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1.
Vaccine ; 40(50): 7280-7287, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36334965

RESUMO

Vaccination is an essential public health intervention to control the COVID-19 pandemic. A minority of Canadians, however, remain hesitant about COVID-19 vaccines, while others outright refuse them. We conducted focus groups to gauge perceptions and attitudes towards COVID-19 vaccines in people who live in a region with historically low rates of childhood vaccination. Participants discussed their perception of COVID-19 vaccines and their intention to get vaccinated, and the low rate of COVID-19 vaccine uptake in Manitoba's Southern Health Region compared to other regions in Canada. We identified three drivers of vaccine hesitancy: (1) risk perceptions about COVID-19 and the vaccines developed to protect against it, (2) religious and conservative views; and (3) distrust in government and science. Participant proposed recommendations for improving communication and uptake of the COVID-19 vaccines included: public health messages emphasising the benefits of vaccination; addressing the community's specific concerns and dispelling misinformation; highlighting vaccine safety; and emphasising vaccination as a desirable behaviour from a religious perspective. Understanding the specific anxieties elicited by COVID-19 vaccines in areas with low childhood immunization rates can inform risk communication strategies tailored to increase vaccination in these specific regions. This study adds important information on potential reasons for vaccine hesitancy in areas with historically low rates of childhood vaccination, and provides important lessons learned for future emergencies in terms of vaccine hesitancy drivers and effective risk communication to increase vaccine uptake.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , COVID-19/prevenção & controle , Pandemias , Hesitação Vacinal , Canadá , Vacinação , Liberdade
2.
Int J Public Health ; 67: 1605241, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36387289

RESUMO

Objectives: This study aimed to investigate public discourses and sentiments regarding the Freedom Convoy in Canada on Twitter. Methods: English tweets were retrieved from Twitter API from 15 January to 14 February 2022 when the Freedom Convoy occurred. Unsupervised topic modelling and sentiment analysis were applied to identify topics and sentiments for each topic. Results: Five topics resulted from the topic modelling, including convoy support, political arguments toward the current prime minister, lifting vaccine mandates, police activities, and convoy fundraising. Overall, sentiments for each topic began with more positive or negative sentiments but approached to neutral over time. Conclusion: The results show that sentiments towards the Freedom Convoy generally tended to be positive. Five topics were identified from the data collected, and these topics highly correlated with the events of the convoy. Our study also demonstrated that a mixed approach of unsupervised machine learning techniques and manual validation could generate timely evidence.


Assuntos
Mídias Sociais , Vacinas , Humanos , Análise de Sentimentos , Liberdade , Canadá
3.
4.
Cien Saude Colet ; 27(12): 4493-4509, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383863

RESUMO

Psychological distress and developing mental disorders in prisons are globally recognized public health issues. This study aimed to identify the prevalence of these symptoms and associated factors in 99 women over 18 years of age in the provisional, closed, and semi-open regimes in Juiz de Fora-MG, Brazil. This cross-sectional census study collected data face-to-face through a semi-structured and multidimensional questionnaire. We assessed outcomes using the Patient Health Questionnaire-4 (PHQ-4). We built a theoretical determination model with three hierarchical blocks for the association analysis. We estimated crude prevalence ratios using the chi-square test and adjusted for each other within each block (p≤0.20). We adopted p≤0.05 for the final Poisson regression model with robust variance. The prevalence of anxiety and depressive symptoms was 75.8% (95%CI 66.1%-83.8%) and 65.7% (95%CI 55.4%-74.9%), respectively. In the final model, anxiety symptoms were associated with depressive symptoms. On the other hand, depressive symptoms were associated with the 20-29 years age group and anxiety symptoms. We identified a prevalence of the outcomes in more than half of the participants, emphasizing the inter-association between them.


Sofrimento psíquico e desenvolvimento de transtornos mentais nas prisões são questões de saúde pública reconhecidas mundialmente. Objetivou-se identificar a prevalência destes sintomas e os fatores associados em 99 mulheres com mais de 18 anos de idade, nos regimes provisório, fechado e semiaberto de Juiz de Fora-MG. Trata-se de um estudo transversal, do tipo censo, com dados coletados face a face através de questionário semiestruturado e multidimensional. Os desfechos foram avaliados pelo Patient Health Questionannaire-4 (PHQ-4). Para a análise de associação foi construído um modelo teórico de determinação com três blocos hierarquizados. Foram estimadas razões de prevalência brutas por meio do teste Qui-quadrado e ajustadas entre si dentro de cada bloco (p≤0,20). Para o modelo final de regressão de Poisson com variância robusta foi adotado p≤0,05. A prevalência de sintomas ansiosos e depressivos foi, respectivamente, de 75,8% (IC95% 66,1%-83,8%) e 65,7% (IC95% 55,4%-74,9%). No modelo final, sintomas ansiosos associaram-se à presença de sintomas depressivos. Já sintomas depressivos associaram-se à faixa etária de 20 a 29 anos e à presença de sintomas ansiosos. Verificou-se prevalência dos desfechos em mais da metade das participantes, com destaque para interassociação entre eles.


Assuntos
Ansiedade , Depressão , Humanos , Feminino , Adolescente , Adulto , Brasil/epidemiologia , Prevalência , Estudos Transversais , Depressão/epidemiologia , Fatores Socioeconômicos , Ansiedade/epidemiologia , Liberdade
5.
Cien Saude Colet ; 27(12): 4511-4520, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383864

RESUMO

Tobacco use is a Public Health issue, and the release of its use in the prison system is controversial. Its prevalence in this population is high, including in women's prisons. The objective of this article is to estimate tobacco use prevalence in women deprived of liberty and its associated factors. Cross-sectional study with 259 participants who answered a questionnaire in a prison in the Brazilian Midwest. The dependent variable was tobacco use, and the independent variables were sociodemographic, life history, legal status, and use of other drugs. Descriptive and bivariate analyses were performed, using prevalence ratios through the Chi-square test and Poisson regression in the multivariate analysis. Tobacco use prevalence was 86.87%. In the final model, the variables: age group, from 18-39 years (PR 1.33; 95%CI 1.10-1.61), alcohol use (PR 1.26; 95%CI 1.00-1.59), marijuana use (PR 1.16; 95%CI 1.03-1.30), and interaction between prison time and cocaine use (PR 1.05; 95%CI 1.00-1.11) remained associated with tobacco use. Tobacco use prevalence was high. The age group 18-39 years, alcohol and marijuana use and interaction between imprisonment length of 36 months or more and cocaine use were associated with tobacco use.


O tabagismo é um problema de Saúde Pública e é controversa a liberação do seu uso no sistema prisional. Sua prevalência nesta população é elevada, inclusive nas prisões femininas. O objetivo deste artigo é estimar a prevalência do tabagismo em mulheres privadas de liberdade e os fatores associados. Estudo de corte transversal, com 259 participantes que responderam um questionário numa prisão no Centro-Oeste do Brasil. A variável dependente foi o tabagismo, e as independentes, as sociodemográficas, histórico de vida, situação jurídica e uso de outras drogas. Realizou-se análises descritiva e bivariada, através de razões de prevalência com o teste Qui-quadrado e, na análise multivariável, a regressão de Poisson. A prevalência de tabagismo foi de 86,87%. No modelo final as variáveis: faixa etária, de 18 a 39 anos (RP 1,33; IC95% 1,10-1,61); uso de álcool (RP 1,26; IC95% 1,00-1,59); uso de maconha (RP 1,16; IC95% 1,03-1,30); e interação entre tempo de prisão e uso de cocaína (RP 1,05; IC95% 1,00-1,11) se mantiveram associadas ao tabagismo. A prevalência de tabagismo foi alta. A faixa etária 18-39 anos, uso de álcool, maconha e interação entre tempo de prisão por 36 meses ou mais e uso de cocaína foram fatores associados ao tabagismo.


Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína , Prisioneiros , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Lactente , Pré-Escolar , Prisões , Brasil/epidemiologia , Prevalência , Estudos Transversais , Uso de Tabaco/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Liberdade
6.
Cien Saude Colet ; 27(12): 4531-4540, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383866

RESUMO

This article analyzes vulnerabilities and prospects of restructuring the lives of women who experienced maternity in prison. This qualitative study was performed with a thematic analysis of the reports of women released from the prison system who experienced pregnancy and delivery in a female penitentiary in a Southern Brazilian capital. Three thematic categories were identified: "Between rupture and freedom", a category focused on the description of moments before the borderline date for the child's stay with the mother in prison, which produces great expectations due to the possibility of women managing to get out of prison along with their child; "Freedom is right there", which narrates leaving prison and the first social contacts outside this environment; and "Inmate in daily life", which addresses the difficulties resulting from social exclusion that women were already facing before imprisonment, that is, having the minimum conditions to keep away from the crime dynamics. Leaving the prison system does not necessarily mean freedom. The "identity crossroads" keep following women and their children even after leaving prison. Therefore, vulnerability manifests itself in the same way or more cruelly than before.


O presente artigo analisa as vulnerabilidades e as perspectivas de reestruturação da vida de mulheres que vivenciaram a maternidade no cárcere. Estudo qualitativo com análise temática dos relatos de mulheres egressas do sistema prisional, que vivenciaram a gestação e o parto em uma penitenciária feminina de uma capital do sul do Brasil. Foram identificadas três categorias temáticas: "Entre a ruptura e a liberdade", categoria com foco na descrição dos momentos antecedentes à data limítrofe para a permanência da criança junto com a mãe no cárcere, fato que produz grande expectativa, pela possibilidade de a mulher conseguir sair da prisão junto com seu filho; "A liberdade é logo ali", categoria que narra o contexto de saída da prisão e os primeiros contatos sociais fora desse ambiente; e "Presas no cotidiano", categoria que aborda as dificuldades decorrentes de exclusão social que as mulheres já estavam enfrentando antes do aprisionamento, ou seja, ter as condições mínimas para manterem-se afastadas da dinâmica do crime. A saída do sistema prisional não significa necessariamente liberdade. As encruzilhadas identitárias seguem acompanhando as mulheres e seus filhos, de tal modo que após a saída do cárcere, a vulnerabilidade manifesta-se do mesmo modo ou mais cruelmente do que antes.


Assuntos
Prisioneiros , Prisões , Gravidez , Criança , Feminino , Humanos , Brasil , Crime , Liberdade
7.
Cien Saude Colet ; 27(12): 4569-4577, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383870

RESUMO

This paper presents an experience report on the supervision of deinstitutionalization of the prison system through the articulation of the Psychosocial Care Network (RAPS) conducted from 2014 to 2021 within the Superintendence of Mental Health/Municipal Health Secretariat of Rio de Janeiro. This work of deinstitutionalizing people deprived of liberty with mental health problems consists of actions at the exit and entrance doors of the prison system and actions for the care of unimputable and imputable people with mental disorders. In the light of the Brazilian Psychiatric Reform, formalized by Law No. 10,216/2001, we aim to present an approach to this process counting on the possibilities of building care policies for insane offenders that are not punitive or segregating. The practical results of this work include more significant participation of the network in the construction of care for insane offenders, elaborating policies that avoid the prison career or reduce the asylum time in the penal system, and understanding that security measures must always have an outpatient nature.


Este artigo apresenta o relato da experiência de supervisão de desinstitucionalização do sistema prisional a partir da articulação da Rede de Atenção Psicossocial (RAPS), realizada de 2014 a 2021 no âmbito da Superintendência de Saúde Mental/Secretaria Municipal de Saúde do Rio de Janeiro. Trata-se de um trabalho de desinstitucionalização de pessoas privadas de liberdade com agravos em saúde mental e dividiu-se em atuações nas portas de saída e de entrada do sistema prisional e em ações voltadas para o cuidado de pessoas com transtornos mentais consideradas inimputáveis e imputáveis. À luz da Reforma Psiquiátrica Brasileira, formalizada pela Lei nº 10.216/2001, pretende-se apresentar uma abordagem sobre esse processo apostando em possibilidades de construir políticas de cuidado para o louco infrator que não sejam punitivistas ou segregadoras. Os resultados práticos desse trabalho incluem uma maior participação da rede na construção do cuidado para o louco infrator, a elaboração de políticas que evitem a carreira prisional ou reduzam o tempo de manicomialização no sistema penal e a compreensão de que a medida de segurança deve sempre ter caráter ambulatorial.


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Brasil , Desinstitucionalização , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Liberdade
8.
Health Policy ; 126(12): 1283-1290, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36384736

RESUMO

Public policies fostering the freedom of choice of provider in the healthcare sector are increasingly common in many countries and regions, where policymakers wish to empower patients and improve health service performance. However, in the literature there is not clear consensus about the impact of expanded patient choice on healthcare quality yet. This study investigates whether increasing patients' freedom of choice influences health system outcomes in terms of various non-clinical aspects of care, a dimension often overlooked by researchers in this field. Our study considers a "natural experiment" that took place within the Spanish National Health System in 2009 under which citizens of the Community (region) of Madrid were allowed to freely choose among any GP and/or specialist in their region. The empirical analysis was conducted by using Spanish microdata for the period 2002-2016 and used synthetic control estimation techniques. The key findings show the reform had a strong and long-lasting impact, reducing average waiting times and increasing patients' satisfaction with the specialist attention received. We did not detect any statistically significant impact of the reform on the other responsiveness domains analysed. Our analysis shows that freedom of choice policies could improve health system performance if they are combined with appropriate economic incentives for health providers.


Assuntos
Comportamento de Escolha , Serviços de Saúde , Humanos , Qualidade da Assistência à Saúde , Satisfação do Paciente , Liberdade
9.
Rev. esp. salud pública ; 96: e202210062-e202210062, Oct. 2022.
Artigo em Espanhol | IBECS | ID: ibc-211611

RESUMO

En ciencias del comportamiento, la expresiónnudge (del inglés, empujón, codazo) se refiere a cualquier aspecto de la arquitectura dela decisión que altera predeciblemente la conducta de las personas en su propio beneficio sin prohibir o restringir de forma signifi-cativa sus opciones. Sus promotores invocan elpaternalismo libertario para justificarlo, lo que significa que se promueve el beneficiodel individuo sin contar con su autonomía, pero sin llegar al punto de coartar la libertad de elección cuando ésta es manifiesta. Eneste trabajo se analiza el papel de losnudges en el ámbito de las políticas de salud. Se lleva a cabo un análisis cognitivo de ellos yse distinguen losnudges clínicos (aquellos que tienen lugar en el seno de la relación sanitario-paciente) de losnudges salubristas(específicos de políticas de salud pública). Se analizan los aspectos éticos de ambas categorías para señalar algunas de sus virtudes ylos retos éticos que plantean. El estudio se centra, de manera particular, en losnudges salubristas, para considerar si es razonable, ycon qué límites, su implementación en crisis sanitarias (por ejemplo, pandemias), donde las políticas públicas se enfrentan al dilemaentre preservar la libertad a costa de la salud pública o, por el contrario, priorizar ésta hasta el punto de limitar aquélla. Se plantea sien este contexto se deberían permitir mayores restricciones de las libertades individuales (por ejemplo, mediante confinamientos ycuarentenas obligatorias, vacunación impuesta, etc.) o bien utilizarnudges como una salida intermedia y menos lesiva de derechosindividuales para promover medidas sanitarias.(AU)


In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people’s behavior to impro-ve the chooser’s own welfare without forbidding or significantly restricting their choices. Its promoters invokelibertarian paternalism,which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the otherhand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzesthe role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinicalnudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specificto public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and theethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and withwhat limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma betweenpreserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whe-ther in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns andquarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individualrights to promote health measures.(AU)


Assuntos
Humanos , Ciências do Comportamento , Direitos Civis , Liberdade , Pandemias , Recusa de Vacinação , Comportamento , Saúde Pública , Ética
10.
Lancet ; 400(10358): 1090, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183715
11.
Med Health Care Philos ; 25(4): 729-736, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36260257

RESUMO

As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual's reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one's reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement.


Assuntos
Liberdade , Autonomia Pessoal , Humanos , Princípios Morais , Cognição
12.
Perspect Psychiatr Care ; 58(4): 2986-2997, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36192125

RESUMO

PURPOSE: The aim of this study was to compare the effect of emotional freedom technique (EFT) on sleep quality and happiness of women who underwent breast cancer surgery and lived in military and nonmilitary families. DESIGN AND METHODS: The patients were randomly divided into four groups of military intervention (n = 34), nonmilitary intervention (n = 33), military control (n = 31), and nonmilitary control (n = 35). Data were collected using demographic information form, Pittsburgh Sleep Quality Index, and Oxford Happiness Questionnaire. FINDINGS: The mean scores of sleep quality and happiness in military and nonmilitary intervention groups improved significantly immediately and 1 month after the intervention compared to control groups (p < 0.001). However, there was no statistically significant difference between the military and nonmilitary intervention groups regarding the mean scores of sleep quality and happiness before, immediately, and 1 month after the intervention (p > 0.05). PRACTICE IMPLICATIONS: Given the efficacy of EFT in improving sleep quality and happiness, it is recommended that this technique be taught to nurses to implement in the entire process of providing nursing care to cancer patients.


Assuntos
Neoplasias da Mama , Militares , Humanos , Feminino , Felicidade , Neoplasias da Mama/cirurgia , Qualidade do Sono , Liberdade
13.
Rev Lat Am Enfermagem ; 30: e3669, 2022.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-36228237

RESUMO

OBJECTIVE: to evaluate the factors associated with risk related to the use of psychoactive substances in male inmates of a prison in a city in the South of Brazil. METHOD: a cross-sectional data from 220 men deprived of liberty, inmates of a provisional custody institution in the State of Paraná, collected with a screening instrument and questionnaire. Binary logistic regression and odds ratio analysis were used to verify associations between risk related to substance use and socio-demographic characteristics of living conditions before incarceration and current incarceration. RESULTS: the adjusted model revealed association of consumption with skin color brown/black and yellow, those who had only one parent responsible until age 15, age at first arrest 18 or older, professing religion, working before arrest, owning their own house, living alone, receiving visitors in prison. CONCLUSION: the identified factors are useful to insert effective treatment proposals and reduce the gaps and social vulnerability existing in prison.


Assuntos
Prisioneiros , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Estudos Transversais , Liberdade , Humanos , Masculino , Prevalência , Prisões , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
14.
15.
J Phys Act Health ; 19(11): 745-757, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36280228

RESUMO

BACKGROUND: Macrolevel factors such as economic and climate factors can be associated with physical activity indicators. This study explored patterns and relationships between economic freedom, climate culpability, and Report Card grades on physical activity-related indicators among 57 countries/jurisdictions participating in the Global Matrix 4.0. METHODS: Participating countries/jurisdictions provided Report Card grades on 10 common indicators. Information on economic freedom and climatic factors were gathered from public data sources. Correlations between the key variables were provided by income groups (ie, low- and middle-income countries/jurisdictions and high-income countries/jurisdictions [HIC]). RESULTS: HIC were more economically neoliberal and more responsible for climate change than low- and middle-income countries. Annual temperature and precipitation were negatively correlated with behavioral/individual indicators in low- and middle-income countries but not in HIC. In HIC, correlations between climate culpability and behavioral/individual and economic indicators were more apparent. Overall, poorer grades were observed in highly culpable countries/jurisdictions in the highly free group, while in less/moderately free groups, less culpable countries/jurisdictions showed poorer grades than their counterparts in their respective group by economic freedom. CONCLUSIONS: Global-level physical activity promotion strategies should closely evaluate different areas that need interventions tailored by income groups, with careful considerations for inequities in the global political economy and climate change.


Assuntos
Exercício Físico , Relatório de Pesquisa , Criança , Adolescente , Humanos , Renda , Liberdade
16.
Int J Qual Stud Health Well-being ; 17(1): 2130508, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36226383

RESUMO

PURPOSE: Active travel (AT) incorporates physical activity into daily living, critical for healthy adolescent development. We explore adolescent and parent attitudes and behaviours related to motivations for adolescent AT and effects of the COVID-19 pandemic. METHODS: We conducted semi-structured Zoom interviews with 25 adolescent-parent dyads in communities across Israel during early stages of the COVID-19 pandemic. Thematic content analysis was used to develop categories and themes. RESULTS: We identified key themes related to adolescent AT: Fostering independence enables adolescent AT; Pampering and safety concerns inhibit adolescent AT; Family and community norms influence adolescent travel modes; Personal enjoyment and positive attitudes facilitate AT; Peers and social networks promote adolescent AT and PA; Built environment and transport options influence AT choices. Interestingly, adolescents indicate AT is an opportunity for peer-to-peer communication without screen distraction, yet they use social media to promote AT and PA. CONCLUSIONS: The findings point to the influence of positive parent perceptions, active and supportive family and community norms on adolescent AT. Peer norms and social networks as well as features of the built environment also have the potential to influence AT. The COVID-19 pandemic encouraged use of AT and provided a setting for positive AT experiences.


Assuntos
COVID-19 , Adolescente , Liberdade , Humanos , Motivação , Pandemias , Pais
17.
BMC Geriatr ; 22(1): 762, 2022 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123606

RESUMO

BACKGROUND: Frailty is a geriatric syndrome associated with disability and negative health outcome. To determine the factors associated with frailty and functional disability in older participants living in community in France. We included 753 community-dwelling old participants with available frailty data at baseline. RESULTS: Overall, 31.9% were frail, 58.3% were prefrail, and 9.8% were robust. The SMAF (French acronym for Functional Autonomy Measurement System) score was significantly lower (mean ± standard deviation: -25.8 ± 11.2) in frail participants compared to prefrail (-14.3 ± 9.7) or robust participants (-8.1 ± 7.0); 82% of frail older participants had limitation in at least one ADL and 97.5% in at least one IADL compared to 54.2 and 76.8%, respectively of pre-frail and 29.7 and 47.3% of robust participants. Age, depression, impaired cognition and diabetes were significantly associated with higher odds of frailty. These variables were also strongly associated with functional disability. Female gender, polypharmacy, and smoking were additional variables significantly associated with degraded SMAF and/or ADL/IADL. CONCLUSIONS: This study showed that functional disability increased proportionally to frailty, and depression, cognitive decline and diabetes are modifiable risk factors significantly associated with frailty and functional disability.


Assuntos
Fragilidade , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Liberdade , Avaliação Geriátrica , Humanos , Vida Independente , Fatores de Risco
18.
Nature ; 609(7926): 243-244, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36064799
19.
J Wound Care ; 31(9): 734-747, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36113543

RESUMO

OBJECTIVE: To evaluate the efficacy, tolerability and acceptability of a new multicomponent compression system in one bandage for the local treatment of patients with venous leg ulcers (VLUs). METHOD: This was an international, prospective, non-comparative, clinical trial, conducted in France and Germany. Eligible participants had a VLU with a wound area of 2-20cm2, lasting for a maximum of 24 months. For a period of 6 weeks, patients were treated with a new multicomponent compression system in one bandage which was worn day and night, providing high working pressure and moderate resting pressure (UrgoK1). Clinical assessments, wound measurement and photographs were planned at weeks 1, 2, 4 and 6. The primary endpoint was the relative wound area reduction (RWAR) after 6 weeks of treatment. Secondary endpoints included wound closure rate, oedema resolution, change in patient's health-related quality of life (HRQoL), acceptability, adherence to the compression therapy, local tolerance, and physician's overall satisfaction with the evaluated compression system. RESULTS: A cohort of 52 patients (52% female, mean age 75.4±13.0 years) with VLUs, including oedema in 58% of cases, were recruited from 22 centres. At baseline, 42 patients had already been treated with a different compression system. VLUs had been present for 5.6±4.9 months and had a mean area of 5.7±4.3cm2. After 6 weeks of treatment, a median RWAR of 91% (interquartile range: 39.4; 100.0) was achieved. Wound closure was reported in 35% of patients. A RWAR ≥40% at week 4, predictive of wound healing at 12 weeks, was achieved in 62% of patients. At the final visit, oedema present at baseline was resolved in 57% of patients. Substantial improvements in the HRQoL of the patients were reported with a decrease of the pain/discomfort and anxiety/depression dimensions. Comfort in wearing the evaluated system was reported as 'very good' or 'good' by 79% of patients, resulting in a high patient adherence to compression therapy. Compared to previous compression systems, half of the patients reported more ease in wearing shoes, and greater satisfaction and comfort with this new system. Nine non-serious adverse events related to the device or its procedure occurred in seven patients. At the final visit, the majority of the physicians were 'very satisfied' or 'satisfied' with the new compression system overall. CONCLUSION: The new multicomponent compression system in one bandage has been shown to promote rapid healing of VLUs, reduce oedema, improve HRQoL and to be well tolerated and accepted. It appears to be a viable alternative to existing compression systems.


Assuntos
Qualidade de Vida , Úlcera Varicosa , Idoso , Idoso de 80 Anos ou mais , Bandagens , Feminino , Liberdade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Úlcera Varicosa/terapia
20.
PLoS One ; 17(9): e0274270, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36083998

RESUMO

In the name of health security, individual freedoms were constrained in an unprecedented way in many countries, democratic or authoritarian, all over the world during the COVID-19 pandemic. Yet the constraints have not been consistent across countries, which motivates this paper to examine the relevance of value preferences towards freedom or security in the society for COVID-19 policies. Based on data for 40 democratic and authoritarian countries, the analyses show that the variation in the stringency of COVID-19 policies can be explained by value preferences of the population only in autocracies. In democracies, however, we do not find such a relationship. Governments in democratic political systems, we argue, are responsive to their constitutions and face prosecution by the judiciary if they violate the law or provisions of the constitution, limiting their capacity to implement strong COVID-19 policies. Nevertheless, their COVID-19 policies restricted citizens' freedoms and liberties, which means that these policies were rather not responsive to citizens' preferences for freedom, democratic rights and liberties. By highlighting how autocracies respond to their citizens' value preferences for security, this paper contributes to a better understanding of how autocracies might gain legitimacy in times of crises.


Assuntos
COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Democracia , Liberdade , Humanos , Pandemias/prevenção & controle , Políticas
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