO

BACKGROUND AND PURPOSE: Perivascular spaces (PVSs) are considered markers of small vessel disease. However, their long-term prognostic implications in transient ischemic attack/ischemic stroke patients are unknown. Ethnic differences in PVS prevalence are also unknown. METHODS: Two independent prospective studies were conducted, 1 comprising predominantly whites with transient ischemic attack/ischemic stroke (OXVASC [Oxford Vascular] study) and 1 comprising predominantly Chinese with ischemic stroke (University of Hong Kong). Clinical and imaging correlates, prognostic implications for stroke and death, and ethnic differences in basal ganglia (BG) and centrum semiovale (CS) PVSs were studied with adjustment for age, sex, vascular risk factors, and scanner strength. RESULTS: Whites with transient ischemic attack/ischemic stroke (n=1028) had a higher prevalence of both BG and CS-PVSs compared with Chinese (n=974; >20 BG-PVSs: 22.4% versus 7.1%; >20 CS-PVSs: 45.8% versus 10.4%; P<0.0001). More than 20 BG or CS-PVSs were both associated with increasing age and white matter hyperintensity, although associations with BG-PVSs were stronger (all P<0.0001). During 6924 patient-years of follow-up, BG-PVSs were also independently associated with an increased risk of recurrent ischemic stroke (adjusted hazard ratio compared with <11 PVSs, 11-20 PVSs: HR, 1.15; 95% confidence interval, 0.78-1.68; >20 PVSs: HR, 1.82; 1.18-2.80; P=0.011) but not intracerebral hemorrhage (P=0.10) or all-cause mortality (P=0.16). CS-PVSs were not associated with recurrent stroke (P=0.57) or mortality (P=0.072). Prognostic associations were similar in both cohorts. CONCLUSIONS: Over and above ethnic differences in frequency of PVSs in transient ischemic attack/ischemic stroke patients, BG and CS-PVSs had similar risk factors, but although >20 BG-PVSs were associated with an increased risk of recurrent ischemic stroke, CS-PVSs were not.


Assuntos
Gânglios da Base/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etnologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etnologia , Substância Branca/diagnóstico por imagem , Idoso , Inglaterra/etnologia , Feminino , Seguimentos , Hong Kong/etnologia , Humanos , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/etnologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência
13.
JAMA Neurol ; 74(6): 686-694, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28395030

RESUMO

Importance: YARS2 mutations have been associated with a clinical triad of myopathy, lactic acidosis, and sideroblastic anemia in predominantly Middle Eastern populations. However, the identification of new patients expands the clinical and molecular spectrum of mitochondrial disorders. Objectives: To review the clinical, molecular, and genetic features of YARS2-related mitochondrial disease and to demonstrate a new Scottish founder variant. Design, Setting, and Participants: An observational case series study was conducted at a national diagnostic center for mitochondrial disease in Newcastle upon Tyne, England, and review of cases published in the literature. Six adults in a well-defined mitochondrial disease cohort and 11 additional cases described in the literature were identified with YARS2 variants between January 1, 2000, and January 31, 2015. Main Outcome and Measures: The spectrum of clinical features and disease progression in unreported and reported patients with pathogenic YARS2 variants. Results: Seventeen patients (median [interquartile range] age at onset, 1.5 [9.8] years) with YARS2-related mitochondrial myopathy were identified. Fifteen individuals (88%) exhibited an elevated blood lactate level accompanied by generalized myopathy; only 12 patients (71%) manifested with sideroblastic anemia. Hypertrophic cardiomyopathy (9 [53%]) and respiratory insufficiency (8 [47%]) were also prominent clinical features. Central nervous system involvement was rare. Muscle studies showed global cytochrome-c oxidase deficiency in all patients tested and severe, combined respiratory chain complex activity deficiencies. Microsatellite genotyping demonstrated a common founder effect shared between 3 Scottish patients with a p.Leu392Ser variant. Immunoblotting from fibroblasts and myoblasts of an affected Scottish patient showed normal YARS2 protein levels and mild respiratory chain complex defects. Yeast modeling of novel missense YARS2 variants closely correlated with the severity of clinical phenotypes. Conclusions and Relevance: The p.Leu392Ser variant is likely a newly identified founder YARS2 mutation. Testing for pathogenic YARS2 variants should be considered in patients presenting with mitochondrial myopathy, characterized by exercise intolerance and muscle weakness even in the absence of sideroblastic anemia irrespective of ethnicity. Regular surveillance and early treatment for cardiomyopathy and respiratory muscle weakness is advocated because early treatment may mitigate the significant morbidity and mortality associated with this genetic disorder.


Assuntos
Acidose Láctica/genética , Anemia Sideroblástica/genética , Cardiomiopatias/genética , Miopatias Mitocondriais/genética , Debilidade Muscular/genética , Insuficiência Respiratória/genética , Tirosina-tRNA Ligase/genética , Acidose Láctica/etnologia , Acidose Láctica/etiologia , Adulto , Idoso , Anemia Sideroblástica/etnologia , Anemia Sideroblástica/etiologia , Cardiomiopatias/etnologia , Cardiomiopatias/etiologia , Inglaterra/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopatias Mitocondriais/complicações , Miopatias Mitocondriais/etnologia , Debilidade Muscular/etnologia , Debilidade Muscular/etiologia , Mutação , Prognóstico , Insuficiência Respiratória/etnologia , Insuficiência Respiratória/etiologia , Escócia/etnologia
14.
BMJ Open ; 7(3): e016577, 2017 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-28360258

RESUMO

INTRODUCTION: Gastroenteritis is the leading cause of morbidity and mortality among young children living in resource-poor settings, majority of which is attributed to rotavirus. Rotavirus vaccination can therefore have a significant impact on infant mortality. However, rotavirus vaccine efficacy in Sub-Saharan Africa and Southeast Asia is significantly lower than in high-income countries. Maternally derived antibodies, infant gut microbiota and concomitant oral polio vaccination have been proposed as potential reasons for poor vaccine performance in low-income settings. The overall aim of this study is to compare the role of maternally derived antibodies and infant gut microbiota in determining immune response to rotavirus vaccine in high-income and low-income settings, using the same vaccine and a similar study protocol. METHODS AND ANALYSIS: The study is an observational cohort in three countries-Malawi, India and UK. Mothers will be enrolled in third trimester of pregnancy and followed up, along with infants after delivery, until the infant completes two doses of oral rotavirus vaccine (along with routine immunisation). The levels of prevaccination maternally derived rotavirus-specific antibodies (IgG) will be correlated with infant seroconversion and antibody titres, 4 weeks after the second dose of rotavirus vaccine. Both within-country and between-country comparisons of gut microbiome will be carried out between children who seroconvert and those who do not. The impact of oral polio vaccine coadministration on rotavirus vaccine response will be studied in Indian infants. ETHICS AND DISSEMINATION: Ethical approvals have been obtained from Integrated Research Application System (IRAS, NHS ethics) in UK, College of Medicine Research and Ethics Committee (COMREC) in Malawi and Institutional Review Board (IRB), Christian Medical College, Vellore in India. Participant recruitment and follow-up is ongoing at all three sites. Analysis of data, followed by publication of the results, is expected in 2018.


Assuntos
Anticorpos Antivirais/imunologia , Gastroenterite/imunologia , Microbioma Gastrointestinal/imunologia , Vacinas contra Rotavirus/imunologia , África/etnologia , Pré-Escolar , DNA Viral/imunologia , Inglaterra/etnologia , Ensaio de Imunoadsorção Enzimática , Europa (Continente)/etnologia , Feminino , Gastroenterite/etnologia , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Índia/etnologia , Lactente , Estudos Prospectivos
15.
HIV Med ; 18(9): 615-622, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28127837

RESUMO

OBJECTIVES: The aim of the study was to determine HIV incidence among men who have sex with men (MSM) who repeat test for HIV at sexually transmitted infection (STI) clinics in England, and identify associated factors. METHODS: Annual HIV incidence and 95% confidence interval (CI) were calculated for a national cohort of MSM who tested HIV negative at any STI clinic in England in 2012 and had a follow-up test within 1 year using routinely collected data. Cox regression analyses were performed to identify predictors of HIV acquisition and population attributable risk for HIV infection was calculated for predictors. RESULTS: In 2012, 85 500 MSM not known to be HIV positive attended any STI clinic in England, and 31% tested for HIV at least twice within 1 year at the same clinic. HIV incidence was 2.0 per 100 person-years (PY; 95% CI 1.8-2.2) among repeat testers. Incidence was higher among MSM of black ethnicity (3.2 per 100 PY) and those with a bacterial STI diagnosis at the initial attendance (3.2 per 100 PY). MSM with a previous syphilis or gonorrhoea infection were at significantly greater risk of acquiring HIV in the subsequent year [adjusted hazard ratio 4.1 (95% CI 2.0-8.3) and 2.1 (95% CI 1.4-3.2), respectively]. The predictors accounted for 37% of HIV infections. CONCLUSIONS: Annual HIV incidence among MSM attending STI clinics in England is high. Previous STIs were predictors of HIV acquisition but only accounted for one in five infections. More discriminatory behavioural predictors of HIV acquisition could provide better triaging of HIV prevention services for MSM attending STI clinics.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina/etnologia , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Estudos de Coortes , Inglaterra/epidemiologia , Inglaterra/etnologia , Infecções por HIV/etnologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Sexo sem Proteção , Adulto Jovem
16.
J Psychosom Obstet Gynaecol ; 38(1): 37-44, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27578057

RESUMO

BACKGROUND: Sociocultural childbirth representations can influence the perceptions of childbirth negatively. In this paper we report on a survey study to explore the factors associated with negative impressions of childbirth in a North-West England University student sample. We also explored whether different sources and perceptions of childbirth information were linked to fear of childbirth. METHODS: All students received a survey link via an online messaging board and/or direct e-mail. Female students who were 18-40 years of age and childless (but planned to have children in the future) were invited to participate. Demographics, birth preferences, a fear of birth and general anxiety measures were included as well as questions about what sources of information shaped students' attitudes toward pregnancy and birth (i.e. visual/written media, experiences of friends/family members, school-based education and other) and impressions of birth from these sources (i.e. positive, negative, both positive and negative and not applicable). RESULTS: Eligible students (n = 276) completed the online questionnaire. The majority were Caucasian (87%) with a mean age of 22.6 years. Ninety-two students (33.3%) reported negative childbirth impressions through direct or vicarious sources. Students with negative birth impressions were significantly more likely to report higher fear of birth scores. Negatively perceived birth stories of friends/family members, and mixed perceptions of visual media representations of birth were associated with higher fear of birth scores. Having witnessed a birth first-hand and describing the experience as amazing was linked to lower fear scores. CONCLUSION: First-hand observations of birth, especially positive experiences, had implications for salutary outcomes. Negative or conflicting perceptions of vicarious experiences were associated with increased levels of childbirth fear. While further research is needed, these insights suggest a need for positive birth stories and messages to be disseminated to mitigate any negative effects of indirect accounts.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Parto/etnologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Inglaterra/etnologia , Feminino , Humanos , Universidades/estatística & dados numéricos , Adulto Jovem
17.
Psychiatr Q ; 88(3): 611-621, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-27837467

RESUMO

The purpose of this study was to investigate East-West cultural attitudes of mental healthcare professionals (MHPs) towards Involuntary Treatment Orders (ITOs) among Taiwan, England, Wales, and New Zealand. Data on Taiwanese MHPs' views of ITO regime were collected from the National Psychiatric Disease Mandatory Assessment and Community Care Review Committee (N = 176). A national survey instrument was designed to assess the level of support for ITOs among senior clinicians and to determine their views on the importance of various factors in decision-making, the mechanisms through which coercion may work, impediments to its use, and its perceived impact on patients and therapeutic relationships. A descriptive analysis was carried out with data presented as appropriate for the distribution and a t-test was used to detect any differences by respondents. Risk reduction was ranked the most important factor in use of ITOs and reasons for discharging an order. Female respondents had higher approval ratings, with 85 % of agreeing that ITOs were of benefit to the therapeutic relationship, assured long-term stability, and increased medication compliance. The results suggest that clinicians decide the use of ITOs largely based on the risk management, both in terms of starting and ending an order. However, the use of ITOs vary which reflected in the practice. Given this variation in the use of enabling legislation, multidisciplinary input in decision-making is an essential safety mechanism.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Comparação Transcultural , Tratamento Psiquiátrico Involuntário , Transtornos Mentais/terapia , Gestão da Segurança , Adulto , Idoso , Inglaterra/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/etnologia , Taiwan/etnologia , País de Gales/etnologia
18.
J Exp Child Psychol ; 155: 128-137, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27965175

RESUMO

The role of experience with other-race faces in the development of the other-race effect was investigated through a cross-cultural comparison between 5- and 6-year-olds and 13- and 14-year-olds raised in a monoracial (British White, n=83) population and a multiracial (Malaysian Chinese, n=68) population. British White children showed an other-race effect to three other-race faces (Chinese, Malay, and African Black) that was stable across age. Malaysian Chinese children showed a recognition deficit for less experienced faces (African Black) but showed a recognition advantage for faces of which they have direct or indirect experience. Interestingly, younger (Malaysian Chinese) children showed no other-race effect for female faces such that they can recognize all female faces regardless of race. These findings point to the importance of early race and gender experiences in reorganizing the face representation to accommodate changes in experience across development.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Reconhecimento Facial , Adolescente , Fatores Etários , Criança , Pré-Escolar , China/etnologia , Comparação Transcultural , Discriminação Psicológica , Inglaterra/etnologia , Feminino , Identidade de Gênero , Humanos , Malásia/etnologia , Masculino
19.
Respir Med ; 120: 131-133, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27817810

RESUMO

Antifibrotic drugs for idiopathic pulmonary fibrosis patients in England and Scotland are only available to those with FVC percent predicted (FVC%pred) less than or equal to 80%. The prescribing guidance does not state which set of reference values should be used and we show that a patient's FVC%pred can change by 4-6% depending on the choice of reference. We calculated FVC%pred for a group of 528 IPF patients using three different sets of reference values. 90% of patients with FVC%pred 80-85% calculated using European Community Coal and Steel (ECSC) reference values fall into the eligible range when NHANES reference values are used.


Assuntos
Fibrose Pulmonar Idiopática/terapia , Capacidade Vital/fisiologia , Idoso , Inglaterra/epidemiologia , Inglaterra/etnologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Fibrose Pulmonar Idiopática/etnologia , Masculino , Inquéritos Nutricionais/normas , Valores de Referência , Testes de Função Respiratória/métodos , Escócia/epidemiologia
20.
Br J Psychiatry ; 209(6): 483-490, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27609812

RESUMO

BACKGROUND: Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities. AIMS: To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT). METHOD: A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis. RESULTS: Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P<0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT (death of a close friend: OR = 0.24, 95% CI 0.07-0.74; donating money to a charity: OR = 0.52, 95% CI 0.3-0.9). CONCLUSIONS: Independent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.


Assuntos
Depressão/psicologia , Acontecimentos que Mudam a Vida , Política , Violência/psicologia , Adulto , Bangladesh/etnologia , Estudos Transversais , Depressão/etnologia , Inglaterra/etnologia , Feminino , Humanos , Masculino , Paquistão/etnologia , Terrorismo/etnologia , Terrorismo/psicologia , Violência/etnologia , Adulto Jovem
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