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Cien Saude Colet ; 27(12): 4493-4509, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383863

RESUMO

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


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


Assuntos
Ansiedade , Depressão , Humanos , Feminino , Adolescente , Adulto , Brasil/epidemiologia , Prevalência , Estudos Transversais , Depressão/epidemiologia , Fatores Socioeconômicos , Ansiedade/epidemiologia , Liberdade
3.
Cien Saude Colet ; 27(12): 4511-4520, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383864

RESUMO

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


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


Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína , Prisioneiros , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Lactente , Pré-Escolar , Prisões , Brasil/epidemiologia , Prevalência , Estudos Transversais , Uso de Tabaco/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Liberdade
4.
Cien Saude Colet ; 27(12): 4531-4540, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383866

RESUMO

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


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


Assuntos
Prisioneiros , Prisões , Gravidez , Criança , Feminino , Humanos , Brasil , Crime , Liberdade
5.
Cien Saude Colet ; 27(12): 4569-4577, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383870

RESUMO

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


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


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Brasil , Desinstitucionalização , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Liberdade
6.
Vaccine ; 40(50): 7280-7287, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36334965

RESUMO

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


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , COVID-19/prevenção & controle , Pandemias , Hesitação Vacinal , Canadá , Vacinação , Liberdade
7.
Int J Public Health ; 67: 1605241, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36387289

RESUMO

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


Assuntos
Mídias Sociais , Vacinas , Humanos , Análise de Sentimentos , Liberdade , Canadá
8.
Med Health Care Philos ; 25(4): 729-736, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36260257

RESUMO

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


Assuntos
Liberdade , Autonomia Pessoal , Humanos , Princípios Morais , Cognição
10.
J Phys Act Health ; 19(11): 745-757, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36280228

RESUMO

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


Assuntos
Exercício Físico , Relatório de Pesquisa , Criança , Adolescente , Humanos , Renda , Liberdade
11.
Int J Qual Stud Health Well-being ; 17(1): 2130508, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36226383

RESUMO

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


Assuntos
COVID-19 , Adolescente , Liberdade , Humanos , Motivação , Pandemias , Pais
12.
Rev Lat Am Enfermagem ; 30: e3669, 2022.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-36228237

RESUMO

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


Assuntos
Prisioneiros , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Estudos Transversais , Liberdade , Humanos , Masculino , Prevalência , Prisões , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
13.
Lancet ; 400(10358): 1090, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183715
14.
Rev. esp. salud pública ; 96: e202210062-e202210062, Oct. 2022.
Artigo em Espanhol | IBECS | ID: ibc-211611

RESUMO

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


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


Assuntos
Humanos , Ciências do Comportamento , Direitos Civis , Liberdade , Pandemias , Recusa de Vacinação , Comportamento , Saúde Pública , Ética
15.
Osteoporos Int ; 33(12): 2517-2525, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36115888

RESUMO

TBS algorithm has been updated to account for regional soft tissue noise. In postmenopausal women with osteoporosis, denosumab improved tissue thickness-adjusted TBS vs placebo independently of bone mineral density over 3 years, with the magnitude of changes from baseline or placebo numerically greater than body mass index-adjusted TBS. INTRODUCTION: To evaluate the effect of denosumab on bone microarchitecture assessed by trabecular bone score (TBS) in the FREEDOM study using the updated algorithm that accounts for regional soft tissue thickness (TBSTT) in dual-energy X-ray absorptiometry (DXA) images and to compare percent changes from baseline and placebo with classical body mass index (BMI)-adjusted TBS (TBSBMI). METHODS: Postmenopausal women with lumbar spine or total hip bone mineral density (BMD) T score < - 2.5 and ≥ - 4.0 received placebo or denosumab 60 mg subcutaneously every 6 months. TBSBMI and TBSTT were assessed on lumbar spine DXA scans at baseline and months 1, 12, 24, and 36 in a subset of 279 women (129 placebo, 150 denosumab) who completed the 3-year FREEDOM DXA substudy and rolled over to open-label extension study. RESULTS: Baseline characteristics were similar between groups. TBSTT in the denosumab group showed numerically greater changes from both baseline and placebo than TBSBMI at months 12, 24, and 36. Denosumab led to progressive increases in BMD (1.2, 5.6, 8.1, and 10.5%) and TBSTT (0.4, 2.3, 2.6, and 3.3%) from baseline to months 1, 12, 24, and 36, respectively. Both TBS changes were significant vs baseline and placebo from months 12 to 36 (p < 0.0001). As expected, BMD and TBSTT were poorly correlated both at baseline and for changes during treatment. CONCLUSION: In postmenopausal women with osteoporosis, denosumab significantly improved bone microstructure assessed by TBSTT over 3 years. TBSTT seemed more responsive to denosumab treatment than TBSBMI and was independent of BMD.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Feminino , Humanos , Osso Esponjoso , Denosumab/farmacologia , Denosumab/uso terapêutico , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea , Absorciometria de Fóton/métodos , Osteoporose/tratamento farmacológico , Vértebras Lombares , Liberdade
16.
EMBO Rep ; 23(10): e55608, 2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36093794

RESUMO

Caenorhabditis elegans embodies the expectations of a solution-driven take on biology on the one hand, and the mysteries and wonders of life that drives biologists to go to their labs on the other hand.


Assuntos
Proteínas de Caenorhabditis elegans , Caenorhabditis elegans , Animais , Biologia , Liberdade
17.
J Heart Lung Transplant ; 41(11): 1572-1580, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36117055

RESUMO

BACKGROUND: Risk scores integrate clinical variables emphasizing symptoms, exercise capacity, and measures of cardiac strain to predict clinical outcome better than any single value in pulmonary arterial hypertension (PAH). Risk scores have demonstrated prognostic utility for outcomes in registries, and recent studies have suggested that they are also therapy-responsive in controlled trials. METHODS: FREEDOM-EV, a global, placebo-controlled, event-driven study, randomized 690 PAH participants 1:1 to oral treprostinil (TRE) or placebo. Clinical assessments were performed every 12 weeks to calculate the non-invasive French risk assessment (FRA), 4-strata COMPERA, REVEAL 2.0, and REVEAL Lite 2; median follow-up was 58 weeks. The Week 12 risk scores were used to predict time to clinical worsening (from Week 12) with Kaplan-Meier product-limit estimates. Log-rank test was used to calculate the statistical difference among risk categories, and mediation analysis tested the hypothesis that improvements in risk score contributed to reduced likelihood for clinical worsening. We assessed the previously proposed "net clinical benefit" (achievement of FRA low-risk status and absence of clinical worsening). RESULTS: Both REVEAL scores, COMPERA, and FRA at Week 12 predicted subsequent clinical worsening better than baseline risk. Mediation analysis demonstrated that Week 12 risk score reduction explained part of TRE's effect on clinical worsening, especially for those with higher baseline risk. TRE assigned participants were more likely to achieve the previously proposed "net clinical benefit" at Weeks 24 and beyond. Few participants who achieved 'net clinical benefit' had subsequent clinical worsening. CONCLUSIONS: Contemporary risk scores were therapy responsive in FREEDOM-EV and early improvements predicted subsequent outcomes. This post hoc analysis suggests that risk scores may be a surrogate for clinical worsening.


Assuntos
Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Humanos , Hipertensão Arterial Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar Primária Familiar , Fatores de Risco , Liberdade
18.
J Health Commun ; 27(7): 460-470, 2022 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-36082842

RESUMO

Alcohol causes cancer, but many alcohol consumers are not aware of this risk. Research is needed to identify effective communication strategies to increase risk perceptions and decrease alcohol consumption. This study examined the effects of threatening and hedging languages in communicating the cancer risk associated with alcohol use. Results from a between-subjects experiment (N = 584) revealed a significant interaction effect: Threatening language combined with lexical hedges led to a higher perceived threat to drinker identity competence, which predicted higher intentions to reduce and stop drinking. Moreover, threatening language increased perceived threat to freedom, predicting greater reactance and lower behavioral intentions. Lastly, hedging increased perceived message tentativeness, predicting lower risk perceptions and behavioral intentions. Implications of our study were discussed.


Assuntos
Intenção , Neoplasias , Humanos , Idioma , Liberdade , Neoplasias/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle
19.
Nature ; 609(7926): 243-244, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36064799
20.
J Nurs Educ ; 61(9): e1, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36098538
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