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1.
Sci Total Environ ; 702: 135040, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31726339

RESUMO

Living in greener places may protect against obesity, but epidemiological evidence is inconsistent and mainly comes from developed nations. We aimed to investigate the association between greenness and obesity in Chinese adults and to assess air pollution and physical activity as mediators of the association. We recruited 24,845 adults from the 33 Communities Chinese Health Study in 2009. Central and peripheral obesity were defined by waist circumference (WC) and body mass index (BMI), respectively, based on international obesity standards. The Normalized Difference Vegetation Index (NDVI) was used to quantify community greenness. Two-level logistic and generalized linear mixed regression models were used to evaluate the association between NDVI and obesity, and a conditional mediation analysis was used also performed. In the adjusted models, an interquartile range increase in NDVI500-m was significantly associated with lower odds of peripheral 0.80 (95% confidence interval [CI]: 0.74-0.87) and central obesity 0.88 (95% CI: 0.83-0.93). Higher NDVI values were also significantly associated with lower BMI. Age, gender, and household income significantly modified associations between greenness and obesity, with stronger associations among women, older participants, and participants with lower household incomes. Air pollution mediated 2.1-20.8% of the greenness-obesity associations, but no mediating effects were observed for physical activity. In summary, higher community greenness level was associated with lower odds of central and peripheral obesity, especially among women, older participants, and those with lower household incomes. These associations were partially mediated by air pollutants. Future well-designed longitudinal studies are needed to confirm our findings.


Assuntos
Obesidade/epidemiologia , Desenvolvimento Sustentável , Poluição do Ar , Índice de Massa Corporal , China/epidemiologia , Cidades/epidemiologia , Exercício , Humanos , Características de Residência , Fatores Socioeconômicos , População Urbana/tendências
2.
Acta Trop ; 200: 105156, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491398

RESUMO

INTRODUCTION: Rabies is one of the most neglected tropical diseases in numerous regions of the world. Annually, 60,000 deaths have been reported, mostly in Asia and Africa. Dogs are responsible for approximately 99% of human deaths due to rabies. Consequently, incidences of canine bites are increased yet rabies continues to remain a neglected disease in Pakistan. The objective of the study was to investigate the Knowledge, Attitude and Practices (KAP) for rabies, among the participants from urban and rural population of Rawalpindi and Islamabad, Pakistan. METHODS: Data was collected by conducting household based cross-sectional survey over a period of 5 months (from January 2018 to May 2018). Quantitative data was collected in the form of questionnaires to investigate awareness and knowledge of rabies among the participants. The questionnaire compromised of socio-demographic features and degree of KAP with respect to rabies management and control. RESULTS: A total sample size of 434 participants responded in the study. Among them, 89.4% were found to have heard about rabies, 38.7% have no knowledge of signs and symptoms, 93.3% knew that infected dogs are the major cause of spreading rabies and 77.6% considered that the vaccination of animals is important for prevention of rabies. However, only 39.8% actively seek medical treatment at a hospital if bitten by a dog. From the 434 participants 61 reported dog bites, of which 68.8% (42/61) were male and 49.1% (30/61) belonged to age group of 6-25 years. CONCLUSION: This study concludes that respondents have relatively limited knowledge, inconsistent attitude and poor practices towards rabies prevention and control. There is a high need of imparting knowledge to the population from multidisciplinary programs for effective management and prevention of rabies.


Assuntos
Doenças do Cão/epidemiologia , Doenças do Cão/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Raiva/epidemiologia , Raiva/psicologia , População Rural/estatística & dados numéricos , População Urbana/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos Transversais , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
3.
Nat Commun ; 10(1): 3376, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388009

RESUMO

The increase in surface air temperature in China has been faster than the global rate, and more high temperature spells are expected to occur in future. Here we assess the annual heat-related mortality in densely populated cities of China at 1.5 °C and 2.0 °C global warming. For this, the urban population is projected under five SSPs, and 31 GCM runs as well as temperature-mortality relation curves are applied. The annual heat-related mortality is projected to increase from 32.1 per million inhabitants annually in 1986-2005 to 48.8-67.1 per million for the 1.5 °C warming and to 59.2-81.3 per million for the 2.0 °C warming, taking improved adaptation capacity into account. Without improved adaptation capacity, heat-related mortality will increase even stronger. If all 831 million urban inhabitants in China are considered, the additional warming from 1.5 °C to 2 °C will lead to more than 27.9 thousand additional heat-related deaths, annually.


Assuntos
Aquecimento Global , Temperatura Alta/efeitos adversos , Mortalidade/tendências , População Urbana/tendências , Aclimatação , Adolescente , Adulto , Idoso , China/epidemiologia , Cidades/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos , Adulto Jovem
4.
BMC Public Health ; 19(1): 1121, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416433

RESUMO

BACKGROUND: Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years. METHODS: Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping. RESULTS: Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles. CONCLUSION: Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.


Assuntos
Dor nas Costas/epidemiologia , População Rural/tendências , População Urbana/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Canadá/epidemiologia , Doença Crônica , Estudos Transversais , Exercício , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Escócia/epidemiologia , Prevalência , Quebeque/epidemiologia , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
5.
Respir Res ; 20(1): 122, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200718

RESUMO

BACKGROUND: Previous studies have found associations between asthma morbidity and air pollution especially in young population, (PLoS One 12:e0180522, 2017; Can J Public Health 103:4-8, 2012; Environ Health Perspect 118:449-57, 2010; Am J Respir Crit Care Med 182:307-16, 2010; J Allergy Clin Immunol 104:717-22, 2008; J Allergy Clin Immunol 104:717-22, 1999; Environ Res 111:1137-47, 2011) but most of them were conducted in areas with relatively low air pollutant level. Moreover, very few studies have investigated the effect and burden modification of heating season during which the ambient air pollution level is significantly different from that during non-heating season in north China. OBJECTIVES: This study aimed to evaluate the effect and burden modification of heating on short-term associations between adult asthma hospitalizations and ambient air pollution in the north China city of Shijiazhuang. METHODS: Generalized additive models combined with penalized distributed lag nonlinear models were used to model associations between daily asthma hospitalizations and ambient air pollutants from 1 January 2013 to 16 December 2016 in Shijiazhuang city, adjusting for long-term and seasonality trend, day of week, statutory holiday, daily mean air pressure and temperature. Attributable risks were calculated to evaluate the burden of asthma hospitalizations due to air pollutants exposure. The effect of pollutants on hospitalization and the attributable measures were estimated in heating and non-heating season separately and the comparisons between the two seasons were conducted. RESULTS: All pollutants demonstrated positive and significant impacts on asthma hospitalizations both in heating season and non-heating season, except for O3 in heating season where a negative association was observed. However, the differences of the pollutant-specific effects between the two seasons were not significant. SO2 and NO2 exposure were associated with the heaviest burden among all pollutants in heating season; meanwhile, PM10 and PM2.5 were associated with the heaviest burden in heating season. CONCLUSIONS: In conclusion, we found evidence of the effect of ambient air pollutants on asthma hospitalizations in Shijiazhuang. The central heating period could modify the effects in terms of attributable risks. The disease burden modification of heating should be taken into consideration when planning intervention measures to reduce the risk of asthma hospitalization.


Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Monitoramento Ambiental/métodos , Calefação/efeitos adversos , Hospitalização , Material Particulado/efeitos adversos , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Asma/diagnóstico , Asma/etiologia , China/epidemiologia , Feminino , Calefação/tendências , Hospitalização/tendências , Humanos , Masculino , Material Particulado/análise , Fatores de Risco , Fatores de Tempo , População Urbana/tendências
6.
BMC Infect Dis ; 19(1): 432, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101081

RESUMO

BACKGROUND: The HIV epidemic remains a concern on the global health agenda, despite progress made in reducing incidence. Investigation of trends among young people is important for monitoring HIV incidence and informing programming. The study examined geographical and sub-population differences in HIV prevalence trends among young people aged 15-24 years in Zambia. METHODS: This study analysed data from Zambia Demographic and Health Surveys (ZDHSs) that were conducted in 2001-2, 2007, and 2013-14. A two-stage cluster stratified sampling procedure was used to select samples of 8050, 7969, and 18,052 for the three surveys, respectively. Young people (15-24 years) with known HIV status were selected for analysis. The outcome variable was HIV status. Log binomial regression analysis of generalised linear models was used to test for trends. RESULTS: Overall HIV prevalence declined over the period 2001-2 to 2013-14 among women and men aged 15-49 years (17.8 and 12.9% to 15.1 and 11.3%, respectively). There was, however, an increase in HIV prevalence among urban young men over this period, from 3.7% in 2001-2 to 7.3% in 2013-14 (aRR 2.17, 95% CI 0.99-4.75), and, in rural areas, from 2.6 to 3.6% (aRR 1.46, 95% CI 0.78-2.75). In contrast, HIV prevalence among women declined over the same period of time. In urban areas, HIV prevalence among women declined from 15.2 to 10.7% (aRR 0.66, 95% CI 0.53-0.93), while in rural areas it declined from 8.2 to 4.8% (aRR 0.41, 95% CI 0.59-0.85). In addition, there was a narrowing gender gap in terms of HIV infection, as the prevalence ratio of females to males declined from 4.2 and 3.1 to 1.5 and 1.3, in urban and rural areas, respectively. CONCLUSIONS: The increase in HIV prevalence among urban young men over the past 12 years, contrasting declining trends among young women in both urban and rural populations, suggests differential effects of prevention efforts. Furthermore, findings that Zambia's overall national HIV prevalence decline masks some striking sex and rural/urban differentials, indicate the need for reconsidering the prevention efforts for young urban men.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , População Rural/tendências , População Urbana/estatística & dados numéricos , População Urbana/tendências , Adulto Jovem , Zâmbia/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-31126097

RESUMO

There are increasing concerns regarding upward trends in drug-related deaths in a number of developed societies. In some countries, these have been paralleled by upward trends in suicide. Of frequent concern to public health policy are local variations in these outcomes, and the factors underlying them. In this paper, we consider the geographic pattern of drug-related deaths and suicide for 2012-2016 across 6791 small areas in England. The aim is to establish the extent of commonalities in area risk factors between the two outcomes, with a particular focus on impacts of deprivation, fragmentation and rurality.


Assuntos
Geografia , Densidade Demográfica , População Rural/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/tendências , Fatores Sexuais , Fatores Socioeconômicos , Suicídio/tendências , População Urbana/tendências
8.
Int J Health Geogr ; 18(1): 8, 2019 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060555

RESUMO

BACKGROUND: Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. METHODS: Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). RESULTS: We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. CONCLUSION: Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.


Assuntos
Acesso aos Serviços de Saúde/economia , Cuidados Paliativos/economia , Vigilância da População , População Rural , Assistência Terminal/economia , População Urbana , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/tendências , Características de Residência , População Rural/tendências , Assistência Terminal/tendências , População Urbana/tendências
9.
JAMA Netw Open ; 2(4): e191919, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30977849

RESUMO

Importance: Patterns in emergency department (ED) use by rural populations may be an important indicator of the health care needs of individuals in the rural United States and may critically affect rural hospital finances. Objective: To describe urban and rural differences in ED use over a 12-year period by demographic characteristics, payers, and characteristics of care, including trends in ambulatory care-sensitive conditions and ED safety-net status. Design, Setting, and Participants: This cross-sectional study of ED visit data from the nationally representative National Hospital Ambulatory Medical Care Survey examined ED visit rates from January 2005 to December 2016. Visits were divided by urban and rural classification and stratified by age, sex, race/ethnicity, and payer. Emergency departments were categorized as urban or rural in accordance with the US Office of Management and Budget classification. Codes from the International Classification of Diseases, Ninth Revision (ICD-9), were used to extract visits related to ambulatory care-sensitive conditions. Safety-net status was determined by the Centers for Disease Control and Prevention definition. Visit rates were calculated using annual US Census Bureau estimates. National Hospital Ambulatory Medical Care Survey estimates were generated using provided survey weights and served as the numerator, yielding an annual, population-adjusted rate. Data were analyzed from June 2017 to November 2018. Main Outcomes and Measures: Emergency department visit rates for 2005 and 2016 with 95% confidence intervals, accompanying rate differences (RDs) comparing the 2 years, and annual rate change (RC) with accompanying trend tests using weighted linear regression models. Results: During the period examined, rural ED visit estimates increased from 16.7 million to 28.4 million, and urban visits increased from 98.6 million to 117.2 million. Rural ED visits increased for non-Hispanic white patients (13.5 million to 22.5 million), Medicaid beneficiaries (4.4 million to 9.7 million), those aged 18 to 64 years (9.6 million to 16.7 million), and patients without insurance (2.7 million to 3.4 million). Rural ED visit rates increased by more than 50%, from 36.5 to 64.5 visits per 100 persons (RD, 28.9; RC, 2.2; 95% CI, 1.2 to 3.3), outpacing urban ED visit rates, which increased from 40.2 to 42.8 visits per 100 persons (RD, 2.6; RC, 0.2; 95% CI, -0.1 to 0.6). By 2016, nearly one-fifth of all ED visits occurred in the rural setting. From 2005 to 2016, rural ED utilization rates increased for non-Hispanic white patients (RD, 26.1; RC, 1.6; 95% CI, 0.4 to 2.8), Medicaid beneficiaries (RD, 56.4; RC, 4.1; 95% CI, 2.1 to 6.1), those aged 18 to 44 years (46.9 to 81.6 visits per 100 persons; RD, 34.7; RC, 2.3; 95% CI, 1.1 to 3.5) as well as those aged 45 to 64 years (27.5 to 53.9 visits per 100 persons; RD, 26.5; RC, 1.6; 95% CI, 0.7 to 2.5), and patients without insurance (44.0 to 66.6 visits per 100 persons per year; RD, 22.6; RC, 2.7; 95% CI, 0.2 to 5.2), with a larger proportion of rural EDs categorized as safety-net status. Conclusions and Relevance: Rural EDs are experiencing important changes in utilization rates, increasingly serving a larger proportion of traditionally disadvantaged groups and with greater pressure as safety-net hospitals.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Feminino , Pesquisas sobre Serviços de Saúde/métodos , Humanos , Classificação Internacional de Doenças , Masculino , Medicaid/estatística & dados numéricos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , População Rural/tendências , Provedores de Redes de Segurança/tendências , Estados Unidos/epidemiologia , População Urbana/tendências , Adulto Jovem
10.
Sci Data ; 6(1): 34, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-31000723

RESUMO

As urban population is forecast to exceed 60% of the world's population by 2050, urban growth can be expected. However, research on spatial projections of urban growth at a global scale are limited. We constructed a framework to project global urban growth based on the SLEUTH urban growth model and a database with a resolution of 30 arc-seconds containing urban growth probabilities from 2020 to 2050. Using the historical distribution of the global population from LandScanTM as a proxy for urban land cover, the SLEUTH model was calibrated for the period from 2000 to 2013. This model simulates urban growth using two layers of 50 arc-minutes grids encompassing global urban regions. While varying growth rates are observed in each urban area, the global urban cover is forecast to reach 1.7 × 106 km2 by 2050, which is approximately 1.4 times that of the year 2012. A global urban growth database is essential for future environmental planning and assessments, as well as numerical investigations of future urban climates.


Assuntos
Modelos Teóricos , População Urbana/tendências , Previsões , Humanos , Urbanização
12.
Midwifery ; 74: 57-67, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30927633

RESUMO

Postnatal depression (PND) has been a common depressive mental disorder among the mothers in a low-income country like Bangladesh where stunting, underweight and wasting are prevalent among infants. The present prospective cohort study was carried out among 297 non-depressed and 103 depressed mothers (ages 18-36 years) to find the association between post natal depression and growth of infants. Data were collected by face to face interview through semi-structured questionnaires and anthropometric measurements were taken with proper anthropometric techniques and calibrated instruments. Postnatal depression was assessed by the Edinburgh Postnatal Depression Scale and infants' physical growth was assessed by Z score of weight, length and Mid-Upper Arm Circumference (MUAC). The overall prevalence of post natal depression was found 22% [95% CI, 21.71-30.29]. Infants of depressed mothers were found iller in comparison with the infants of non-depressed mothers (p < 0.001) which could result in growth retardation of infants. According to the MUAC level, infants of depressed mothers were more at risk of malnutrition (p < 0.001). Early detection of postpartum depression, implementation of interventions, prevention or treatment of maternal depressive disorders and effective strategies will not only ameliorate the impact of PND among mothers but also facilitates infant growth.


Assuntos
Desenvolvimento Infantil/fisiologia , Depressão Pós-Parto/complicações , Mães/psicologia , Adolescente , Adulto , Bangladesh/epidemiologia , Peso Corporal , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Lactente , Cuidado do Lactente/métodos , Cuidado do Lactente/normas , Entrevistas como Assunto/métodos , Mães/estatística & dados numéricos , Prevalência , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricos , Pesquisa Qualitativa , População Urbana/tendências
13.
Drug Alcohol Depend ; 197: 191-196, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30844615

RESUMO

BACKGROUND: Prescription opioid misuse (POM) remains a public health concern in the United States. Although the problem has been studied extensively, little research attention is paid to POM among African-Americans (AAs), and even fewer studies consider rural status in their analysis. The goal of this study, therefore, was to identify and compare prevalence and predictors of POM among rural and urban AA adults using data from a nationally representative sample. METHODS: Using pooled data across five years (2012-2016) of the National Survey on Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with POM among AA adults. RESULTS: Findings show that urban and rural AAs have comparable prevalence rates of POM, which is somewhat surprising given that POM often varies based on rural status. A number of factors (e.g., receiving government assistance, religiosity, smoking tobacco or marijuana, misuse of other prescription medications) were significantly correlated with POM for urban and rural AAs, while others (e.g., being age 50+, graduating high school, visiting an emergency department, being arrested, binge drinking) varied by rural status. CONCLUSION: Results indicate that AA nonmedical prescription opioid users are not a monolith and have distinct demographic, clinical, and psychosocial profiles based on geographic region. Because AAs have been virtually ignored in the POM literature, our findings are an important step towards understanding POM among this understudied group. These results invite additional investigation into AA POM and encourage researchers to consider rural status in their analysis of POM among AAs.


Assuntos
Afro-Americanos/psicologia , Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , População Rural/tendências , População Urbana/tendências , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico , Prevalência , Autorrelato , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
14.
Int J Health Geogr ; 18(1): 4, 2019 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728007

RESUMO

BACKGROUND: Active travel for utilitarian purposes contributes to total physical activity and may help counter the obesity epidemic. However, the evidence linking active travel and individual-level body weight is equivocal. Statistical modeling that accounts for spatial autocorrelation and unmeasured spatial predictors has not yet used to explore whether the health benefits of active travel are shared equally across socioeconomic groups. METHODS: Bayesian hierarchical models with spatial random effects were developed using travel survey data from Saskatoon, Canada (N = 4625). Differences in log-transformed body mass index (BMI) were estimated for levels of active travel use (vehicular travel only, mixed vehicular/active travel, and active travel only), household income, and neighbourhood deprivation after controlling for sociodemographic and physical activity variables. The modifying effect of household income on the association between active travel and BMI was also evaluated. RESULTS: Significant and meaningful decreases in BMI were observed for mixed (ß = - 0.02, CrI - 0.036 to - 0.004) and active only (ß = - 0.043, CrI - 0.06 to - 0.025) compared to vehicular only travelers. BMI was significantly associated with levels of household income and neighbourhood deprivation. Accounting for the interaction between travel mode and household income, decreases in BMI were observed for active only compared to vehicular only travellers in the highest income category (ß = - 0.061, CrI - 0.115 to - 0.007). CONCLUSION: Strategies to increase active travel use can support healthy weight loss and maintenance, but the opportunity to benefit from active travel use may be limited by low income. Considerations should be given to how interventions to increase active transportation might exacerbate social inequalities in BMI. Spatial statistical models are needed to account for unmeasured but spatially structured neighbourhood factors.


Assuntos
Índice de Massa Corporal , Exercício/fisiologia , Características da Família , Renda , Viagem/economia , População Urbana , Adulto , Idoso , Teorema de Bayes , Estudos Transversais , Feminino , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Características de Residência , Saskatchewan/epidemiologia , Fatores Socioeconômicos , Viagem/tendências , População Urbana/tendências , Adulto Jovem
15.
Int J Health Geogr ; 18(1): 5, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755210

RESUMO

BACKGROUND: Developing countries, such as India, are experiencing rapid urbanization, which may have a major impact on the environment: including worsening air and water quality, noise and the problems of waste disposal. We used health data from an ongoing cohort study based in southern India to examine the relationship between the urban environment and homeostasis model assessment of insulin resistance (HOMA-IR). METHODS: We utilized three metrics of urbanization: distance from urban center; population density in the India Census; and satellite-based land cover. Restricted to participants without diabetes (N = 6350); we built logistic regression models adjusted for traditional risk factors to test the association between urban environment and HOMA-IR. RESULTS: In adjusted models, residing within 0-20 km of the urban center was associated with an odds ratio for HOMA-IR of 1.79 (95% CI 1.39, 2.29) for females and 2.30 (95% CI 1.64, 3.22) for males compared to residing in the furthest 61-80 km distance group. Similar statistically significant results were identified using the other metrics. CONCLUSIONS: We identified associations between urban environment and HOMA-IR in a cohort of adults. These associations were robust using various metrics of urbanization and adjustment for individual predictors. Our results are of public health concern due to the global movement of large numbers of people from rural to urban areas and the already large burden of diabetes.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Resistência à Insulina/fisiologia , Vigilância da População , População Urbana/tendências , Adulto , Estudos de Coortes , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Previsões , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de Risco
16.
BMC Geriatr ; 19(1): 10, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30634916

RESUMO

BACKGROUND: The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes. METHODS: We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities. RESULTS: The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53-8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55-7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04-3.61] and 4.72 [CI 3.43-6.49]), and Hubei (AORs 2.36 [CI 1.82-3.07] and 4.11 [CI 2.80-6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases. CONCLUSION: Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.


Assuntos
Envelhecimento/fisiologia , Nível de Saúde , Limitação da Mobilidade , População Rural , Fatores Socioeconômicos , População Urbana , Idoso , Envelhecimento/psicologia , China/epidemiologia , Doença Crônica , Feminino , Humanos , Renda/tendências , Seguro Saúde/tendências , Masculino , Pessoa de Meia-Idade , População Rural/tendências , População Urbana/tendências
17.
Am J Public Health ; 109(3): 458-464, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30676802

RESUMO

OBJECTIVES: To estimate the association between rates of police-related deaths and neighborhood residential segregation (by income, race/ethnicity, or both combined) in the United States. METHODS: We identified police-related deaths that occurred in the United States (2015-2016) using a data set from the Guardian newspaper. We used census data to estimate expected police-related death counts for all US census tracts and to calculate the Index of Concentration at the Extremes as a segregation measure. We used multilevel negative binomial models for the analyses. RESULTS: Overall, police-related death rates were highest in neighborhoods with the greatest concentrations of low-income residents (vs high-income residents) and residents of color (vs non-Hispanic White residents). For non-Hispanic Blacks, however, the risk was greater in the quintile of neighborhoods with the highest concentration of non-Hispanic White residents than in certain neighborhoods with relatively higher concentrations of residents of color (the third and fourth quintiles). CONCLUSIONS: Neighborhood context matters-beyond individual race/ethnicity-for understanding, preventing, and responding to the occurrence of police-related deaths. Public Health Implications. Efforts to monitor, prevent, and respond to police-related deaths should consider neighborhood context, including levels of segregation by income and race/ethnicity.


Assuntos
Causas de Morte/tendências , Grupos Étnicos/estatística & dados numéricos , Polícia/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Pobreza/tendências , Características de Residência/estatística & dados numéricos , População Urbana/tendências , Feminino , Previsões , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos , População Urbana/estatística & dados numéricos
18.
Psychiatry Res ; 272: 491-498, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30611969

RESUMO

Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological distress in both the clinical and the research settings, although its factor structure is still debated. In this study, the factor structure of the SCL-90-R has been investigated in two independent samples of Italian adolescents. Two samples of 817 (urban sample) and 507 (rural sample) adolescents attending high schools were involved. Confirmatory factorial analysis (CFA) was used alongside hierarchical nested, progressively constrained models to assess configural, metric and scalar invariance of the best models fitted by CFA. The standard nine-factor structure of the SCL-90-R resulted reproducible and invariant between the two samples, in both its correlated and hierarchical second-order implementations. Estimated reliability of the nine scales of the SCL-90-R was optimal. This study also confirmed the reproducibility of the bifactor models of the SCL-90-R with nine orthogonally independent factors and with nine correlated primary factors, which have been tested in some recent studies. Overall, the SCL-90-R measures both common and unique features of psychological distress in community samples. The measurement invariance across different levels of psychological distress in the factor structure of the SCL-90-R is an issue deserving further testing and investigation.


Assuntos
Comportamento do Adolescente/psicologia , Lista de Checagem/normas , Escalas de Graduação Psiquiátrica/normas , População Rural/tendências , Estudantes/psicologia , População Urbana/tendências , Adolescente , Adulto , Lista de Checagem/métodos , Análise Fatorial , Feminino , Humanos , Itália/epidemiologia , Masculino , Psicometria , Reprodutibilidade dos Testes , Características de Residência
19.
Diabetes Care ; 42(3): 476-485, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30659076

RESUMO

OBJECTIVE: The objective of the current study was to assess the secular trends in the prevalence of diabetes, prediabetes, and risk factors from two epidemiological surveys done 10 years apart in three adult populations of different geographic and socioeconomic backgrounds in Tamil Nadu, India. RESEARCH DESIGN AND METHODS: This survey was conducted in 2016 using methodology similar to that used in 2006. Persons aged ≥20 years (n = 9,848) were screened for diabetes, prediabetes, and the risk variables. Fasting and 2-h plasma glucose, lipid profile, blood pressure, anthropometry, and socioeconomic and behavioral details were recorded. Comparative analyses of age-standardized prevalence were done. Prevalence ratios (PRs) between 2016 and 2006 of diabetes and also prediabetes were assessed using Poisson regression analyses. RESULTS: Prevalence of diabetes increased from 18.6% (95% CI 16.6-20.5) to 21.9 (20.5-23.3) in the city, 16.4 (14.1-18.6) to 20.3 (18.9-21.6) in the town, and 9.2 (8.0-10.5) to 13.4 (11.9-14.8) in the periurban villages (PUVs) (P < 0.0001 in all). The PR showed a nonsignificant 8% rise in diabetes in the city, while significant increases had occurred in the town (39%) and PUVs (34%). Prevalence of prediabetes also increased. Age, family history of diabetes, and waist circumference were common risk determinants among the populations. Though general obesity and abdominal obesity increased, the latter was associated with the increased prevalence. CONCLUSIONS: Prevalence of diabetes and prediabetes increased in all locations; the rise was significant only in the town and PUVs. Abdominal obesity is significantly associated with increased trend even among the villagers. Rural populations may be targeted for future public health measures to combat diabetes.


Assuntos
Diabetes Mellitus/epidemiologia , População Rural , População Urbana , Adulto , Idoso , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estado Pré-Diabético/epidemiologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , População Rural/tendências , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , População Urbana/tendências , Circunferência da Cintura , Adulto Jovem
20.
J Gerontol B Psychol Sci Soc Sci ; 74(3): 484-495, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-28541537

RESUMO

OBJECTIVES: To estimate the association between socioeconomic status (SES) and adult mortality in Indonesia and determine the contribution of adult behavioral risk factors to SES differences in mortality. METHODS: Discrete failure-time regression models and period life tables were used to estimate life expectancy at age 30 (e30) across wealth and consumption groups by sex and urban/rural residence. RESULTS: For urban men, e30 increases by an average of 1.10 years per wealth quartile (p = .014) from 38.7 years (95% confidence interval (CI): 37.4-40.5) in the bottom wealth quartile to 42.1 years (95% CI: 40.3-44.1) in the top quartile; for rural men, e30 increases by an average of 1.35 years per quartile (p = .007) from 40.6 years (95% CI: 39.2-42.5) in the bottom wealth quartile to 44.3 years (95% CI: 42.4-46.6) in the top quartile. SES differences are smaller for women. Behavioral risk factors are inconsistently patterned across SES and do not explain SES differences in mortality. DISCUSSION: The associations between SES and adult life expectancy in Indonesia are moderate when compared with developed countries and are not explained by traditional behavioral risk factors. In a context where behavioral risk factors are inconsistent across SES groups, mortality inequality may be driven by inequalities in health care access or other social factors.


Assuntos
Expectativa de Vida/tendências , Mortalidade/tendências , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Países em Desenvolvimento , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , População Rural/tendências , Classe Social , População Urbana/tendências , Adulto Jovem
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