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1.
Nat Commun ; 13(1): 636, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35105869

RESUMO

Worldwide, racial and ethnic minorities have been disproportionately impacted by COVID-19 with increased risk of infection, its related complications, and death. In the initial phase of population-based vaccination in the United States (U.S.) and United Kingdom (U.K.), vaccine hesitancy may result in differences in uptake. We performed a cohort study among U.S. and U.K. participants who volunteered to take part in the smartphone-based COVID Symptom Study (March 2020-February 2021) and used logistic regression to estimate odds ratios of vaccine hesitancy and uptake. In the U.S. (n = 87,388), compared to white participants, vaccine hesitancy was greater for Black and Hispanic participants and those reporting more than one or other race. In the U.K. (n = 1,254,294), racial and ethnic minority participants showed similar levels of vaccine hesitancy to the U.S. However, associations between participant race and ethnicity and levels of vaccine uptake were observed to be different in the U.S. and the U.K. studies. Among U.S. participants, vaccine uptake was significantly lower among Black participants, which persisted among participants that self-reported being vaccine-willing. In contrast, statistically significant racial and ethnic disparities in vaccine uptake were not observed in the U.K sample. In this study of self-reported vaccine hesitancy and uptake, lower levels of vaccine uptake in Black participants in the U.S. during the initial vaccine rollout may be attributable to both hesitancy and disparities in access.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/etnologia , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Vacinação/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , /estatística & dados numéricos , /estatística & dados numéricos , COVID-19/psicologia , Estudos de Coortes , Feminino , /estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , SARS-CoV-2/genética , Autorrelato , Reino Unido/etnologia , Estados Unidos/epidemiologia , /estatística & dados numéricos , Adulto Jovem
3.
Circulation ; 144(6): 410-422, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34247495

RESUMO

BACKGROUND: Individuals of South Asian ancestry represent 23% of the global population, corresponding to 1.8 billion people, and have substantially higher risk of atherosclerotic cardiovascular disease compared with most other ethnicities. US practice guidelines now recognize South Asian ancestry as an important risk-enhancing factor. The magnitude of enhanced risk within the context of contemporary clinical care, the extent to which it is captured by existing risk estimators, and its potential mechanisms warrant additional study. METHODS: Within the UK Biobank prospective cohort study, 8124 middle-aged participants of South Asian ancestry and 449 349 participants of European ancestry who were free of atherosclerotic cardiovascular disease at the time of enrollment were examined. The relationship of ancestry to risk of incident atherosclerotic cardiovascular disease-defined as myocardial infarction, coronary revascularization, or ischemic stroke-was assessed with Cox proportional hazards regression, along with examination of a broad range of clinical, anthropometric, and lifestyle mediators. RESULTS: The mean age at study enrollment was 57 years, and 202 405 (44%) were male. Over a median follow-up of 11 years, 554 of 8124 (6.8%) individuals of South Asian ancestry experienced an atherosclerotic cardiovascular disease event compared with 19 756 of 449 349 (4.4%) individuals of European ancestry, corresponding to an adjusted hazard ratio of 2.03 (95% CI, 1.86-2.22; P<0.001). This higher relative risk was largely consistent across a range of age, sex, and clinical subgroups. Despite the >2-fold higher observed risk, the predicted 10-year risk of cardiovascular disease according to the American Heart Association/American College of Cardiology Pooled Cohort equations and QRISK3 equations was nearly identical for individuals of South Asian and European ancestry. Adjustment for a broad range of clinical, anthropometric, and lifestyle risk factors led to only modest attenuation of the observed hazard ratio to 1.45 (95% CI, 1.28-1.65, P<0.001). Assessment of variance explained by 18 candidate risk factors suggested greater importance of hypertension, diabetes, and central adiposity in South Asian individuals. CONCLUSIONS: Within a large prospective study, South Asian individuals had substantially higher risk of atherosclerotic cardiovascular disease compared with individuals of European ancestry, and this risk was not captured by the Pooled Cohort Equations.


Assuntos
Aterosclerose/epidemiologia , Aterosclerose/etiologia , Adulto , Idoso , Bancos de Espécimes Biológicos , Suscetibilidade a Doenças , Feminino , Seguimentos , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Reino Unido/epidemiologia , Reino Unido/etnologia
4.
Nat Commun ; 12(1): 3546, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112768

RESUMO

The ability to identify segments of genomes identical-by-descent (IBD) is a part of standard workflows in both statistical and population genetics. However, traditional methods for finding local IBD across all pairs of individuals scale poorly leading to a lack of adoption in very large-scale datasets. Here, we present iLASH, an algorithm based on similarity detection techniques that shows equal or improved accuracy in simulations compared to current leading methods and speeds up analysis by several orders of magnitude on genomic datasets, making IBD estimation tractable for millions of individuals. We apply iLASH to the PAGE dataset of ~52,000 multi-ethnic participants, including several founder populations with elevated IBD sharing, identifying IBD segments in ~3 minutes per chromosome compared to over 6 days for a state-of-the-art algorithm. iLASH enables efficient analysis of very large-scale datasets, as we demonstrate by computing IBD across the UK Biobank (~500,000 individuals), detecting 12.9 billion pairwise connections.


Assuntos
Genética Populacional/métodos , Genômica/métodos , Algoritmos , Simulação por Computador , Bases de Dados Genéticas , Genoma Humano , Haplótipos , Humanos , Linhagem , Polimorfismo de Nucleotídeo Único , Controle de Qualidade , Reino Unido/epidemiologia , Reino Unido/etnologia
6.
PLoS One ; 16(3): e0247193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33770083

RESUMO

BACKGROUND: Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called "terminal anaesthesia", TA). However, the general public's views about sedation in EOLC are not known. We sought to investigate the general public's views to inform policy and practice in the UK. METHODS: We performed two anonymous online surveys of members of the UK public, sampled to be representative for key demographic characteristics (n = 509). Participants were given a scenario of a hypothetical terminally ill patient with one week of life left. We sought views on the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia. We asked participants about the intentions of doctors, what risks of sedation would be acceptable, and the equivalence of terminal anaesthesia and euthanasia. FINDINGS: Of the 509 total participants, 84% and 72% indicated that it is permissible to offer titrated analgesia and gradual sedation (respectively); 75% believed it is ethical to offer TA. Eighty-eight percent of participants indicated that they would like to have the option of TA available in their EOLC (compared with 79% for euthanasia); 64% indicated that they would potentially wish for TA at the end of life (52% for euthanasia). Two-thirds indicated that doctors should be allowed to make a dying patient completely unconscious. More than 50% of participants believed that TA and euthanasia were non-equivalent; a third believed they were. INTERPRETATION: These novel findings demonstrate substantial support from the UK general public for the use of sedation and TA in EOLC. More discussion is needed about the range of options that should be offered for dying patients.


Assuntos
Eutanásia/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Assistência Terminal/ética , Adulto , Idoso , Atitude Frente a Saúde/etnologia , Morte , Ética Médica , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Suicídio Assistido/ética , Inquéritos e Questionários , Inconsciência , Reino Unido/etnologia
7.
Lupus ; 30(4): 597-607, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33413005

RESUMO

Systemic lupus erythematosus (SLE) is a systemic autoimmune/inflammatory disease. Patients diagnosed with juvenile-onset SLE (jSLE), when compared to individuals with adult-onset SLE, develop more severe organ involvement, increased disease activity and greater tissue and organ damage. In adult-onset SLE, clinical characteristics, pathomechanisms, disease progression and outcomes do not only vary between individuals and age groups, but also ethnicities. However, in children and young people, the influence of ethnicity on disease onset, phenotype and outcome has not been investigated in detail. In this study, we investigated clinical and laboratory characteristics in pediatric SLE patients from different ethnic backgrounds (White Caucasian, Asian, Black African/Caribbean) accessing data from a national cohort of jSLE patients (the UK JSLE Cohort Study). Among jSLE patients in the UK, ethnicity affects both the disease's clinical course and outcomes. At diagnosis, Black African/Caribbean jSLE patients show more "classical" laboratory and clinical features when compared to White Caucasian or Asian patients. Black African/Caribbean jSLE patients exhibit more renal involvement and more frequently receive cyclophosphamide and rituximab. Studies targeting ethnicity-specific contributors to disease expression and phenotypes are necessary to improve our pathophysiological understanding, diagnosis and treatment of jSLE.


Assuntos
/estatística & dados numéricos , Laboratórios/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/etnologia , Nefrite Lúpica/tratamento farmacológico , Adolescente , Idade de Início , Criança , Estudos de Coortes , Ciclofosfamida/uso terapêutico , Progressão da Doença , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Nefrite Lúpica/complicações , Nefrite Lúpica/etnologia , Nefrite Lúpica/fisiopatologia , Masculino , Fenótipo , Rituximab/uso terapêutico , Índice de Gravidade de Doença , Reino Unido/etnologia
8.
BMJ Mil Health ; 167(2): 84-88, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32487673

RESUMO

INTRODUCTION: The majority of combat deaths occur before arrival at a medical treatment facility but no previous studies have comprehensively examined this phase of care. METHODS: The UK Joint Theatre Trauma Registry was used to identify all UK military personnel who died in Afghanistan (2004-2014). These data were linked to non-medical tactical and operational records to provide an accurate timeline of events. Cause of death was determined from records taken at postmortem review. The primary objective was to report time between injury and death in those killed in action (KIA); secondary objectives included: reporting mortality at key North Atlantic Treaty Organisation timelines (0, 10, 60, 120 min), comparison of temporal lethality for different anatomical injuries and analysing trends in the case fatality rate (CFR). RESULTS: 2413 UK personnel were injured in Afghanistan from 2004 to 2014; 448 died, with a CFR of 18.6%. 390 (87.1%) of these died prehospital (n=348 KIA, n=42 killed non-enemy action). Complete data were available for n=303 (87.1%) KIA: median Injury Severity Score 75.0 (IQR 55.5-75.0). The predominant mechanisms were improvised explosive device (n=166, 54.8%) and gunshot wound (n=96, 31.7%).In the KIA cohort, the median time to death was 0.0 (IQR 0.0-21.8) min; 173 (57.1%) died immediately (0 min). At 10, 60 and 120 min post injury, 205 (67.7%), 277 (91.4%) and 300 (99.0%) casualties were dead, respectively. Whole body primary injury had the fastest mortality. Overall prehospital CFR improved throughout the period while in-hospital CFR remained constant. CONCLUSION: Over two-thirds of KIA deaths occurred within 10 min of injury. Improvement in the CFR in Afghanistan was predominantly in the prehospital phase.


Assuntos
Serviços Médicos de Emergência/normas , Militares/estatística & dados numéricos , Mortalidade/tendências , Fatores de Tempo , Guerra/estatística & dados numéricos , Adulto , Afeganistão , Serviços Médicos de Emergência/classificação , Serviços Médicos de Emergência/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Militares/classificação , Mortalidade/etnologia , Reino Unido/epidemiologia , Reino Unido/etnologia , Guerra/etnologia , Guerra/prevenção & controle
9.
Child Dev ; 92(1): 273-290, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32757217

RESUMO

Many Western industrialized nations have high levels of ethnic diversity but to date there are very few studies which investigate prelinguistic and early language development in infants from ethnic minority backgrounds. This study tracked the development of infant communicative gestures from 10 to 12 months (n = 59) in three culturally distinct groups in the United Kingdom and measured their relationship, along with maternal utterance frequency and responsiveness, to vocabulary development at 12 and 18 months. No significant differences were found in infant gesture development and maternal responsiveness across the groups, but relationships were identified between gesture, maternal responsiveness, and vocabulary development.


Assuntos
Desenvolvimento Infantil/fisiologia , Comparação Transcultural , Gestos , Desenvolvimento da Linguagem , Adulto , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Reino Unido/etnologia , Vocabulário , Adulto Jovem
10.
J Parkinsons Dis ; 11(1): 299-307, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33104038

RESUMO

BACKGROUND: Ethnic phenotypic differences in Parkinson's disease (PD) are important to understand the heterogeneity of PD and develop biomarkers and clinical trials. OBJECTIVE: To investigate (i) whether there are non-motor symptoms (NMS)- and comorbidity-based phenotypic differences between Black, Asian and Minority Ethnic (BAME) and White PD patients and (ii) whether clinically available biomarkers may help differentiate and explain the differences between the groups. METHODS: This is a multicentre (four sites, London), real-life, cross-sectional study including PD patients of BAME or White ethnicity. The primary outcome was a detailed NMS assessment; additional measurements included disease and motor stage, comorbidity, sociodemographic parameters and brain MRI imaging. RESULTS: 271 PD patients (54 Asian, 71 Black, and 146 White) were included balanced for age, gender, and disease severity (HY). Black patients had a shorter disease duration compared to White and Asian populations. The SCOPA-Motor activities of daily living scores as well as the NMSS scores were significantly higher in both Black (total score and domain "miscellaneous") and Asian (total score and domains "sleep/fatigue", "mood/apathy" and "perception/hallucinations") than White individuals. Both BAME populations had higher prevalence of arterial hypertension, and the Black population had a higher prevalence of diabetes mellitus. Brain MRI revealed a greater severity of white matter changes in Black compared to the White and Asian cohorts. CONCLUSION: These findings suggest differences in phenotype of PD in BAME populations with greater burden of NMS and motor disability and a higher rate of cardiovascular comorbidities.


Assuntos
Atividades Cotidianas , /etnologia , Doença de Parkinson/etnologia , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Substância Branca/patologia , /etnologia , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Humanos , Hipertensão/etnologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Reino Unido/etnologia , Substância Branca/diagnóstico por imagem
11.
Eur J Drug Metab Pharmacokinet ; 46(1): 71-83, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33165774

RESUMO

BACKGROUND AND OBJECTIVES: GSK2982772 is an oral small-molecule RIPK1 inhibitor with potential therapeutic efficacy in immune-mediated inflammatory diseases (IMIDs). An inter-ethnic comparison of GSK2982772 pharmacokinetics was conducted based on data from Western (Study 1) and Japanese subjects (Study 2). METHODS: Both studies were single-centre, randomised, double-blind, placebo-controlled studies with objectives to assess the safety and characterise the pharmacokinetics of GSK2982772. Western subjects in Study 1 (NCT03305419), Part A (N = 15), were randomly assigned to receive 120 mg three times daily (TID), 240 mg TID, or 360 mg twice daily (BID) doses of GSK2982772, or placebo (TID or BID) for 1 day. Part B subjects (N = 47) received GSK2982772 120 mg TID, 240 mg TID, or placebo TID for 14 days. Japanese subjects in Study 2 (N = 13) (NCT03590613) were randomly assigned to receive TID doses of GSK2982772 60, 120, 240 mg TID or placebo TID for 1 day. RESULTS: GSK2982772 was well tolerated and adverse events were generally mild. Maximum observed plasma drug concentration (Cmax), time to reach Cmax (Tmax), area under the plasma drug concentration versus time curve after the first GSK2982772 dose (AUC(0-7)) of 120 and 240 mg, and (AUC(0-24)) values for the 120 and 240 mg TID doses over a single day were similar in Japanese and Western subjects. CONCLUSIONS: The pharmacokinetics and tolerability of GSK2982772 were similar between Western and Japanese subjects, justifying inclusion of Japanese subjects in future global clinical studies to assess the therapeutic potential of RIPK1 inhibition for the treatment of IMIDs. Clinical Trials: NCT03305419 and NCT03590613 available from http://www.clinicaltrials.gov .


Assuntos
/etnologia , Voluntários Saudáveis , Oxazepinas/sangue , Proteína Serina-Treonina Quinases de Interação com Receptores/antagonistas & inibidores , Triazóis/sangue , /etnologia , Adulto , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Japão/etnologia , Masculino , Pessoa de Meia-Idade , Oxazepinas/administração & dosagem , Oxazepinas/farmacocinética , Triazóis/administração & dosagem , Triazóis/farmacocinética , Reino Unido/etnologia
12.
BMJ Mil Health ; 166(6): 411-413, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33293376

RESUMO

Disease non-battle injury has plagued British expeditionary forces through the ages. While in recent years significant mortality has reduced, it has had a large impact on operational effectiveness, at times leading to closure of major medical treatment facilities (MTFs).Infection Prevention and Control (IPC) benefits from a subject matter expert and champion to ensure it remains at the front of people's minds and to be on hand to manage acute and dynamic situations. To mitigate the lack of an IPC Nursing Officer, we piloted a deployed military IPC Lead Link Practitioner (IPC-LL) for the first time on a large-scale overseas exercise (SAIF SAREEA 3). An experienced generalist nurse deploying as the IPC-LL (after specific training) provided pre-deployment IPC education and preparation, deployed IPC advice, undertook mandatory audits and monitored IPC compliance throughout the MTFs on the exercise. Data from 22 IPC audits conducted on the exercise showed that the presence of the IPC-LL improved IPC compliance and standards overall in the MTF where based, compared with others. In addition, a gastroenteritis outbreak occurred and was successfully managed with significant input from the IPC-LL. The IPC-LL was also able to add value by pre-empting potential IPC problems from occurring.There is a small pool of deployable Infection Prevention and Control Nursing Officers, so this new IPC-LL role could help to fill the capability gap. The IPC-LL could be the dedicated person focusing on IPC elements, reducing the IPC risk within the deployed field hospital setting where deployed experts are not available.


Assuntos
Controle de Infecções/métodos , Ensino/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Humanos , Infecções/epidemiologia , Infecções/etnologia , Projetos Piloto , Reino Unido/epidemiologia , Reino Unido/etnologia
13.
Arch Psychiatr Nurs ; 34(6): 507-512, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33280673

RESUMO

BACKGROUND: Coronavirus disease caused by the novel coronavirus Covid-19 is a current worldwide outbreak. The use of quarantine and isolation proved effective in containing the spread of infection. OBJECTIVES: The purpose of this cross-sectional study was to assess the mental health of Albanian people residing in the country and abroad during the quarantine period for the Covid-19 pandemic. DESIGN: This study was carried out from 25th March - 20th April 2020 through a web survey shared on social networks. The goal was to reach at least the minimum sample size for cross-sectional studies. The Patient Health Questionnaire (PHQ-9) was used to assess mental health. Chi-square (χ2) and Fisher -Exact test were used to assess the statistical significance among variables. P values ≤0.05 were considered statistically significant. RESULTS: 715 participants were included in the final analyses (78.41% females and 21.53% males). Most were residents in Albania (80.41%) and the others resided mainly in Italy (6.89%), Greece (3.51%), Germany (2.43%), Kosovo (1.62%) and the UK (1.69%). Statistical association was found between gender, country of residency and measures taken. Summary score of PHQ-9 items was 6.4662. The total score of depression classification shows that 31.82% and 12.90% of participants have respectively mild and moderate depression. Female participants showed the highest score for some items of PHQ-9, p≤0.05. CONCLUSIONS: Findings suggest that health care professionals should recognize and address mental health problems associated with Covid-19 especially in vulnerable groups. Acting in a timely and proper manner is essential in preventing these problems from becoming chronic.


Assuntos
COVID-19/etnologia , COVID-19/psicologia , Transtorno Depressivo/etnologia , Pandemias , Estresse Psicológico/etnologia , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Albânia/etnologia , Estudos Transversais , Feminino , Alemanha/etnologia , Grécia/etnologia , Humanos , Itália/etnologia , Kosovo , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Reino Unido/etnologia , Adulto Jovem
14.
Genes (Basel) ; 11(12)2020 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-33322828

RESUMO

Autosomal recessive retinitis pigmentosa is caused by mutations in over 40 genes, one of which is the ceramide kinase-like gene (CERKL). We present a case series of six patients from six unrelated families diagnosed with inherited retinal dystrophies (IRD) and with two variants in CERKL recruited from a multi-ethnic British population. A retrospective review of clinical data in these patients was performed and included colour fundus photography, fundus autofluorescence (AF) imaging, spectral domain-optical coherence tomography (SD-OCT), visual fields and electroretinogram (ERG) assessment where available. Three female and three male patients were included. Age at onset ranged from 7 years old to 45 years, with three presenting in their 20s and two presenting in their 40s. All but one had central visual loss as one of their main presenting symptoms. Four patients had features of retinitis pigmentosa with significant variation in severity and extent of disease, and two patients had no pigment deposition with only macular involvement clinically. Seven variants in CERKL were identified, of which three are novel. The inherited retinopathies associated with the CERKL gene vary in age at presentation and in degree of severity, but generally are characterised by a central visual impairment early on.


Assuntos
Mutação , Linhagem , Fosfotransferases (Aceptor do Grupo Álcool)/genética , Retinite Pigmentosa , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retinite Pigmentosa/etnologia , Retinite Pigmentosa/genética , Estudos Retrospectivos , Reino Unido/etnologia
15.
Sci Rep ; 10(1): 18895, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33144665

RESUMO

To determine if metabolic characteristics differed in women with and without polycystic ovary syndrome (PCOS) between a Caucasian and Middle East population. Comparative cross-sectional analysis. Demographic and metabolic data from Middle Eastern women from Qatar Biobank (97 with PCOS, 622 controls) were compared to a Caucasian PCOS biobank in Hull UK (108 with PCOS, 69 controls). In both populations, PCOS women showed a worse cardiovascular risk profile of increased systolic and diastolic blood pressure, increased C-reactive protein (CRP), reduced HDL, insulin resistance as well as increased androgens compared to their respective controls without PCOS. UK women without PCOS had higher systolic and diastolic blood pressures, and increased testosterone results (p < 0.01) compared to Middle Eastern women without PCOS who had higher inflammatory markers (WBC and CRP), HDL and insulin resistance (p < 0.001). UK PCOS women had a higher body mass index, systolic and diastolic blood pressures, triglycerides (p < 0.01), whilst Middle Eastern PCOS women showed increased testosterone, free androgen index, HDL and CRP (P < 0.01). There was no difference in insulin or insulin resistance between the two PCOS cohorts. This study highlights ethnic population differences because, whilst cardiovascular risk indices were increased for both PCOS cohorts, this may be for different reasons: BMI, waist and hip measurements, systolic and diastolic blood pressure, and triglycerides were higher in the UK cohort whilst testosterone, HDL and CRP were higher in the Middle East population. Insulin resistance did not differ between the two PCOS populations despite differences in BMI.


Assuntos
Biomarcadores/metabolismo , Doenças Cardiovasculares/epidemiologia , Síndrome do Ovário Policístico/metabolismo , /etnologia , Adulto , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Estudos de Casos e Controles , HDL-Colesterol/metabolismo , Estudos Transversais , Feminino , Humanos , Resistência à Insulina , Oriente Médio/etnologia , Síndrome do Ovário Policístico/etnologia , Reino Unido/etnologia , Adulto Jovem
16.
BMC Public Health ; 20(1): 1574, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081730

RESUMO

BACKGROUND: In the UK, Gypsy, Roma and Traveller (GRT) communities are generally considered to be at risk of low or variable immunisation uptake. Many strategies to increase uptake for the general population are relevant for GRT communities, however additional approaches may also be required, and importantly one cannot assume that "one size fits all". Robust methods are needed to identify content and methods of delivery that are likely to be acceptable, feasible, effective and cost effective. In this paper, we describe the approach taken to identify potential interventions to increase uptake of immunisations in six GRT communities in four UK cities; and present the list of prioritised interventions that emerged. METHODS: This work was conducted in three stages: (1) a modified intervention mapping process to identify ideas for potential interventions; (2) a two-step prioritisation activity at workshops with 51 GRTs and 25 Service Providers to agree a prioritised list of potentially feasible and acceptable interventions for each community; (3) cross-community synthesis to produce a final list of interventions. The theoretical framework underpinning the study was the Social Ecological Model. RESULTS: Five priority interventions were agreed across communities and Service Providers to improve the uptake of immunisation amongst GRTs who are housed or settled on an authorised site. These interventions are all at the Institutional (e.g. cultural competence training) and Policy (e.g. protected funding) levels of the Social Ecological Model. CONCLUSIONS: The "upstream" nature of the five interventions reinforces the key role of GP practices, frontline workers and wider NHS systems on improving immunisation uptake. All five interventions have potentially broader applicability than GRTs. We believe that their impact would be enhanced if delivered as a combined package. The robust intervention development and co-production methods described could usefully be applied to other communities where poor uptake of immunisation is a concern. STUDY REGISTRATION: Current Controlled Trials ISRCTN20019630, Date of registration 01-08-2013, Prospectively registered.


Assuntos
Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Imunização , Grupos Populacionais , Roma (Grupo Étnico) , Assistência à Saúde Culturalmente Competente/etnologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Reino Unido/etnologia
17.
HIV Med ; 21(9): 607-612, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33021067

RESUMO

OBJECTIVES: The aim of the study was to analyse and compare estimated glomerular filtration rate (eGFR) slopes during exposure to tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) in individuals who initiated TAF, regardless of prior regimen, before October 2016. METHODS: An observational cohort study was conducted at 11 clinics in the UK and Ireland. Mixed effects models with random intercept and time terms fitted were used to generate and compare eGFR slopes while participants were exposed to TDF and TAF, with adjustment for age, eGFR at TDF/TAF initiation, gender, ethnicity, and time-updated CD4 cell count and HIV RNA measurements. RESULTS: Data were available for 357 subjects (median age 50 years; 80% male; 82% white/other ethnicity; 51% men who have sex with men; median nadir CD4 count 216 cells/µL). The median duration of exposure to TAF was 2.0 (interquartile range 1.6, 2.3) years. At TAF initiation, the median CD4 count was 557 cells/µL, the median eGFR was 80 mL/min/1.73 m2, and 86% had suppressed HIV infection. The mean adjusted eGFR slope during TDF and TAF exposure was -2.08 [95% confidence interval (CI) -2.24, -1.92] and 1.18 (95% CI 0.20, 1.52) mL/min/1.73 m2/year, respectively (P < 0.001). Individuals who experienced rapid eGFR decline (> 3 or 5 mL/min/1.73 m2/year) while receiving TDF experienced significant eGFR recovery while on TAF (P < 0.001). CONCLUSIONS: Significant improvement in eGFR slope was observed in patients who switched from TDF- to TAF-containing antiretroviral regimens. These data provide further support for the renal safety of TAF, and for switching those who experience progressive worsening of renal function from TDF to TAF.


Assuntos
Alanina/farmacologia , Infecções por HIV/tratamento farmacológico , Rim/fisiologia , Tenofovir/análogos & derivados , Tenofovir/farmacologia , Adulto , Alanina/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Infecções por HIV/fisiopatologia , Humanos , Irlanda/etnologia , Rim/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Tenofovir/uso terapêutico , Resultado do Tratamento , Reino Unido/etnologia
18.
Nutrients ; 12(10)2020 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-33022955

RESUMO

We aimed to assess if the same cognitive batteries can be used cross-nationally to monitor the effect of Phenylketonuria (PKU). We assessed whether a battery, previously used with English adults with PKU (AwPKU), was also sensitive to impairments in Italian AwPKU. From our original battery, we selected a number of tasks that comprehensively assessed visual attention, visuo-motor coordination, executive functions (particularly, reasoning, planning, and monitoring), sustained attention, and verbal and visual memory and learning. When verbal stimuli/or responses were involved, stimuli were closely matched between the two languages for psycholinguistic variables. We administered the tasks to 19 Italian AwPKU and 19 Italian matched controls and compared results from with 19 English AwPKU and 19 English matched controls selected from a previously tested cohort. Participant election was blind to cognitive performance and metabolic control, but participants were closely matched for age and education. The Italian AwPKU group had slightly worse metabolic control but showed levels of performance and patterns of impairment similar to the English AwPKU group. The Italian results also showed extensive correlations between adult cognitive measures and metabolic measures across the life span, both in terms of Phenylalanine (Phe) levels and Phe fluctuations, replicating previous results in English. These results suggest that batteries with the same and/or matched tasks can be used to assess cognitive outcomes across countries allowing results to be compared and accrued. Future studies should explore potential differences in metabolic control across countries to understand what variables make metabolic control easier to achieve.


Assuntos
Disfunção Cognitiva/diagnóstico , Testes Neuropsicológicos/estatística & dados numéricos , Fenilcetonúrias/etnologia , Fenilcetonúrias/psicologia , /psicologia , Adolescente , Adulto , Cognição , Disfunção Cognitiva/etnologia , Disfunção Cognitiva/etiologia , Comparação Transcultural , Feminino , Humanos , Itália/etnologia , Idioma , Masculino , Fenilalanina/sangue , Fenilcetonúrias/sangue , Reprodutibilidade dos Testes , Reino Unido/etnologia , Adulto Jovem
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