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1.
Proc Natl Acad Sci U S A ; 118(31)2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34312227

RESUMO

There are multiple sources of data giving information about the number of SARS-CoV-2 infections in the population, but all have major drawbacks, including biases and delayed reporting. For example, the number of confirmed cases largely underestimates the number of infections, and deaths lag infections substantially, while test positivity rates tend to greatly overestimate prevalence. Representative random prevalence surveys, the only putatively unbiased source, are sparse in time and space, and the results can come with big delays. Reliable estimates of population prevalence are necessary for understanding the spread of the virus and the effectiveness of mitigation strategies. We develop a simple Bayesian framework to estimate viral prevalence by combining several of the main available data sources. It is based on a discrete-time Susceptible-Infected-Removed (SIR) model with time-varying reproductive parameter. Our model includes likelihood components that incorporate data on deaths due to the virus, confirmed cases, and the number of tests administered on each day. We anchor our inference with data from random-sample testing surveys in Indiana and Ohio. We use the results from these two states to calibrate the model on positive test counts and proceed to estimate the infection fatality rate and the number of new infections on each day in each state in the United States. We estimate the extent to which reported COVID cases have underestimated true infection counts, which was large, especially in the first months of the pandemic. We explore the implications of our results for progress toward herd immunity.


Assuntos
COVID-19/epidemiologia , Inquéritos Epidemiológicos/métodos , Número Básico de Reprodução , Teorema de Bayes , COVID-19/diagnóstico , COVID-19/prevenção & controle , COVID-19/transmissão , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Imunidade Coletiva , Incidência , Modelos Estatísticos , Mortalidade , Prevalência , SARS-CoV-2/isolamento & purificação , Estados Unidos/epidemiologia
2.
BMC Infect Dis ; 21(1): 553, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34112096

RESUMO

BACKGROUND: The global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya. METHODS: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3943 children aged 12-23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. RESULTS: Immunisation coverage ranged from 82% [81-84] for the third dose of polio to 97.4% [96.7-98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66-71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43-57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. CONCLUSIONS: Children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.


Assuntos
Equidade em Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Quênia , Masculino , Mães , Fatores Socioeconômicos
3.
Health Qual Life Outcomes ; 19(1): 162, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112207

RESUMO

BACKGROUND: The EQ-5D-3L is a widely used generic health-related quality of life measure commonly applied to describe health outcomes and to measure disease burden. The aim of this study was to generate Brazilian population norms, stratified by age and gender, based on Brazilian preference weights for EQ-5D-3L. METHODS: A multicenter cross-sectional study was conducted in three Brazilian urban areas. The final sample consisted of 5774 respondents, aged from 18 to 64 years. Amongst other information, respondents were asked to self-report their health status using the EQ-5D-3L descriptive system and visual analog scale (EQ-VAS). Data on socio-demographic characteristics was obtained through specific questionnaires. The Brazilian TTO scoring algorithm was used to derive the utility values. Multivariate logistic regression models were fitted to analyze the influence of age, sex, education status and sample site on the presence of any problem for each dimension of EQ5D. RESULTS: Mean values were computed for both weighted index scores and self-rated health status (EQ-VAS), and stratified by gender and age groups. Health status declines with age, ranging between 0.87 for the youngest group 18-29 year-olds and 0.76 for 60-64-year-old. Men reported higher scores (0.85) than the woman (0.79). Lower education levels were associated with lower EQ-5D index score in most age groups. CONCLUSION: This study provides EQ-5D reference values for the Brazilian population. These values can be used by local decision-makers and researchers in economic evaluations and population health studies.


Assuntos
Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Psicometria/instrumentação , Qualidade de Vida/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Inquéritos e Questionários/normas , Adolescente , Adulto , Fatores Etários , Brasil , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
4.
Medicine (Baltimore) ; 100(18): e25336, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950922

RESUMO

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is the fourth and third leading cause of death worldwide and in China, respectively. Sedentary behavior has been shown to increase the risk of respiratory disease, such as asthma. However, the relationship between sedentary behavior and COPD is unclear. This study aimed to investigate the association between sedentary behavior and COPD.Data was extracted from the 2018 a large-scale cross-sectional study of Chronic Disease and Lifestyle Population Survey in Sichuan Province of China, in which sedentary behavior and chronic diseases were self-reported according to medical records. The association between sedentary behavior on risk of COPD was estimated using multivariable regression model in non-matching cohorts and generalized propensity score-weighted (GPSW)cohorts, respectively, controlling for potential confounders.Individuals who remained sedentary for more than 7 hours per day were more likely to have COPD than the control group (<3 hours) both in conventional multivariate logistic regression analysis (OR = 2.020, 95%CI: 1.575-2.585, P < .001) and GPSW analysis (OR = 2.381, 95%CI: 1.778-3.188, P < .001). After GPSW and the sensitivity analysis using refined smoking variable further found a dose-effect between sedentary behavior and COPD, with 1.242 (95%CI: 1.006-1.532, P < .05) times risk of COPD in those sedentary behavior of more than 5 hours per day (GPSW) and 1.377 (95%CI: 1.092-1.736, P < .05) times risk in those sedentary behavior above 5 hours per day (sensitivity analysis), comparing with the control group.Sedentary behavior is independently associated with increased risk of COPD, adjusting for other confounders. The findings of this study have important implications for future research and public health guidance. Reducing sedentary time may have a significant role in COPD prevention.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Comportamento Sedentário , Adolescente , Adulto , Idoso , China/epidemiologia , Fatores de Confusão Epidemiológicos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
5.
Cir Cir ; 89(3): 416-417, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34037608

RESUMO

La salud mental en respuesta a la pandemia de COVID-19 es un tema importante. En este artículo se hace una comparación en la población peruana dando a conocer diversos estudios, agregando los factores asociados a su desarrollo.Mental health as a response to the COVID-19 pandemic is an important subject. This article makes a comparison with the Peruvian population, releasing many studies, adding the factors associated with its development.


Assuntos
COVID-19/psicologia , Depressão/epidemiologia , Pandemias , Adulto , Ansiedade/epidemiologia , COVID-19/epidemiologia , Comunicação , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Peru/epidemiologia , Distribuição por Sexo , Televisão , Adulto Jovem
6.
Medicine (Baltimore) ; 100(20): e26011, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011100

RESUMO

ABSTRACT: The purpose of this study was to determine predictors of pain severity among older United States (US) adults with pain.This cross-sectional, retrospective study utilized 2017 Medical Expenditure Panel Survey data. Eligible participants were alive for the calendar year, aged ≥50 years, and reported pain in the past 4 weeks. Hierarchical logistic regression models, adjusting for the survey design, were used to identify significant predictors of pain severity (i.e., extreme/quite a bit or moderate/little pain).An estimated 14,250,534 adults aged ≥50 with pain reported extreme/quite a bit of pain. Many variables were associated with extreme/quite a bit of pain, including: age 50 to 64 vs ≥65 years (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI] = 1.22-1.82); males vs females (AOR = 0.80, 95% CI = 0.67-0.95); white race vs others (AOR = 0.75, 95% CI = 0.61-0.92); married vs other marital status (AOR = 1.31, 95% CI = 1.08-1.57); income <200% vs ≥200% federal poverty level (AOR = 1.30, 95% CI = 1.06-1.60); employed vs unemployed (AOR = 0.47, 95% CI = 0.37-0.60); limitation vs no limitation (AOR = 2.64, 95% CI = 2.09-3.33); 0, 1, 3, or 4 vs ≥5 chronic conditions (AOR ranged from 0.39 for 0 conditions to 0.77 for 4 conditions); excellent/very good or good vs fair/poor perceived physical health status (AOR ranged from 0.28 for excellent/very good to 0.40 for good); smokers vs non-smokers (AOR = 1.56, 95% CI = 1.27-1.93); exercise versus no exercise (AOR = 0.74, 95% CI = 0.62-0.88); and South vs West census region (AOR = 1.34, 95% CI = 1.04-1.74).This study found several characteristics could predict pain severity among older US adults who reported extreme/quite a bit of pain. These characteristics may guide specific areas of focus to improve patients' pain management.


Assuntos
Vida Independente/estatística & dados numéricos , Dor/diagnóstico , Índice de Gravidade de Doença , Fatores Etários , Idoso , Estudos Transversais , Feminino , Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Vida Independente/economia , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Manejo da Dor , Medição da Dor/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos/epidemiologia
7.
Nat Commun ; 12(1): 3205, 2021 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-34050160

RESUMO

Interactions between climate change and anthropogenic activities result in increasing numbers of open fires, which have been shown to harm maternal health. However, few studies have examined the association between open fire and pregnancy loss. We conduct a self-comparison case-control study including 24,876 mothers from South Asia, the region with the heaviest pregnancy-loss burden in the world. Exposure is assessed using a chemical transport model as the concentrations of fire-sourced PM2.5 (i.e., fire PM2.5). The adjusted odds ratio (OR) of pregnancy loss for a 1-µg/m3 increment in averaged concentration of fire PM2.5 during pregnancy is estimated as 1.051 (95% confidence intervals [CI]: 1.035, 1.067). Because fire PM2.5 is more strongly linked with pregnancy loss than non-fire PM2.5 (OR: 1.014; 95% CI: 1.011, 1.016), it contributes to a non-neglectable fraction (13%) of PM2.5-associated pregnancy loss. Here, we show maternal health is threaten by gestational exposure to fire smoke in South Asia.


Assuntos
Aborto Espontâneo/epidemiologia , Poluentes Atmosféricos/efeitos adversos , Incêndios , Exposição Materna/efeitos adversos , Fumaça/efeitos adversos , Aborto Espontâneo/etiologia , Adulto , Poluição do Ar/efeitos adversos , Poluição do Ar/estatística & dados numéricos , Ásia/epidemiologia , Estudos de Casos e Controles , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Exposição Materna/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Gravidez , Fatores de Risco , Imagens de Satélites/estatística & dados numéricos , Adulto Jovem
8.
PLoS Med ; 18(4): e1003584, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33901171

RESUMO

BACKGROUND: Given the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status. METHODS AND FINDINGS: We used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010-2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales. Forty-eight chronic or recurrent conditions had an independent impact on mortality, activity limitations, or perceived heath. Multimorbidity prevalence varied between 30% (1-year time frame) and 39% (lifetime frame), and more markedly according to sex (higher in women), age (with greatest increases in middle-aged), and socioeconomic status (higher in less educated and low-income individuals and manual workers). We identified various multimorbid combinations, mostly involving vasculometabolic and musculoskeletal conditions and mental disorders, which could be explained by direct causation, shared or associated risk factors, or less frequently, confounding or chance. Combinations with the highest health impacts included diseases with complications but also associations of conditions affecting systems involved in locomotion and sensorial functions (impact on activity limitations), and associations including mental disorders (impact on perceived health). The interaction effects of the associated conditions varied on a continuum from subadditive and additive (associations involving cardiometabolic conditions, low back pain, osteoporosis, injury sequelae, depression, and anxiety) to multiplicative and supermultiplicative (associations involving obesity, chronic obstructive pulmonary disease, migraine, and certain osteoarticular pathologies). Study limitations included self-reported information on chronic conditions and the insufficient power of some analyses. CONCLUSIONS: Multimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups.


Assuntos
Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Multimorbidade , Doenças Musculoesqueléticas/epidemiologia , Atividades Cotidianas , Adulto , Idoso , Comorbidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
9.
BMC Pregnancy Childbirth ; 21(1): 299, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849462

RESUMO

BACKGROUND: Postnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention than antenatal care. This study determines the level of PNC coverage and its determinants in Srilanka. METHODS: This is a secondary analysis of the 2016 Demographic and Health Survey. Receiving full postnatal care (FPNC) was defined with a set of indicators to detect adequate care for mother and newborn. Demographic and socio-economic associated factors for receiving FPNC were identified using binary and multiple logistic regression. Variables that had marginal relationship with receiving FPNC which p-value less than or equal to 0.2 at binary analysis were selected and included in the multiple logistic regression models. We used manual backward stepwise regression to identify variables which had independent association with receiving FPNC on the basis of adjusted odds ratios (AOR), with 95% confidence interval (CI) and p-value less than 0.05. All analyses were performed in SPSS 25. RESULTS: Of the 8313 women with a live birth in the last 5 years, more than 98% had received postnatal care at facility at least 24 h. More than three-fourth of mothers (n = 5104) received the FPNC according to WHO guideline. Four factors were positively associated with receiving FPNC: mothers received antenatal home visits by Public health midwife (AOR = 1.98, 95% CI 1.65-2.39), mothers who got information about antenatal complications and places to go at antenatal clinics (AOR = 1.56, 95% CI 1.27-1.92), been Sinhala (AOR = 1.89, 95% CI 1.35-2.66) and having own mobile phone (AOR = 1.19, 95% CI 1.02-1.38). Mothers who are residing in rural area (AOR = 0.697 95% CI = 0.52-0.93] compared to those who reside in urban areas and maternal age between 20 and 34 years [AOR = 0.72, 95% CI 0.54-0.97] compared to maternal age less than 20 years were detected as negatively associated. CONCLUSION: Receiving FPNC in Srilanka is high. However, inequity remains to be a challenge. Socio-demographic factors are associated with FPNC coverage. Strategies that aim to improve postnatal care should target improvement of non-health factors as well.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Adulto , Fatores Etários , Criança , Pré-Escolar , Pai/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , Gravidez , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Sri Lanka , População Urbana/estatística & dados numéricos , Adulto Jovem
10.
Nutrients ; 13(4)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33919739

RESUMO

Intrauterine malnutrition has a long-term effect on human health. This study aimed to evaluate the associations between exposure to famine in early life and obesity in adulthood in Chinese adults. A total of 5033 participants (22,132 observations) of the China Health and Nutrition Survey (CHNS) in 1991-2015 were classified into three famine exposure groups according to their birth year: unexposed (1963-1966), fetal-exposed (1959-1962) and childhood-exposed (1955-1958). Compared with the unexposed group, the fetal-exposed group had higher levels of body-mass-index (BMI) and waist-circumference (WC), and higher prevalence of overweight and central obesity, whereas the childhood-exposed group had lower levels of the measurements. However, the positive associations of fetal exposure with BMI, WC and prevalence of overweight and central obesity were attenuated by additionally adjusting for age at survey. Stratified analysis showed that the adverse effect of fetal exposure to famine was only observed in subjects at several specific age-groups, and in men living in rural areas and in women living in more severe famine exposed areas (p for interaction < 0.05). Our results provide evidence for the weak effect of fetal exposure to famine on body measurements in adulthood, and suggest the importance of severity of famine exposure and timing of exposure.


Assuntos
Fome Epidêmica/estatística & dados numéricos , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Inanição/epidemiologia , Adulto , Índice de Massa Corporal , China/epidemiologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Prevalência , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Índice de Gravidade de Doença , Inanição/diagnóstico , Inanição/fisiopatologia , Fatores de Tempo
11.
Nutrients ; 13(5)2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33925406

RESUMO

We explored the differences in dietary habits and dietary patterns between individuals characterized by irrational beliefs with no or low anxiety and depressive symptoms and individuals characterized by irrational beliefs with high anxiety and depressive symptomatology. Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of cardiovascular disease (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent mental health assessment through the irrational beliefs inventory (IBI), the Zung self-rating depression scale (ZDRS) and the state-trait anxiety inventory (STAI). Demographic characteristics, a thorough medical history, dietary behaviour and other lifestyle behaviours were also evaluated and analysed using factor analysis. Five main factors related to dietary patterns were extracted for the high-IBI/low-STAI group of participants (explaining the 63% of the total variation in consumption), whereas four factors were extracted for the high-IBI/high-STAI participants, the high-IBI/low-ZDRS participants and the high-IBI/high-ZDRS participants, explaining 53%, 54% and 54% of the total variation, respectively. A Western-type dietary pattern was the most dominant factor for individuals reporting irrational beliefs and anxiety or depressive symptomatology. The high refined carbohydrates and fats dietary pattern was the most dominant factor for individuals with irrational beliefs but without psychopathology. Linear regression analysis showed that irrational beliefs, in combination with anxiety or depression, age, sex and BMI, were important predictors of adherence to the Mediterranean diet. Dietary habits interact with irrational beliefs and, in association with the consequent psychological disorders, are associated with overall diet, and presumably may affect the health status of individuals.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Dieta/métodos , Nutrientes , Adulto , Estudos de Coortes , Dieta/estatística & dados numéricos , Feminino , Grécia/epidemiologia , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
12.
Nutrients ; 13(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33809915

RESUMO

Although epidemiological studies revealed a relationship between psychosocial states, such as depressive symptoms, and nutritional intake, limited information is currently available on vitamin intake. The Short Form-36 Health Survey (SF-36) is not limited to a specific disease, it is constructed based on a universal concept of health and is used to evaluate the Quality of life (QOL). A three-component scoring method was developed for "Physical component score (PCS)", "Mental component score (MCS)", and "Role/social score (RCS)". Collectively, these summary scores are called the "QOL summary score", which is regarded as a more detailed health summary score. In the present study, we aimed at epidemiologically examine the relationship between vitamin intake and QOL in middle-aged and elderly population in 3162 residents in Japan. In women, a multiple regression analysis showed a positive correlation between all vitamin intake and PCS scores, and between vitamin B6, folic acid, vitamin C, and MCS scores. In consideration of depression as MCS of SF-36 and chronic pain as PCS, an insufficient vitamin intake may affect QOL in women; however, a causal relationship has not yet been demonstrated.


Assuntos
Nível de Saúde , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Qualidade de Vida , Vitaminas/administração & dosagem , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Inquéritos e Questionários
13.
Anaesthesia ; 76(9): 1233-1244, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33694157

RESUMO

We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.


Assuntos
Estado Terminal/epidemiologia , Fadiga/epidemiologia , Fadiga/terapia , Inquéritos Epidemiológicos/métodos , Sobreviventes/estatística & dados numéricos , Estado Terminal/terapia , Fadiga/fisiopatologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Prevalência , Qualidade de Vida , Autogestão/métodos , Autogestão/estatística & dados numéricos , Índice de Gravidade de Doença
14.
Anesthesiology ; 134(5): 683-696, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33667293

RESUMO

BACKGROUND: Physician burnout, widespread across medicine, is linked to poorer physician quality of life and reduced quality of care. Data on prevalence of and risk factors for burnout among anesthesiologists are limited. The objective of the current study was to improve understanding of burnout in anesthesiologists, identify workplace and personal factors associated with burnout among anesthesiologists, and quantify their strength of association. METHODS: During March 2020, the authors surveyed member anesthesiologists of the American Society of Anesthesiologists. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey. Additional survey questions queried workplace and personal factors. The primary research question was to assess rates of high risk for burnout (scores of at least 27 on the emotional exhaustion subscale and/or at least 10 on the depersonalization subscale of the Maslach Burnout Inventory Human Services Survey) and burnout syndrome (demonstrating all three burnout dimensions, consistent with the World Health Organization definition). The secondary research question was to identify associated risk factors. RESULTS: Of 28,677 anesthesiologists contacted, 13.6% (3,898) completed the survey; 59.2% (2,307 of 3,898) were at high risk of burnout, and 13.8% (539 of 3,898) met criteria for burnout syndrome. On multivariable analysis, perceived lack of support at work (odds ratio, 6.7; 95% CI, 5.3 to 8.5); working greater than or equal to 40 h/week (odds ratio, 2.22; 95% CI, 1.80 to 2.75); lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (odds ratio, 2.21; 95% CI, 1.35 to 3.63); and perceived staffing shortages (odds ratio, 2.06; 95% CI, 1.76 to 2.42) were independently associated with high risk for burnout. Perceived lack of support at work (odds ratio, 10.0; 95% CI, 5.4 to 18.3) and home (odds ratio, 2.13; 95% CI, 1.69 to 2.69) were most strongly associated with burnout syndrome. CONCLUSIONS: The prevalence of burnout among anesthesiologists is high, with workplace factors weighing heavily. The authors identified risk factors for burnout, especially perceived support in the workplace, where focused interventions may be effective in reducing burnout.


Assuntos
Anestesiologistas/psicologia , Anestesiologistas/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Inquéritos Epidemiológicos/métodos , Adulto , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
15.
BMC Pregnancy Childbirth ; 21(1): 253, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771106

RESUMO

BACKGROUND: Adolescent pregnancy is a major public health problem both in developed and developing countries with huge consequences to maternal health and pregnancy outcomes. However, there is limited evidence on the prevalence and associated factors of adolescent pregnancy in East Africa. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent pregnancy in Eastern Africa. METHOD: The most recent Demographic and Health Survey (DHS) datasets of the 12 East African countries were used. A total weighted sample of 17, 234 adolescent girls who ever had sex was included. A multilevel binary logistic regression analysis was fitted to identify the significantly associated factors of adolescent pregnancy. Finally, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the factors that are significantly associated with adolescent pregnancy. RESULTS: The overall prevalence of adolescent pregnancy in East Africa was 54.6% (95%CI: 53.85, 55.34%). In the multivariable multilevel analysis; being age 18-19 years [AOR = 3.06; 95%CI: 2.83, 3.31], using contraceptive [AOR = 1.41; 95%CI: 1.28, 1.55], being employed girls [AOR = 1.11; 95%CI: 1.03, 1.19], being spouse/head within the family [AOR = 1.62; 95% CI: 1.45, 1.82], and being from higher community level contraceptive utilization [AOR = 1.10; 95%CI:1.02, 1.19] were associated with higher odds of adolescent pregnancy. While adolescent girls attained secondary education and higher [AOR = 0.78; 95%CI: 0.68, 0.91], initiation of sex at age of 15 to 14 years [AOR = 0.69; 95%CI: 0.63, 0.75] and 18 to 19 years [AOR = 0.31; 95%CI: 0.27, 0.35], being unmarried [AOR = 0.25; 95%CI: 0.23, 0.28], having media exposure [AOR = 0.85; 95%CI: 0.78, 0.92], and being girls from rich household [AOR = 0.64; 95%CI: 0.58, 0.71] were associated with lower odds of adolescent pregnancy. CONCLUSION: This study found that adolescent pregnancy remains a common health care problem in East Africa. Age, contraceptive utilization, marital status, working status, household wealth status, community-level contraceptive utilization, age at initiation of sex, media exposure, educational level and relation to the household head were associated with adolescent pregnancy. Therefore, designing public health interventions targeting higher risk adolescent girls such as those from the poorest household through enhancing maternal education and empowerment is vital to reduce adolescent pregnancy and its complications.


Assuntos
Anticoncepção/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , África Oriental , Fatores Etários , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Estado Civil , Gravidez , Gravidez na Adolescência/prevenção & controle , Prevalência , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 21(1): 195, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33750345

RESUMO

BACKGROUND: Globally, 4 million infants die in their first 4weeks of life every year; above 8 million infants died before their first year of birthday, and nearly 10 million children died before their 5th birthday. Majority of the deaths were occurred at home because of not receiving health care. In Ethiopia, 120,000 infants died during their first 4 weeks of life. The aim of this study was to assess maternal knowledge about neonatal danger signs and its associations after they had been thought by health professionals in Ethiopia. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as a data source. The 2016 EDHS data were collected using a two stage sampling method. All the regions were stratified into urban and rural areas. The study sample taken from the 2016 EDHS data and used in this further analysis was 325. A logistic regression model was used to assess the associations with post health education maternal knowledge on neonatal danger signs. RESULTS: In this study, mothers who had poor knowledge about neonatal danger signs (NDS) were 69.8 % (227) (95 %CI (64.8, 74.8 %). In the final logistic model, wanted no more child ((AOR = 4.15), (95 %CI = 1.12, 15.41)), female child ((AOR = 0.58), (95 %CI = 0.34, 0.98)), primary level maternal education ((AOR = 0.42), (95 %CI = 0.19, 0.92)), secondary level maternal education ((AOR = 0.37), (95 %CI = 0.16, 0.91)), and average size of child ((AOR = 2.64), (95 %CI = 1.26, 5.53)), and small size child ((AOR = 4.53), (95 %CI = 1.52, 13.51)) associated with post health education maternal knowledge about NDS. CONCLUSION: The mothers' knowledge about NDS is poor even they were gave a birth in health facilities. Wanting of additional child, child sex, maternal education and size of child were associated with NDS knowledge. This indicates that the mode of health education provided for mother might not be appropriate and needs protocol changes.


Assuntos
Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Mães/estatística & dados numéricos , Morte Perinatal/prevenção & controle , Adolescente , Adulto , Pré-Escolar , Etiópia/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/educação , Parto , Gravidez , Fatores Socioeconômicos , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 21(Suppl 1): 238, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33765956

RESUMO

BACKGROUND: Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS: EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS: 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS: Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.


Assuntos
Confiabilidade dos Dados , Inquéritos Epidemiológicos/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Bangladesh , Feminino , Humanos , Recém-Nascido , Nepal , Assistência Perinatal/organização & administração , Gravidez , Tanzânia
18.
Ann Ig ; 33(6): 533-542, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33565568

RESUMO

Background: To date, it is unknown how many Italians have had or have a mild SARS-CoV-2 infection, because of the lack of epidemiological studies involving the general population. Study design: Aim of this study was to investigate the prevalence/incidence of a symptoms-based mild SARS-CoV-2 infection in southern Tuscany, by using an online survey. Methods: An anonymous random middle-aged sample of 3,460 individuals completed the survey. A symptom-score ≥5, calculated on 195 patients with RT-PCR COVID-19 disease (sensitivity/specificity of 0.815/0.780 respectively) was used for the diagnosis. Results: This cut-off highlighted that 12.3% of all the population might have had a SARS-CoV-2 infection, while 3.9% of them might have it at the time of the survey. Female sex (OR=1.334 [1.029-1.728]; p=0.030), obesity status (OR=1.961 [1.304-2.949]; p=0.001), asthma (OR=2.035 [1.433-2.890]; p=0.0001), autoim-mune diseases (OR=2.103 [1.381-3.201]; p=0.001), were all risk factors for showing mild SARS-CoV-2 infection. Instead, the elderly had a low probability to develop mild forms of the disease (OR=0.984 [0.975-0.994]; p=0.001). Conclusion: A remarkable number of subjects in Southern Tuscany may have already had a mild SARS-CoV-2 infection. Symptoms scores might be used to screen subjects with a suspected infection. Female sex, obesity, asthma, autoimmune diseases may be factors linked with mild forms of COVID-19 disease.


Assuntos
COVID-19/diagnóstico , Saúde Pública , Avaliação de Sintomas/estatística & dados numéricos , Fatores Etários , Asma/complicações , Doenças Autoimunes/complicações , COVID-19/epidemiologia , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais
20.
Arch Soc Esp Oftalmol ; 96(7): 347-352, 2021 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33610384

RESUMO

INTRODUCTION: The objetive of these study is to know the characteristics of COVID-19 in patients with uveitis associated with Systemic Autoimmune Disease (SAD) through telematic survey. MATERIAL AND METHODS: Internal Medicine Society and Group of Systemic Autoimmune disease conducted a telematic survey of patients with SAD to learn about the characteristics of COVID-19 in this population. RESULTS: A total of 2,789 patients answered the survey, of which 28 had a diagnosis of uveitis associated with SAE. The majority (82%) were female and caucasian (82%), with a mean age of 48 years. The most frequent SAEs were Behçet's disease followed by sarcoidosis and systemic lupus erythematosus. 46% of the patients were receiving corticosteroid treatment at a mean prednisone dose of 11mg/day. Regarding infection, 14 (50%) patients reported symptoms compatible with SARS-CoV-2 infection. RT-PCR was performed on the nasopharyngeal smear in two patients and in one of them (4%) it was positive. CONCLUSIONS: Both asymptomatic and symptomatic COVID-19 patients with ASD-associated UNI had received similar immunosuppressive treatment.


Assuntos
Doenças Autoimunes/tratamento farmacológico , COVID-19/complicações , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Uveíte/tratamento farmacológico , Adulto , Idoso , Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Feminino , Glucocorticoides/administração & dosagem , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Sarcoidose/epidemiologia , Espanha/epidemiologia , Uveíte/complicações , Uveíte/epidemiologia
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