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1.
PLoS One ; 15(10): e0239576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33113548

RESUMO

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Doença Crônica/economia , Comorbidade , Infecções por Coronavirus/economia , Países em Desenvolvimento/economia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Alimentos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pobreza , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
2.
Environ Health Prev Med ; 25(1): 49, 2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-32892744

RESUMO

BACKGROUND: The health hazards of indoor air pollution are well-established but studies of the health effects due to pollution from heating are rare. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly. METHODS: We used two consecutive surveys in a cohort of over 17,000 adults aged 45 or older, who were interviewed first in 2011-2012 and then in 2013. In these surveys, taking advantage of random survey time, we applied a random effects logit regression model that included an interaction between pollution-producing heating fuel and a dummy variable, which measured interview time based on whether or not it was heating season. RESULTS: Exposure to pollution-producing heating fuel was associated with a 39.9% (OR 1.399; 95%CI 1.227-1.594) and 71.0% (OR 1.710; 95%CI 1.523-1.920) increase in the likelihood of disability in activities of daily living (DADL) and disability in instrumental activities of daily living (DIADL), respectively. In heating season between year 2011 and 2013, moving from clean heating energy for heating to pollution-producing fuel was linked with an increase in the likelihoods having DADL and DIADL, with the OR of 2.014 (95%CI 1.126-3.600) and 1.956 (95%CI 1.186-3.226), respectively. However, disability increases due to change from clean energy to pollution-producing heating energy did not appear in advantaged education respondents. CONCLUSIONS: We found that exposure to heating by burning of coal, wood, or crop residue was associated with disability in performing daily living activities. Health policymakers should take indoor pollution due to heating into consideration as it is a major determinant of activities of daily living in elderly people; especially, such policy should focus on elderly people who have disadvantaged education.


Assuntos
Atividades Cotidianas , Poluição do Ar em Ambientes Fechados/efeitos adversos , Pessoas com Deficiência/estatística & dados numéricos , Calefação/efeitos adversos , Habitação , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar em Ambientes Fechados/análise , China , Feminino , Calefação/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
3.
PLoS One ; 15(9): e0238204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881884

RESUMO

OBJECTIVE: How disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups. METHODS: Individual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups. RESULTS: Three distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups. DISCUSSION: This study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Fatores Socioeconômicos , Atividades Cotidianas , Idoso , Doença Crônica/mortalidade , Análise por Conglomerados , Estudos Transversais , Avaliação da Deficiência , Feminino , Transição Epidemiológica , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Inquéritos e Questionários
4.
J Prim Care Community Health ; 11: 2150132720953680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32909504

RESUMO

BACKGROUND: Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. METHODS: We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. RESULTS: Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/- 6.1 and the mean follow-up PDQ was 81.9 +/- 7.7, resulting in a mean improvement of -10.6 (95% CI 1.2 - -22.3, P = .08). Participants in the chiropractic team (mean change -25.0, P = .01) and those completing the study before COVID-19 (mean change = -22.6, P < .01) were found to have significantly greater improvement at follow-up. CONCLUSION: This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.


Assuntos
Dor Crônica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Manipulação Quiroprática , Equipe de Assistência ao Paciente/organização & administração , Doenças da Coluna Vertebral/terapia , Adolescente , Adulto , Canadá , Centros Comunitários de Saúde , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 69(36): 1238-1243, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914770

RESUMO

Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities.


Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Angústia Psicológica , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
6.
BMC Public Health ; 20(1): 1461, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993585

RESUMO

BACKGROUND: The aim of this study is to quantify the burden caused by viral hepatitis in China from 1990 to 2016. METHODS: Data from the GBD 2016 study were extracted to calculate incidence, prevalence and disability-adjusted life years (DALYs). Trends in DALYs were assessed in 33 provinces/regions. RESULTS: From 1990 to 2016, the total incidence of hepatitis decreased by 88.5%. However, the prevalence of hepatitis (counts in thousands), increased by 37.6% from 153,856 (95% UI: 136,047-172,319) in 1990 to 211,721 (95% UI: 179,776-240,981) in 2016, with age-standardized prevalence rates changing slightly. The number and age-standardized rates of prevalence increased by 35.9 and 1.6% for hepatitis B, respectively, and by 81.8 and 30.4% for hepatitis C. Guangxi, Guangdong and Hainan had the highest age-standardized prevalence rates (≥16,500 per 100,000). Tibet, Qinghai and Gansu had the highest age-standardized DALYs rates (≥40 per 100,000). The largest absolute number of DALYs was observed in the 15-49 year age group in 2016. The highest rate of DALYs occurred in males aged 50-69 years and in females aged ≧70 years. CONCLUSION: The incidence and DALYs of viral hepatitis decreased dramatically from 1990 to 2016. However, the prevalence still remains at a high level, which may result in heavy burdens in the future.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Carga Global da Doença/estatística & dados numéricos , Hepatite/epidemiologia , Idoso , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Sorogrupo
7.
BMC Public Health ; 20(1): 1475, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993606

RESUMO

BACKGROUND: In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS: We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS: In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS: The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.


Assuntos
Doença Crônica/tendências , Pessoas com Deficiência/estatística & dados numéricos , Promoção da Saúde/organização & administração , Anos de Vida Ajustados por Qualidade de Vida , Cloreto de Sódio na Dieta/efeitos adversos , Adulto , Doenças Cardiovasculares/epidemiologia , Dieta/estatística & dados numéricos , Previsões , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Cloreto de Sódio na Dieta/administração & dosagem
8.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 177-184, jul.-ago. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193505

RESUMO

INTRODUCCIÓN: El ciclo de rehabilitación se caracteriza por contribuir efectivamente en la calidad de vida y estimular la integración de las personas con discapacidad a sus diferentes roles. OBJETIVO: El propósito de este estudio fue demostrar las propiedades psicométricas de validez y fiabilidad del instrumento para medir el alcance de las acciones de los fisioterapeutas en el ciclo de rehabilitación de personas con discapacidad. MÉTODO: Este instrumento (42 ítems) se aplicó a una muestra de 118 fisioterapeutas colombianos de diferentes regiones del país. La validez del contenido fue realizada por 5 expertos mediante una matriz de validación y por una prueba piloto con 10 fisioterapeutas con características semejantes a las de la muestra. La validez de confiabilidad se estableció por homogeneidad con alfa de Cronbach y la de constructo mediante análisis factorial de extracción. RESULTADOS: La prueba KMO para validez de constructo resultó en 0,763, y la prueba de Bartlett con un p-valor prácticamente igual a cero. Los ítems 9, 36, 37 y 42 explican más del 80% de la varianza y el coeficiente alfa de Cronbach global resultó en 0,946. CONCLUSIONES: Se han obtenido resultados que sugieren la pertinencia del uso de este cuestionario como instrumento de recogida de datos para la investigación sobre las acciones en el ciclo de rehabilitación de personas con discapacidad en fisioterapeutas colombianos


INTRODUCTION: The rehabilitation cycle is characterized by effectively contributing to the quality of life and stimulating the integration of people with disabilities into their different roles. GOAL: The purpose of this study was to demonstrate the psychometric properties of validity and reliability of the instrument to measure the scope of the actions of physiotherapists in the rehabilitation cycle of people with disabilities. METHOD: This instrument (42 items) was applied to a sample of 118 Colombian physiotherapists from different regions of the country. The validity of the content was carried out by 5 experts through a validation matrix and by a pilot test with 10 physiotherapists with characteristics similar to those of the sample. Reliability validity was established by homogeneity with Cronbach's Alpha and construct validity using extraction factor analysis. RESULTS: The KMO test for construct validity resulted in .763, the Bartlett test with a p-value practically equal to zero. Items 9, 36, 37 and 42 explain more than 80% of the variance. The results showed that the scale is highly reliable (Cronbach Global Alpha Coefficient = 946). CONCLUSIONS: Sufficient validity has been obtained to use of this questionnaire as an instrument of data collection for research into the actions in the rehabilitation cycle of people with disabilities of Colombian physiotherapists


Assuntos
Humanos , Masculino , Feminino , Adulto , Psicometria/instrumentação , Reprodutibilidade dos Testes , Pessoas com Deficiência/reabilitação , Modalidades de Fisioterapia/instrumentação , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Qualidade de Vida , Análise Fatorial , Inquéritos e Questionários
9.
BMC Public Health ; 20(1): 1294, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847576

RESUMO

BACKGROUND: Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia. METHODS: A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ). RESULTS: Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning. CONCLUSION: Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision. TRIAL REGISTRATION: Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pessoas com Deficiência/psicologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Vida Independente/psicologia , Masculino , New South Wales/epidemiologia , Pesquisa Qualitativa , Qualidade de Vida/psicologia
11.
Rehabil Psychol ; 65(3): 199-205, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32804531

RESUMO

Objective/Purpose: The objective of this article is to provide information about the ways in which the novel coronavirus 2019 (COVID-19) pandemic may affect the ongoing public health issue of violence against people with disabilities and how rehabilitation psychologists and other providers can address these concerns in their practice. METHOD: This article reviews the literature on violence against people with disabilities as well as emerging literature on the COVID-19 pandemic and its social and medical consequences. RESULTS: The COVID-19 pandemic magnifies existing issues and barriers facing people with disabilities who are experiencing interpersonal violence. These issues include reliance on the perpetrator for care and assistance, barriers to reporting abuse and seeking help, fear of retaliation and other negative consequences if abuse is reported, emotional abuse related to disability, and exacerbation of secondary physical and mental health sequalae of abuse. CONCLUSIONS/IMPLICATIONS: The COVID-19 pandemic and its consequences enhance the already increased risk for abuse among people with disabilities. Providers who work with individuals with disabilities should address these issues at both the individual client and systems levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/psicologia , Violência/psicologia , Violência/estatística & dados numéricos , Pessoas com Deficiência/reabilitação , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos
12.
Med Care ; 58(9): 826-832, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826747

RESUMO

BACKGROUND: In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE. OBJECTIVE: The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade. RESEARCH DESIGN: Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data. MEASURES: National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability. RESULTS: DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability. CONCLUSIONS: The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Atividades Cotidianas , Adulto , Fatores Etários , Idoso , Doença Crônica , Grupos de Populações Continentais , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Desempenho Físico Funcional , Características de Residência , Fatores Sexuais , Serviço Social/economia , Fatores Socioeconômicos , Estados Unidos , Avaliação da Capacidade de Trabalho
14.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32690805

RESUMO

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.


Assuntos
Preservativos Femininos , Preservativos , Comportamento Sexual , Adolescente , Fatores Etários , Preservativos/estatística & dados numéricos , Preservativos Femininos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interpessoais , Profilaxia Pré-Exposição , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Gravidez não Planejada , Fatores Raciais , Sexo Seguro , Autoimagem , Educação Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Apoio Social
15.
PLoS One ; 15(7): e0236665, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730313

RESUMO

This study aimed to examine the association between disability and cardiovascular (CV) disease incidence and mortality in Korea longitudinally, using a national representative sample. We used the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, which includes information on the disability of the National Screening Program participants such as severity and type of disability, which were obtained from the Korean National Disability Registry. Cox proportional hazard models were used to evaluate the association between disability and CV disease incidence and mortality. We constructed four models with different levels of adjustment, in which Model 3 was a fully adjusted model. This study included 514,679 participants, and 7,317 CV deaths were reported within a mean follow up of 10.8 ± 3.9 years (maximum, 13.9 years). For 5,572,130 person-year (PY) follow-up, the CV mortality rate was 1.313 per 1,000 PY. In Models 1 and 2, CV disease incidence was significantly higher in participants with disability than in those without disability. In Model 3, the incidence was higher only among participants aged 50-64 years and severe disabled participants aged <50 years. CV mortality was significantly higher in participants with disability than in those without disability in all Models, and the mortality increased in both sexes in Models 1 and 2 but only increased in men in Model 3. Similar results were observed in the subgroup analysis of health behavior and chronic diseases. People with disability showed higher CV disease incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/patologia , Comorbidade , Bases de Dados Factuais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Taxa de Sobrevida
16.
Geriatr Gerontol Int ; 20(8): 765-772, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32608124

RESUMO

AIM: To examine whether patterns of social participation vary in their associations with functional disability. METHODS: Data from 44 978 participants (22 750 men and 22 228 women) who participated in the 2010 Japan Gerontological Evaluation Study were analyzed; a study of those aged ≥65 years from 23 municipalities in eight prefectures. Social participation information was obtained at baseline with an eight-item questionnaire. Incidence of functional disability from 2010 to 2013 was defined as a new certification of eligibility for municipal public long-term care insurance. Social participation patterns were analyzed using exploratory factor analysis and participants were classified into quartiles of factor scores of social participation patterns. A competing risk model was used to calculate the hazard ratios and 95% confidence intervals for the incidence of functional disability in 3 years of follow-up. RESULTS: Two social patterns were identified: sports groups/clubs and hobby groups, and political groups/organizations and industry/trade associations. For both patterns, compared with participants in the lowest quartile, participants in the highest quartile were more likely to be male, college educated, high-income and current drinkers. Both patterns were associated with reduced incidence of functional disability (adjusted hazard ratios for top quartile of sports and hobby pattern: 0.66, 95% confidence interval: 0.59, 0.74; for political and industry/trade pattern: 0.81, 95% confidence interval: 0.72, 0.90; P for trend <0.001 for both). CONCLUSIONS: Those whose social participation patterns were characterized by frequent participation in sports groups/clubs and hobby groups or political groups/organizations and industry/trade associations were less likely to develop a functional disability. Geriatr Gerontol Int 2020; 20: 765-772.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Passatempos/psicologia , Participação Social/psicologia , Esportes/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Avaliação Geriátrica , Humanos , Incidência , Japão/epidemiologia , Masculino , Modelos de Riscos Proporcionais , Inquéritos e Questionários
17.
Public Health ; 185: 102-109, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32603874

RESUMO

OBJECTIVES: Chinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations. STUDY DESIGN: We used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities. METHODS: Participants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures. RESULTS: There were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed. CONCLUSIONS: Chinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations.


Assuntos
Atividades Cotidianas , Pessoas com Deficiência/estatística & dados numéricos , Nível de Saúde , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , China/epidemiologia , Doença Crônica/epidemiologia , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Aposentadoria , Inquéritos e Questionários
18.
Am J Public Health ; 110(9): 1332, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673108

RESUMO

Objectives. To describe county-level socioeconomic profiles associated with Kentucky's 2017-2018 hepatitis A outbreak that predominately affected communities affected by the opioid epidemic.Methods. We linked county-level characteristics on socioeconomic and housing variables to counties' hepatitis A rates. Principal component analysis identified county profiles of poverty, education, disability, income inequality, grandparent responsibility, residential instability, and marital status. We used Poisson regression to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs).Results. Counties with scores reflecting an extremely disadvantaged profile (RR = 1.21; 95% CI = 0.99, 1.48) and greater percentage of nonmarried men, residential instability, and income inequality (RR = 1.15; 95% CI = 0.94, 1.41) had higher hepatitis A rates. Counties with scores reflecting more married adults, residential stability, and lower income inequality despite disability, poverty, and low education (RR = 0.77; 95% CI = 0.59, 1.00) had lower hepatitis A rates. Counties with a higher percentage of workers in the manufacturing industry had slightly lower rates (RR = 0.97; 95% CI = 0.94, 1.00).Conclusions. As expected, impoverished counties had higher hepatitis A rates. Evaluation across the socioeconomic patterns highlighted community-level factors (e.g., residential instability, income inequality, and social structures) that can be collected to augment hepatitis A data surveillance and used to identify higher-risk communities for targeted immunizations.


Assuntos
Hepatite A/epidemiologia , Epidemia de Opioides , Fatores Socioeconômicos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Habitação/estatística & dados numéricos , Humanos , Kentucky/epidemiologia , Masculino
19.
BMC Public Health ; 20(1): 1095, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652981

RESUMO

BACKGROUND: Long-term sickness absence results in increased risks of permanent disability and a compromised quality of life. Return to work is an important factor in reducing these risks. Little is known about return to work factors for long-term sick-listed workers with subjective health complaints. The aim of this study was to evaluate prognostic factors for partial or full return to a paid job for at least 28 days for long-term sick-listed workers with subjective health complaints, and to compare these factors with those of workers with other disorders. METHODS: Data from a prospective cohort study of 213 participants with subjective health complaints and 1.037 reference participants were used. The participants answered a questionnaire after 84 weeks of sickness absence. Return to work was measured after one and two years. Univariable logistic regression analyses were performed (P ≤ 0.157) for variables per domain with return to work (i.e. demographic, socio-economic and work-related, health-related, and self-perceived ability). Subsequently, multivariable logistic regression analyses with backward selection (P ≤ 0.157) were performed. Remaining factors were combined in a multivariable and final model (P ≤ 0.05). RESULTS: Both for workers with subjective health complaints and for the reference group, non-health-related factors remained statistically significant in the final model. This included receiving a partial or complete work disability benefit (partial: OR 0.62, 95% CI 0.26-1.47 and OR 0.69, 95% CI 0.43-1.12; complete: OR 0.24, 95% CI 0.10-0.58 and OR 0.12, 95% CI 0.07-0.20) and having a positive self-perceived possibility for return to work (OR 1.06, 95% CI 1.01-1.11 and OR 1.08, 95% CI 1.05-1.11). CONCLUSIONS: Non-health-related factors seem to be more important than health-related factors in predicting return to work after long-term sickness absence. Receiving a work disability benefit and having negative expectations for return to work seem to complicate return to work most for workers with subjective health complaints. With respect to return to work predictors, workers with subjective health complaints do not differ from the reference group.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Emprego/estatística & dados numéricos , Nível de Saúde , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo
20.
Eur Psychiatry ; 63(1): e52, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-456901

RESUMO

As COVID-19 has plagued our world, the term "social distancing" has been widely used with the aim to encourage the general population to physically distance themselves from others in order to reduce the spread of the virus. However, this term can have unintended but detrimental effects, as it evokes negative feelings of being ignored, unwelcome, left alone with one's own fears, and even excluded from society. These feelings may be stronger in people with mental illnesses and in socio-economically disadvantaged groups, such as stigmatized minorities, migrants, and homeless persons [1], many of them also having high risk for suicidal behaviors [2]. Mental health disorders are pervasive worldwide; the global burden accounting for approximately 21.2-32.4% of years lived with disability-more than any other group of illnesses [3]. So, the vulnerable group of people with mental health disorders represents a considerable share of the total global population.


Assuntos
Infecções por Coronavirus/epidemiologia , Emoções , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pneumonia Viral/epidemiologia , Distância Social , Terminologia como Assunto , Criança , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Saúde Mental/estatística & dados numéricos , Pandemias , Estereotipagem , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos
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