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1.
Environ Sci Pollut Res Int ; 27(22): 28222-28246, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32415446

RESUMEN

This study investigates the spatial influence and spillover effects of foreign direct investment (FDI) on environmental pollution (EP) by using panel spatial data in 1970-2016 for 12 selected Arab countries. It employs the STochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model. The spatial econometric approach is applied to examine the validity of the pollution haven hypothesis (PHH) and the pollution halo hypothesis (P-HH) (from now on, we will use the acronyms PHH and P-HH to denote the pollution haven hypothesis and pollution halo hypothesis, respectively). The Sustainable Development Goals (SDGs) are linked to the study results with a focus on cleaner production practices. The global Moran's I, local Moran's I, and Lagrange multiplier (LM) tests are used to ascertain the existence of spatial autocorrelation (SAR) and determine its trend. We also apply the spatial lag model (SLM), the spatial error model (SEM), and the spatial Durbin model (SDM) to achieve the study objectives. Data are analyzed by using the SDM on the basis of the results of the Wald and likelihood ratio tests. The results of the LM and global and local Moran's I tests confirm the existence of SAR. The SDM results reveal that a slight increase in CO2 is an influence of the FDI on EP. Findings support the existence of PHH in the Arab countries. The direct effect of the FDI is increased CO2 and environmental degradation, and the spatial spillover effects are statistically insignificant. This study suggests a set of policies for managing and directing FDI toward clean technology-based industries and reduced CO2 emissions. Such policies may contribute to the achievement of some SDGs and balancing economic development and environmental sustainability according to the cleaner production practice perspective in the Arab countries and other states with similar conditions.


Asunto(s)
Árabes , Dióxido de Carbono/análisis , Desarrollo Económico , Contaminación Ambiental/análisis , Humanos , Inversiones en Salud , Análisis Espacial
2.
Psychosom Med ; 82(6): 548-560, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32412944

RESUMEN

OBJECTIVE: Decades of research suggest that there may be important ethnic differences in the hemodynamic mechanisms that co-determine arterial blood pressure, the primary diagnostic index of hypertension. In general, studies have observed that, compared with European Americans (EAs), African Americans (AAs) exhibit higher total peripheral resistance (TPR), an important summative index of peripheral vascular constriction. In contrast, EAs have been reliably shown to exhibit greater cardiac output (CO), which is directly linked to left ventricle and overall cardiac blood flow. We have previously proposed that elevated basal TPR, in particular, represents one component of the cardiovascular conundrum, characterized, paradoxically, by elevated resting heart rate variability among AAs relative to EAs. The present meta-analysis and systematic review of the literature sought to extend this previous work by establishing the magnitude of the empirically implied ethnic differences in resting TPR and CO. METHODS: A search of the literature yielded 140 abstracts on differences in TPR between AAs and EAs; 40 were included. Sample sizes, means, and standard deviations for baseline TPR with samples that included EAs and AAs were collected, and Hedges g was computed. RESULTS: Findings indicated that AAs had higher baseline TPR than did EAs (Hedges g = 0.307, SE = 0.043, confidence interval= 0.224 to 0.391, p < .001). In addition, EAs had higher resting CO than did AAs (Hedges g = -0.214, SE = 0.056, confidence interval = -0.324 to -0.104, p < .001). CONCLUSIONS: We discuss the present findings in the context of the role of elevated TPR in the deleterious effects of high blood pressure specifically for AAs.

3.
Artículo en Inglés | MEDLINE | ID: mdl-32410013

RESUMEN

In this population-based study, we explored the relationships between immigration, socio-economic status (SES), and perinatal outcomes. We quantified the effects of SES on birthweight disparities between native and immigrant mothers in Spain. We obtained birth and SES data from the 2011 census and administrative registers for years 2011-2015. The associations between origin, statuses, and the likelihood of low birthweight were estimated using logistic regressions. Fairlie's nonlinear extension of the Oaxaca-Blinder decomposition method was applied to identify the extent to which the differences in birthweight between groups corresponded to socio-economic composition or to rates. Our results showed that African and Latin American mothers exhibited advantage in the perinatal outcomes over native mothers [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.63-0.90 and OR 0.73; 95% CI 0.65-0.82, respectively]. Decomposition analyses revealed that such advantage was not affected by the lower positions within the socio-economic structure that African and Latin American populations occupied.

4.
Am J Surg ; 2020 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-32354603

RESUMEN

BACKGROUND: Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients. METHODS: We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013). RESULTS: Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients. CONCLUSIONS: ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study.

5.
PLoS One ; 15(4): e0231599, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32287320

RESUMEN

BACKGROUND: Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars. RESULTS: Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase. CONCLUSIONS: Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.


Asunto(s)
Ageísmo/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Racismo/estadística & datos numéricos , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Americanos Asiáticos/estadística & datos numéricos , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/terapia , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Estados Unidos
6.
J Aging Health ; : 898264320912611, 2020 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242759

RESUMEN

Objectives: We explore how a new cancer diagnosis affects trajectories of personal mastery among non-Hispanic Black and White older adults. We estimate whether and how cancer therapy (chemotherapy, surgery, radiation), the amount and type of health care contacts, the financial burden, and the physical symptoms of cancer explain within- and between-gender differences in mastery. Method: Using the 2006-2014 data from the Health and Retirement Study, we apply matching and multiple regression models testing mediating and moderating effects. Results: White men experience a substantially more pronounced decline in mastery after a cancer diagnosis than all women and Black men. Cancer treatment disproportionately decreases White men's mastery via exposure to health care settings. Discussion: Cultural norms of masculinity and femininity imbue cancer and its treatment with gender-specific meanings. Deference to medical authority and losses of independence, decision-making, and self-reliance are incompatible with masculinity and might affect mastery more adversely in older White men.

7.
Gerontologist ; 2020 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-32271380

RESUMEN

BACKGROUND AND OBJECTIVES: Studies comparing racial/ethnic differences on measures of psychological and physical well-being for dementia caregivers have reported differences between minority and white caregivers. Recruitment methods often differ for minority and white participants due to enrollment targets and may lead to biased comparisons, especially in convenience samples. We aimed to examine racial/ethnic differences in dementia caregiver outcomes and to determine whether differences vary between studies with population-based or convenience samples. RESEARCH DESIGN AND METHODS: We systematically reviewed articles with primary data from PubMed, Google Scholar, and PsycINFO. We included studies comparing African American or Hispanic/Latino to white dementia caregivers on measures of psychological well-being or physical well-being. Reviewers screened titles and abstracts, reviewed full texts and conducted risk-of-bias assessments. Meta-analyses were conducted to assess effects by race/ethnicity and study bias. RESULTS: A total of 159 effects were extracted from 38 studies, 2 of which were population based. Random-effects models revealed small but statistically significant effects with better psychological well-being in African American caregivers compared with white caregivers in both population-based (d = -0.22) and convenience sample studies (d = -0.21). Hispanics/Latino caregivers reported lower levels of physical well-being than white caregivers (d = 0.12), though these effects varied by level of rated study bias. DISCUSSION AND IMPLICATIONS: Consistency across study methods raises confidence in the validity of previous reports of better psychological well-being in African American caregivers. Future studies should use population-based samples with subgroups of Hispanic/Latino, Asian American, and American Indian caregivers that are culturally distinct on factors such as country of origin and tribe.

8.
Public Health Nutr ; : 1-12, 2020 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-32131930

RESUMEN

OBJECTIVE: To assess the relationship between malnutrition, socioeconomic status (SES) and ethnicity in Chilean adult population. DESIGN: Nationally representative survey (ENS) conducted in 2016-2017. Sociodemographic information, weight, height and hemoglobin (Hb) were measured (2003 ENS). Excess weight was defined as BMI ≥25 kg/m2. Undernutrition included underweight (BMI <18·5 kg/m2), short stature (height <1·49 m in women and <1·62 m in men) or anaemia (Hb <12 g/l). Education and household income level were used as indicators of SES; ethnicity was self-reported. We applied linear combinations of estimators to compare the prevalence of excess weight and undernutrition by SES and ethnicity. SETTING: Chile. PARTICIPANTS: In total, 5082 adults ≥20 years (64 % women) and 1739 women ≥20 years for anaemia analyses. RESULTS: Overall, >75 % of women and men had excess weight. Low SES women either by income or education had higher excess weight ((82·0 (77·1, 86·1) v. 65·0 (54·8, 74·1)) by income; (85·3 (80·6, 89·0) v. 68·2 (61·6, 74·1) %) by education) and short stature (20-49 years; 31(17·9, 48·2) v. 5·2 (2·2,11·4) by education); obesity was also more frequent among indigenous women (20-49 years; 55·8 (44·4, 66·6) v. 37·2 (32·7, 42·0) %) than non-indigenous women. In men, excess weight did not significantly differ by SES or ethnicity, but short stature concentrated in low SES (20-49 years; 47·6 (24·6, 71·6) v. 4·5 (2·1, 9·5) by education) and indigenous men (21·5 (11·9, 5·5, 11·9) v. 8·2 (5·5, 11·9)) (P < 0·05 for all). CONCLUSIONS: In Chile, malnutrition is disproportionately concentrated among women of low SES and indigenous origin; these inequalities should be considered when implementing prevention policies.

9.
J Genet Couns ; 29(2): 147-165, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32144851

RESUMEN

As genetic counseling services expand and reach a wider catchment of the population, there is a critical need to better understand the impact of services on a greater diversity of patients. We conducted a systematic review to evaluate genetic counseling experiences and outcomes among racial and ethnic minorities. Six databases extracted articles published from 2005 to 2019 that assessed genetic counseling participation, knowledge and awareness, motivators, barriers, perceptions, and outcomes for racial and ethnic minority populations in the United States. Genetic counseling outcomes were categorized using the Framework for Outcomes of Clinical commUnication Services. A total of 1,227 abstracts were identified, of which 23 papers met inclusion criteria. Results suggest the possibility of racial and ethnic differences in some genetic counseling experiences and outcomes but noted differences were not adequately replicated between studies. The few included studies differed greatly in aims, methods, and results, which made comparison across study designs challenging and effectively barred thematic analysis. Additional research is needed that includes more study populations and settings with patients of diverse racial and ethnic backgrounds, as well as more structured study designs that allow for elucidations of differences between White and non-White populations.

10.
J Pediatr ; 220: 116-124.e3, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32171561

RESUMEN

OBJECTIVE: To evaluate whether differences in pediatric tonsillectomy use by race/ethnicity and type of insurance were impacted by the American Academy of Otolaryngology-Head and Neck Surgery's 2011 tonsillectomy clinical practice guidelines. STUDY DESIGN: We included children aged <15 years from Florida or South Carolina who underwent tonsillectomy in 2004-2017. Annual tonsillectomy rates within groups defined by race/ethnicity and type of health insurance were calculated using US Census data, and interrupted time series analyses were used to compare the guidelines' impact on utilization across groups. RESULTS: The average annual tonsillectomy rate was greater among non-Hispanic white children (66 procedures per 10 000 children) than non-Hispanic black (38 procedures per 10 000 children) or Hispanic children (41 procedures per 10 000 children) (P < .001). From the year before to the year after the guidelines' release, tonsillectomy use decreased among non-Hispanic white children (-11.1 procedures per 10 000 children), but not among non-Hispanic black (-0.9 procedures per 10 000 children) or Hispanic children (+3.9 procedures per 10 000 children) (P < .05). Use was greater among publicly than privately insured children (75 vs 52 procedures per 10 000 children, P < .001). The guidelines were associated with a reversal of the upward trend in use seen in 2004-2010 among publicly insured children (-5.5 procedures per 10 000 children per year, P < .001). CONCLUSIONS: Tonsillectomy use is greatest among white and publicly insured children. However, the American Academy of Otolaryngology-Head and Neck Surgery's 2011 clinical practice guideline statement was associated with an immediate decrease and change in use trends in these groups, narrowing differences in utilization by race/ethnicity and type of insurance.

11.
Dis Colon Rectum ; 63(6): 850-858, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32167969

RESUMEN

BACKGROUND: Low implementation of colorectal cancer screening in ethnic minorities is the main reason for racial and ethnic disparities in colorectal cancer morbidity and mortality. Peer support is widely used for promoting health care in ethnic minorities. However, whether it improves their acceptance to undergo the screening remains controversial. OBJECTIVE: We performed a meta-analysis of the currently available studies to further explore its effectiveness. DATA SOURCES: This meta-analysis was undertaken using PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for randomized controlled trials. STUDY SELECTION: We included studies that compared peer support interventions among ethnic minorities versus other interventions to promote uptake of colorectal cancer screening. RESULTS: Thirteen studies comprising 8090 participants met the eligibility criteria. Peer support intervention can increase colorectal cancer screening implementation and raise awareness and intention to undergo the screening in ethnic minorities more significantly than fecal occult blood test outreach, print, and usual care. Subgroup analysis showed that peer support intervention achieved great results in Asian Americans and intervention of peer counseling. LIMITATIONS: The results of subgroup analysis had substantial heterogeneity, which may decrease the precision of our estimates. CONCLUSIONS: Peer support can significantly improve the awareness about and the intention for receiving colorectal cancer screening in ethnic minorities and is an ideal choice for promoting the screening among ethnic minorities, particularly in a diverse community. Peer support intervention is recommended to promote the implementation of screening in Asian Americans. Peer counseling is worth promoting; however, church-based peer counseling programs require enhanced management to maintain their fidelity.

12.
13.
J Am Geriatr Soc ; 68(6): 1279-1285, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32092157

RESUMEN

BACKGROUND/OBJECTIVES: Decision making in financial and healthcare matters is of critical importance for well-being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making. DESIGN: Community-based epidemiologic cohort study. SETTING: Communities in northeastern Illinois. PARTICIPANTS: Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision-making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276). MEASUREMENTS: All participants completed clinical assessments, a decision-making measure that resembles real-world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare). RESULTS: In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (ß = -8.20; SE = 1.34; 95% CI = -10.82 to -5.57; P < .01) and separately on decision making (ß = -.80; SE = .23; 95% CI = -1.25 to -.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (ß = -.45; SE = .24; 95% CI = -.93 to .02; P = .06), but literacy remained significantly associated with decision making (ß = .04; SE = .01; 95% CI = .02-.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making. CONCLUSIONS: Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well-being for diverse populations. J Am Geriatr Soc 68:1279-1285, 2020.

14.
Otolaryngol Head Neck Surg ; 162(4): 479-488, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32069169

RESUMEN

OBJECTIVE: To demonstrate whether race, education, income, or insurance status influences where patients seek medical care and the cost of care for a broad range of otolaryngologic diseases in the United States. STUDY DESIGN: Retrospective cohort study using data from the Medical Expenditure Panel Survey, from 2007 to 2015. SETTING: Nationally representative database. SUBJECTS AND METHODS: Patients with 14 common otolaryngologic conditions were identified using self-reported data and International Classification of Diseases, 9th Revision Clinical Modification diagnosis codes. To analyze disparities in the utilization and cost of otolaryngologic care, a multivariate logistic regression model was used to compare outpatient and emergency department visit rates and costs for African American, Hispanic, and Caucasian patients, controlling for sociodemographic characteristics. RESULTS: Of 78,864 respondents with self-reported otolaryngologic conditions, African American and Hispanic patients were significantly less likely to visit outpatient otolaryngologists than Caucasians (African American: adjusted odds ratio [aOR], 0.57; 95% CI, 0.5-0.65; Hispanic: aOR, 0.64; 95% CI, 0.56-0.73) and reported lower average costs per emergency department visit than Caucasians (African American: $4013.67; Hispanic: $3906.21; Caucasian: $7606.46; P < .001). In addition, uninsured, low-income patients without higher education were significantly less likely to receive outpatient otolaryngologic care than privately insured, higher-income, and more educated individuals (uninsured: aOR, 0.38; 95% CI, 0.29-0.51; poor: aOR, 0.75; 95% CI, 0.64-0.87; no degree: aOR, 0.67; 95% CI, 0.54-0.82). CONCLUSION: In this study, significant racial and socioeconomic discrepancies exist in the utilization and cost of health care for otolaryngologic conditions in the United States.


Asunto(s)
Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Enfermedades Otorrinolaringológicas/economía , Enfermedades Otorrinolaringológicas/terapia , Adolescente , Adulto , Anciano , Estudios de Cohortes , Grupos de Población Continentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos , Adulto Joven
15.
J Immunoassay Immunochem ; 41(3): 281-296, 2020 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-32065027

RESUMEN

Lymphocyte subsets reference ranges are helpful for a precise diagnosis and therapy of various diseases. We attempted in the current study to establish Moroccan lymphocyte reference range and reveal age, gender, ethnicity, income, and instructional levels dependent differences. Lymphocyte subsets percentage and absolute count were determined by 4-color flow cytometry in a population study of 145 adults Moroccan healthy volunteers. Analysis showed significant age-dependent changes. Age was associated with a decrease of naïve CD4+ and CD8+ T cells and an increase of memory CD4+ or CD8+ T cells. Activated CD4+ CD38+ and CD8+ CD38+ T cells, Treg as well as NK cell showed age-dependent alterations. In contrast, B cells remained unchanged. A higher percentage of CD3+ and CD4+ T cells was observed in females while CD8+, B and NK cells count were higher in men. Ethnicity, instructional levels, and personal income seem to not influence lymphocyte subsets reference values. This study provides reference ranges for lymphocyte subsets of healthy Moroccan adults. These results can be used for other North African (Maghrebian) countries considering their geographic, ethnic, economic, and cultural similarities.

16.
J Surg Res ; 249: 42-49, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31918329

RESUMEN

BACKGROUND: The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described. METHODS: A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis. RESULTS: The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race. CONCLUSIONS: Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.


Asunto(s)
Apendicectomía/estadística & datos numéricos , Apendicitis/cirugía , Disparidades en Atención de Salud/estadística & datos numéricos , Perforación Intestinal/epidemiología , Laparoscopía/estadística & datos numéricos , Afroamericanos/estadística & datos numéricos , Factores de Edad , Apendicitis/complicaciones , Apendicitis/diagnóstico , Niño , Errores Diagnósticos/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Perforación Intestinal/etiología , Tiempo de Internación/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Tiempo de Tratamiento/estadística & datos numéricos
17.
PLoS One ; 15(1): e0226606, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31929543

RESUMEN

BACKGROUND: The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS: Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS: Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS: PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.


Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Grupos Étnicos/estadística & datos numéricos , Inmunosupresores/uso terapéutico , Infarto del Miocardio/prevención & control , Intervención Coronaria Percutánea/métodos , Sirolimus/uso terapéutico , Anciano , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Malasia/epidemiología , Masculino , Región Mediterránea/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Polímeros , Pronóstico , Estudios Prospectivos , República de Corea/epidemiología
18.
Diabetes Res Clin Pract ; 160: 108006, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31923438

RESUMEN

AIMS: To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. METHODS: An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. RESULTS: In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. CONCLUSIONS: We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.


Asunto(s)
Diabetes Mellitus Tipo 2/etnología , Grupos Étnicos/estadística & datos numéricos , Hipoglucemiantes/uso terapéutico , Grupo de Ascendencia Continental Asiática , Estudios de Cohortes , Femenino , Humanos , Hipoglucemiantes/farmacología , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Reino Unido
19.
J Racial Ethn Health Disparities ; 7(3): 584-585, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31898058

RESUMEN

There was an error in Fig. 1 as published in this article, and the Hemodialysis and Palliative Care titles in the figure are reversed.

20.
AIDS Behav ; 24(4): 985-997, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31555931

RESUMEN

As national HIV prevention goals aim to increase the proportion of persons living with HIV, determining existing disparities in retention in care will allow for targeted intervention. The purpose of this systematic review was to identify existing disparities in retention in care. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guided this systematic review. Electronic databases, including PubMed/MEDLINE, CINAHL, Sociological Collection, PsychInfo, and Cab Direct/Global Health, were systematically searched and twenty studies were included. This review identified disparities in retention in care that have been documented by race, gender, age, HIV exposure, incarceration history, place of birth, and U.S. geographic location. Research is necessary to further identify existing disparities in retention in care and to better understand determinants of health disparities. Additionally, interventions must be tailored to meet the needs of health disparate populations and should be assessed to determine their effectiveness in reducing health disparities.


Asunto(s)
Infecciones por VIH/prevención & control , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Retención en el Cuidado/estadística & datos numéricos , Adulto , Femenino , VIH , Infecciones por VIH/tratamiento farmacológico , Disparidades en Atención de Salud/etnología , Humanos , Adulto Joven
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