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BACKGROUND: Food membership clubs that charge a small fee for a set number of items are in place in Wessex to address food insecurity (inadequate reliable access to sufficient affordable, nutritious food). These clubs incorporate longer-term solutions such as budgeting support, benefit maximisation, and cooking skills. The Wessex DIET project was established to measure acceptability and impact of these clubs. Given the paucity of evidence on the prevalence of food insecurity in those accessing such clubs, we aimed to quantify food insecurity and assess diet quality and wellbeing at recruitment. METHODS: In this mixed-methods study, we recruited individuals accessing food clubs in Wessex from March 31 to July 31, 2022. Participants provided informed consent and completed a survey (paper or online) at recruitment that collected data on diet and health. We used the modified six-item US Department of Agriculture (USDA) food security survey module. Follow-up surveys were administered after use of clubs (planned for 3, 6, and 12 months). Participants were invited to participate in a semi-structured interview. We used data from the baseline survey to quantify food insecurity and assess diet quality and wellbeing at point of first access to food clubs. FINDINGS: Of 97 participants recruited, five (5%) were aged 18-24 years, 15 (15%) 25-34 years, 48 (49%) 35-54 years, 13 (13%) 55-64 years, and nine (9%) 65 years and older (seven [7%] did not report their age). 69 (71%) participants were female and 23 (24%) were male (five [5%] did not respond to this question), 79 (81%) were White, and 65 (67%) reported having at least one dependent child. 55 (57%) reported skipping or cutting size of meals because there was not enough money for food. Food security status was calculated in 74 participants who answered all six questions of the USDA module, with 30 (41%) reporting low food security and 32 (43%) reporting very low food security. 31 (32%) of 97 participants reported rarely or never eating fruit, with 23 (24%) eating fruit at least once a day. The most common reported frequency of vegetable consumption was 2-3 times a week (26, 27%) and 4-6 times a week (23, 24%). 12 participants agreed to an interview. The clubs were well received, with participants noticing an improvement in their diet and finances. INTERPRETATION: This study highlights the high prevalence of food insecurity in those accessing food clubs in Wessex, which is expected in a population using food aid, and positive reflections from participants regarding their diet quality after using this service. Findings might not be generalisable nationally. Follow-up will assess impact of the clubs on food insecurity, diet quality and wellbeing, contributing to the evidence base of the effectiveness of food clubs to address these outcomes. FUNDING: National Institute for Health and Care Research (NIHR) Applied Research Collaboration Wessex.
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Dieta , Abastecimento de Alimentos , Feminino , Humanos , Masculino , Características da Família , Insegurança Alimentar , Inquéritos e Questionários , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
BACKGROUND: A proportion of people infected with SARS-CoV-2 develop post-COVID-19 condition (also known as long COVID), a predominantly multisystem condition resulting in varying degrees of functional disability limiting day-to-day activities. We aimed to describe the impact of long COVID on work. METHODS: We co-produced baseline and follow-up online surveys with people with lived experience of long COVID (including three of the co-authors). Respondents were aged 18 years and older with self-reported long COVID following confirmed or suspected COVID-19 infection who were not hospitalised in the first 2 weeks of illness. The baseline survey was administered in November, 2020, using convenience non-probability sampling through social media. Following informed consent, participants completed a follow-up survey at 1 year (November, 2021). Ethics approval was granted by the University of Southampton. FINDINGS: Of 2210 invited, 1153 (52%) participants responded to the survey (mean age of 47·7 years [SD 10·6], 965 [84%] female, 1096 [95%] White, and 892 [78%] holding a university degree). 54 participants (4·7%) reported recovery at follow-up. Median duration of illness was 19·8 months (IQR 19·3-20·1) at follow-up. An equal proportion reported being unable to work at baseline (20·4%, n=235) and follow-up (20·6%, n=237). However, a higher proportion reported being made redundant or taking early retirement at follow-up (8·9%, n=102) than at baseline (2·2%, n=25). 209 (18·1%) reported losing or resigning or leaving their job due to long COVID at follow-up compared with 170 (14·8%) participants at baseline. 307 (26·6%) participants reported not taking time off-sick due to long COVID at baseline, decreasing to 122 (10·6%) at follow-up. Of the 656 individuals reporting length of time off-sick, 354 (54%) were off-sick for more than 3 months, with 113 (17·2%) off-sick for more than 12 months. Nearly half (47%, n=538) reported a loss in income. INTERPRETATION: The convenience non-probability sampling limits generalisability. Research is needed in a representative population sample to characterise the effect on working patterns in people with long COVID, particularly in those with less flexible and more physically demanding occupations who may be less able to take time off to recover. FUNDING: None.
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COVID-19 , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , COVID-19/epidemiologia , SARS-CoV-2 , Síndrome de COVID-19 Pós-Aguda , Inquéritos e Questionários , Projetos de PesquisaRESUMO
BACKGROUND: The World Health Organization recommended the use of chemical-based disinfectants as an effective prevention of the COVID-19 pandemic. However, calls for poisoning were reported in several medical centers. The widespread use of chemical-based disinfectants as a preventive measure during the COVID-19 pandemic has underscored potential gaps in community awareness and performance, posing health risks. This study evaluates and compares levels of awareness and performance regarding the safe use of disinfectants in Jordan and UAE. METHODS: The study was conducted between October 2022 and June 2023 via an online questionnaire. Data of respondents from Jordan (n = 828) and UAE (n = 619) were analyzed using SPSS. ANOVA, Mann-Whitney, and Kruskal-Wallis tests evaluated significant differences in awareness and performance levels across different demographic groups in Jordan/UAE and between them. Spearman's correlation test examined the correlation between awareness and performance among respondents. Multinomial logistic regression analysis explored associations between various variables and awareness/performance levels within each population. RESULTS: Findings reveal weak awareness (72.4% and 9.03% in UAE and Jordan, respectively) and moderate performance level (98.8% in UAE and Jordan), with a weak correlation (UAE, rho = 0.093; Jordan, rho = 0.164) observed between the two countries (P < 0.05). Multinomial logistic regression analysis indicates gender-related associations with awareness levels and education-related associations with performance levels. CONCLUSIONS: The study emphasizes the urgent need for awareness campaigns and workshops to promote safer disinfectant practices to develop effective interventions aligning with sustainable development goals.
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COVID-19 , Desinfetantes , Conhecimentos, Atitudes e Prática em Saúde , SARS-CoV-2 , Humanos , Jordânia/epidemiologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Masculino , Feminino , Emirados Árabes Unidos/epidemiologia , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem , Adolescente , IdosoRESUMO
INTRODUCTION: There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. METHODS: A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. RESULTS: Fifty-four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. CONCLUSION: This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals. PATIENT OR PUBLIC CONTRIBUTION: This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.
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Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Concepcional , Humanos , Feminino , Masculino , Adulto , Reino Unido , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Idioma , Gravidez , ConscientizaçãoRESUMO
BACKGROUND AND AIM: Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS: An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS: Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION: We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION: This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.
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COVID-19 , Síndrome de COVID-19 Pós-Aguda , Adulto , Humanos , Estigma Social , Saúde Mental , Acessibilidade aos Serviços de SaúdeRESUMO
BACKGROUND: Evidence on the long-term employment consequences of SARS-CoV-2 infection is lacking. We used data from a large, community-based sample in the UK to estimate associations between Long Covid and employment outcomes. METHODS: This was an observational, longitudinal study using a pre-post design. We included survey participants from 3 February 2021 to 30 September 2022 when they were aged 16-64 years and not in education. Using conditional logit modelling, we explored the time-varying relationship between Long Covid status ≥12 weeks after a first test-confirmed SARS-CoV-2 infection (reference: pre-infection) and labour market inactivity (neither working nor looking for work) or workplace absence lasting ≥4 weeks. RESULTS: Of 206 299 participants (mean age 45 years, 54% female, 92% white), 15% were ever labour market inactive and 10% were ever long-term absent during follow-up. Compared with pre-infection, inactivity was higher in participants reporting Long Covid 30 to <40 weeks [adjusted odds ratio (aOR): 1.45; 95% CI: 1.17-1.81] or 40 to <52 weeks (aOR: 1.34; 95% CI: 1.05-1.72) post-infection. Combining with official statistics on Long Covid prevalence, and assuming a correct statistical model, our estimates translate to 27 000 (95% CI: 6000-47 000) working-age adults in the UK being inactive because of Long Covid in July 2022. CONCLUSIONS: Long Covid is likely to have contributed to reduced participation in the UK labour market, though it is unlikely to be the sole driver. Further research is required to quantify the contribution of other factors, such as indirect health effects of the pandemic.
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COVID-19 , Emprego , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Emprego/estatística & dados numéricos , Estudos Longitudinais , Reino Unido/epidemiologia , Adolescente , Adulto Jovem , Estudos de CoortesRESUMO
BACKGROUND: In England, 41% of children aged 10-11 years live with overweight or obesity. Identifying children at risk of developing overweight or obesity may help target early prevention interventions. We aimed to develop and externally validate prediction models of childhood overweight and obesity at age 10-11 years using routinely collected weight and height measurements at age 4-5 years and maternal and early-life health data. METHODS: We used an anonymised linked cohort of maternal pregnancy and birth health records in Hampshire, UK between 2003 and 2008 and child health records. Childhood body mass index (BMI), adjusted for age and sex, at 10-11 years was used to define the outcome of overweight and obesity (BMI ≥ 91st centile) in the models. Logistic regression models and multivariable fractional polynomials were used to select model predictors and to identify transformations of continuous predictors that best predict the outcome. Models were externally validated using data from the Born in Bradford birth cohort. Model performance was assessed using discrimination and calibration. RESULTS: Childhood BMI was available for 6566 children at 4-5 (14.6% overweight) and 10-11 years (26.1% overweight) with 10.8% overweight at both timepoints. The area under the curve (AUC) was 0.82 at development and 0.83 on external validation for the model only incorporating two predictors: BMI at 4-5 years and child sex. AUC increased to 0.84 on development and 0.85 on external validation on additionally incorporating maternal predictors in early pregnancy (BMI, smoking, age, educational attainment, ethnicity, parity, employment status). Models were well calibrated. CONCLUSIONS: This prediction modelling can be applied at 4-5 years to identify the risk for childhood overweight at 10-11 years, with slightly improved prediction with the inclusion of maternal data. These prediction models demonstrate that routinely collected data can be used to target early preventive interventions to reduce the prevalence of childhood obesity.
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Obesidade Infantil , Gravidez , Feminino , Humanos , Criança , Pré-Escolar , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Sobrepeso/epidemiologia , Índice de Massa Corporal , Modelos Logísticos , Prevalência , Fatores de Risco , Peso ao NascerRESUMO
OBJECTIVE: To present the first national-level report card on the state of women's preconception health in England. DESIGN: Cross-sectional population-based study. SETTING: Maternity services, England. POPULATION: All pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (n = 652 880). METHODS: We analysed the prevalence of 32 preconception indicator measures in the overall population and across socio-demographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. RESULTS: The three most prevalent indicators were the proportion of the 22.9% of women who smoked 1 year before pregnancy who did not quit smoking before pregnancy (85.0%), those who had not taken folic acid supplementation before pregnancy (72.7%) and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area-based deprivation level. The ten indicators prioritised were not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in the most deprived areas, smoking around the time of conception, overweight, pre-existing mental health condition, pre-existing physical health condition, previous pregnancy loss and previous obstetric complication. CONCLUSIONS: Our findings suggest important opportunities to improve the state of preconception health and reduce socio-demographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better quality indicators could be explored and linked to build a comprehensive surveillance infrastructure.
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Aborto Espontâneo , Cuidado Pré-Concepcional , Gravidez , Feminino , Humanos , Estudos Transversais , Inglaterra/epidemiologia , Ácido FólicoRESUMO
BACKGROUND: Foetal and early childhood development contributes to the risk of adult non-communicable diseases such as hypertension and cardiovascular disease. We aimed to investigate whether kidney size at birth is associated with markers of kidney function at 7-11 years. METHODS: Foetal kidney dimensions were measured using ultrasound scans at 34 weeks gestation and used to derive kidney volume (cm3) in 1802 participants in the Born in Bradford (BiB) birth cohort. Blood and urine samples were taken from those who participated in the BiB follow-up at 7-11 years (n = 630) and analysed for serum creatinine, cystatin C, urea, and urinary albumin to creatinine ratio (ACR), protein to creatinine ratio (PCR) and retinol binding protein (RBP). Estimated glomerular filtration rate (eGFR) was calculated using Schwartz creatinine only and combined with cystatin C, and cystatin C only Zappitelli and Filler equations. Linear regression was used to examine the association between foetal kidney volume and eGFR, ACR, PCR and blood pressure, unadjusted and adjusted for confounders. RESULTS: Kidney volume was positively associated in adjusted models with eGFR calculated using Schwartz combined (0.64 ml/min diff per unit increase in volume, 95% CI 0.25 to 1.02), Zappitelli (0.79, 95% CI 0.38 to 1.20) and Filler (2.84, 95% CI 1.40 to 4.28). There was an association with the presence of albuminuria but not with its level, or with other urinary markers or with blood pressure. CONCLUSION: Foetal kidney volume was associated with small increases in eGFR in mid-childhood. Longitudinal follow-up to investigate the relationship between kidney volume and markers of kidney function as children go through puberty is required.
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Rim , Criança , Humanos , Recém-Nascido , Albuminúria/urina , Biomarcadores , Creatinina , Cistatina C , Taxa de Filtração Glomerular/fisiologia , Rim/anatomia & histologia , Rim/fisiologia , Testes de Função Renal , Tamanho do ÓrgãoRESUMO
BACKGROUND: The fast spread of COVID-19 reinforced the daily use of disinfectants around the world. However, the awareness gap of disinfectant use could lead to health risks during the prevention of the pandemic. This study aims to assess the level of awareness and performance towards COVID-related disinfectant use among various university communities (student, staff, and faculty) in Lebanon. METHODS: A cross-sectional study was conducted between December 2021 and June 2022 among 925 participants (males and females aged between 18 and 64 years old) from academic settings in Lebanese universities using convenience sampling. An online validated survey (score-based questionnaire) of personal disinfectants' utilization was conducted to evaluate the awareness and performance levels using SPSS (version 21). Mann-Whitney and Kruskal-Wallis tests were used to check significant differences in awareness and performance levels among gender, age, provinces, educational level, university status, and field of study. Friedman test was used to test for significant differences in performance level questions pre-and post-COVID-19. The Spearman correlation test was used to determine the correlation between the awareness and performance of the respondents regarding the use of disinfectants. RESULTS: It was found that the majority of the respondents showed a weak level of awareness (70.8%) while their performance (61.9%) was moderate. Spearman's correlation analysis concluded a weak correlation between the awareness and performance levels (p < 0.01). The Mann-Whitney test indicated that there was a significant difference (p < 0.05) in awareness and performance levels between males and females. Another notable variable was the educational level of the respondents (p < 0.05) with postgraduate degrees holders recording higher mean scores of awareness than the ones with undergraduate and high school degrees as per Kruskal-Wallis test. Significant differences were shown in awareness scores among the age groups and in performance scores among the field of study (p < 0.05). CONCLUSIONS: The study findings highlighted the necessity of awareness campaigns and training programs addressing the technical handling of disinfectants among the communities in Lebanon. Lebanese governmental authorities (Ministry of Public Health, MoPH, and Ministry of Education and Higher Education, MEHE), and the healthcare professionals and public health researchers in Lebanon may utilize this new evidence to initiate public health interventions as a part of the United Nations (UN) sustainability goal of wellbeing (Sustainable Development Goal 3, SDG 3).
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COVID-19 , Desinfetantes , Feminino , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Líbano , COVID-19/prevenção & controle , Estudos Transversais , UniversidadesRESUMO
BACKGROUND: A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised. METHODS: A mixed methods approach was used to assess feasibility of implementing SLOPE CORE. Health Visitors (HVs) were trained to use the tool, and in the processes for recruiting parents into the study. HVs were recruited using purposive sampling and parents by convenience sampling. HVs and parents were invited to take part in interviews or focus groups to explore their experiences of the tool. HVs were asked to complete a system usability scale (SUS) questionnaire. RESULTS: Five HVs and seven parents took part in the study. HVs found SLOPE CORE easy to use with a mean SUS of 84.4, (n = 4, range 70-97.5) indicating excellent usability. Five HVs and three parents took part in qualitative work. The tool was acceptable and useful for both parents and HVs. Parents expressed a desire to know their child's risk of future obesity, provided this was accompanied by additional information, or support to modify risk. HVs appreciated the health promotion opportunity that the tool presented and felt that it facilitated difficult conversations around weight, by providing 'clinical evidence' for risk, and placing the focus of the conversation onto the tool result, rather than their professional judgement. The main potential barriers to use of the tool included the need for internet access, and concerns around time needed to have a sensitive discussion around a conceptually difficult topic (risk). CONCLUSIONS: SLOPE CORE could potentially be useful in clinical practice. It may support targeting limited resources towards families most at risk of childhood obesity. Further research is needed to explore how the tool might be efficiently incorporated into practice, and to evaluate the impact of the tool, and any subsequent interventions, on preventing childhood obesity.
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Obesidade Infantil , Criança , Gravidez , Pré-Escolar , Feminino , Humanos , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Design Centrado no Usuário , Estudos de Viabilidade , Interface Usuário-Computador , Projetos de PesquisaRESUMO
BACKGROUND: Maternal obesity increases the risk of adverse long-term health outcomes in mother and child including childhood obesity. We aimed to investigate the association between interpregnancy weight gain between first and second pregnancies and risk of overweight and obesity in the second child. METHODS: We analysed the healthcare records of 4789 women in Hampshire, UK with their first two singleton live births within a population-based anonymised linked cohort of routine antenatal records (August 2004 and August 2014) with birth/early life data for their children. Measured maternal weight and reported height were recorded at the first antenatal appointment of each pregnancy. Measured child height and weight at 4-5 years were converted to age- and sex-adjusted body mass index (BMI z-score). Log-binomial regression was used to examine the association between maternal interpregnancy weight gain and risk of childhood overweight and obesity in the second child. This was analysed first in the whole sample and then stratified by baseline maternal BMI category. RESULTS: The prevalence of overweight/obesity in the second child was 19.1% in women who remained weight stable, compared with 28.3% in women with ≥3 kg/m2 weight gain. Interpregnancy gain of ≥3 kg/m2 was associated with increased risk of childhood overweight/obesity (adjusted relative risk (95% CI) 1.17 (1.02-1.34)), with attenuation on adjusting for birthweight of the second child (1.08 (0.94-1.24)). In women within the normal weight range at first pregnancy, the risks of childhood obesity (≥95th centile) were increased with gains of 1-3 kg/m2 (1.74 (1.07-2.83)) and ≥3 kg/m2 (1.87 (1.18-3.01)). CONCLUSION: Children of mothers within the normal weight range in their first pregnancy who started their second pregnancy with a considerably higher weight were more likely to have obesity at 4-5 years. Supporting return to pre-pregnancy weight and limiting weight gain between pregnancies may achieve better long-term maternal and offspring outcomes.
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Ganho de Peso na Gestação/fisiologia , Obesidade Infantil/diagnóstico , Adulto , Criança , Estudos de Coortes , Correlação de Dados , Feminino , Ganho de Peso na Gestação/genética , Humanos , Masculino , Obesidade Infantil/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Reino Unido/epidemiologiaRESUMO
Breast cancer (BC) has recently become the most common cancer type worldwide, with metastatic disease being the main reason for disease mortality. This has brought about strategies for early detection, especially the utilization of minimally invasive biomarkers found in various bodily fluids. Exosomes have been proposed as novel extracellular vesicles, readily detectable in bodily fluids, secreted from BC-cells or BC-tumor microenvironment cells, and capable of conferring cellular signals over long distances via various cargo molecules. This cargo is composed of different biomolecules, among which are the novel non-coding genome products, such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and the recently discovered circular RNA (circRNA), all of which were found to be implicated in BC pathology. In this review, the diverse roles of the ncRNA cargo of BC-derived exosomes will be discussed, shedding light on their primarily oncogenic and additionally tumor suppressor roles at different levels of BC tumor progression, and drug sensitivity/resistance, along with presenting their diagnostic, prognostic, and predictive biomarker potential. Finally, benefiting from the miRNA sponging mechanism of action of lncRNAs and circRNAs, we established an experimentally validated breast cancer exosomal non-coding RNAs-regulated target gene axis from already published exosomal ncRNAs in BC. The resulting genes, pathways, gene ontology (GO) terms, and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis could be a starting point to better understand BC and may pave the way for the development of novel diagnostic and prognostic biomarkers and therapeutics.
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Neoplasias da Mama , Exossomos , MicroRNAs , RNA Longo não Codificante , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Biologia Computacional/métodos , Exossomos/genética , Exossomos/metabolismo , Feminino , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , RNA Circular/genética , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Microambiente TumoralRESUMO
BACKGROUND: Maternal iodine requirements increase during pregnancy to supply thyroid hormones critical for fetal neurodevelopment. Iodine insufficiency may result in poorer cognitive or child educational outcomes but current evidence is sparse and inconsistent. OBJECTIVES: To quantify the association between maternal iodine status and child educational outcomes. METHODS: Urinary iodine concentrations (UIC) and iodine/creatinine ratios (I:Cr) were measured in 6971 mothers at 26-28 weeks' gestation participating in the Born in Bradford cohort. Maternal iodine status was examined in relation to child school achievement (early years foundation stage (EYFS), phonics, and Key Stage 1 (KS1)), other learning outcomes, social and behavioural difficulties, and sensorimotor control in 5745 children aged 4-7 years. RESULTS: Median (interquartile range) UIC was 76 µg/L (46, 120), and I:Cr was 83 µg/g (59, 121). Overall, there was no strong or consistent evidence to support associations between UIC or I:Cr and neurodevelopmental outcomes. For instance, predicted EYFS and phonics scores (primary outcomes) at the 25th vs 75th I:Cr percentiles (99% confidence intervals) were similar, with no evidence of associations: EYFS scores were 32 (99% CI 31, 33) and 33 (99% CI 32, 34), and phonics scores were 34 (99% CI 33, 35) and 35 (99% CI 34, 36), respectively. CONCLUSIONS: In the largest single study of its kind, there was little evidence of detrimental neurodevelopmental outcomes in children born to pregnant women with iodine insufficiency as defined by World Health Organization-outlined thresholds. Alternative functional biomarkers for iodine status in pregnancy and focused assessment of other health outcomes may provide additional insight.
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Iodo , Criança , Cognição , Feminino , Idade Gestacional , Humanos , Estado Nutricional , Gravidez , Gravidez Múltipla , Reino Unido/epidemiologiaAssuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Vigilância em Saúde Pública , Recuperação de Função Fisiológica , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/mortalidade , Eficiência , Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pandemias , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/mortalidade , Fatores de TempoRESUMO
BACKGROUND: Geographical inequalities in overweight and obesity prevalence among children are well established in cross-sectional research. We aimed to examine how environmental area characteristics at birth are related to these outcomes in childhood. METHODS: Anonymised antenatal and birth data recorded by University Hospital Southampton linked to school-measured weight and height data for children within Southampton, UK, were utilised (14,084 children at ages 4-5 and 5637 at ages 10-11). Children's home address at birth was analysed at the Lower and Middle layer Super Output Area (LSOA/MSOA) levels (areas with average populations of 1500 and 7000, respectively). Area-level indices (walkability, relative density of unhealthy food outlets, spaces for social interaction), natural greenspace coverage, supermarket density and measures of air pollution (PM2.5, PM10 and NOx) were constructed using ArcGIS Network Analyst. Overweight/obesity was defined as a body mass index (BMI; kg/m2) greater than the 85th centile for sex and age. Population-average generalised estimating equations estimated the risk of being overweight/obese for children at both time points. Confounders included maternal BMI and smoking in early pregnancy, education, ethnicity and parity. We also examined associations for a subgroup of children who moved residence between birth and outcome measurement. RESULTS: There were mixed results between area characteristics at birth and overweight/obesity at later ages. MSOA relative density of unhealthy food outlets and PM10 were positively associated with overweight/obesity, but not among children who moved. LSOA greenspace coverage was negatively associated with the risk of being overweight/obese at ages 10-11 in all children (relative risk ratio 0.997, 95% confidence interval 0.995-0.999, p = 0.02) and among children who moved. CONCLUSIONS: Local access to natural greenspaces at the time of birth was inversely associated with becoming overweight or obese by age 10-11, regardless of migration. Increased access/protection of greenspace may have a role in the early prevention of childhood obesity.
Assuntos
Exposição Ambiental/efeitos adversos , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Inglaterra , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Nearly a third of children in the UK are overweight, with the prevalence in the most deprived areas more than twice that in the least deprived. The aim was to develop a risk identification model for childhood overweight/obesity applied during pregnancy and early life using routinely collected population-level healthcare data. METHODS: A population-based anonymised linked cohort of maternal antenatal records (January 2003 to September 2013) and birth/early-life data for their children with linked body mass index (BMI) measurements at 4-5 years (n = 29,060 children) in Hampshire, UK was used. Childhood age- and sex-adjusted BMI at 4-5 years, measured between September 2007 and November 2018, using a clinical cut-off of ≥ 91st centile for overweight/obesity. Logistic regression models together with multivariable fractional polynomials were used to select model predictors and to identify transformations of continuous predictors that best predict the outcome. RESULTS: Fifteen percent of children had a BMI ≥ 91st centile. Models were developed in stages, incorporating data collected at first antenatal booking appointment, later pregnancy/birth, and early-life predictors (1 and 2 years). The area under the curve (AUC) was lowest (0.64) for the model only incorporating maternal predictors from early pregnancy and highest for the model incorporating all factors up to weight at 2 years for predicting outcome at 4-5 years (0.83). The models were well calibrated. The prediction models identify 21% (at booking) to 24% (at ~ 2 years) of children as being at high risk of overweight or obese by the age of 4-5 years (as defined by a ≥ 20% risk score). Early pregnancy predictors included maternal BMI, smoking status, maternal age, and ethnicity. Early-life predictors included birthweight, baby's sex, and weight at 1 or 2 years of age. CONCLUSIONS: Although predictive ability was lower for the early pregnancy models, maternal predictors remained consistent across the models; thus, high-risk groups could be identified at an early stage with more precise estimation as the child grows. A tool based on these models can be used to quantify clustering of risk for childhood obesity as early as the first trimester of pregnancy, and can strengthen the long-term preventive element of antenatal and early years care.
Assuntos
Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Pré-Escolar , Estudos de Coortes , Análise de Dados , Feminino , Humanos , Masculino , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Severe iodine insufficiency in pregnancy has significant consequences, but there is inadequate evidence to indicate what constitutes mild or moderate insufficiency, in terms of observed detrimental effects on pregnancy or birth outcomes. A limited number of studies have examined iodine status and birth outcomes, finding inconsistent evidence for specific outcomes. METHODS: Maternal iodine status was estimated from spot urine samples collected at 26-28 weeks' gestation from 6971 mothers in the Born in Bradford birth cohort. Associations with outcomes were examined for both urinary iodine concentration (UIC) and iodine-to-creatinine ratio (I:Cr). Outcomes assessed included customised birthweight (primary outcome), birthweight, small for gestational age (SGA), low birthweight, head circumference and APGAR score. RESULTS: There was a small positive association between I:Cr and birthweight in adjusted analyses. For a typical participant, the predicted birthweight centile at the 25th percentile of I:Cr (59 µg/g) was 2.7 percentage points lower than that at the 75th percentile of I:Cr (121 µg/g) (99% confidence interval (CI) 0.8 to 4.6), birthweight was predicted to be 41 g lower (99% CI 13 to 69) and the predicted probability of SGA was 1.9 percentage points higher (99% CI 0.0 to 3.7). There was no evidence of associations using UIC or other birth outcomes, including stillbirth, preterm birth, ultrasound growth measures or congenital anomalies. CONCLUSION: Lower maternal iodine status was associated with lower birthweight and greater probability of SGA. Whilst small, the effect size for lower iodine on birthweight is comparable to environmental tobacco smoke exposure. Iodine insufficiency is avoidable, and strategies to avoid deficiency in women of reproductive age should be considered. TRIAL REGISTRATION: ClinicalTrials.gov NCT03552341. Registered on June 11, 2018.
Assuntos
Anormalidades Congênitas/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Iodo/metabolismo , Mães/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Reino UnidoRESUMO
BACKGROUND/OBJECTIVES: Childhood obesity is a serious public health challenge. Cross-sectional evidence indicates that childhood obesity is strongly linked to area deprivation level, yet longitudinal research is scarce. We assessed the association of home-based and school-based deprivation indices with change in childhood body-mass index (BMI) z-score and BMI status over 6 years in Hampshire, England. SUBJECTS/METHODS: This longitudinal study linked the National Child Measurement Programme data for children aged 4-5 years (2007-08 to 2009-10) to 10-11 years. The dataset was stratified into two groups: 18,733 children for whom home deprivation quintiles, according to the Index of Multiple Deprivation (IMD), remained constant, and 6153 children who moved home deprivation quintiles between the two time points. The associations between IMD quintiles and change in BMI z-score and status were analysed. RESULTS: 63.7% of children remained a healthy weight, 3.1% remained overweight, 5.3% remained with obesity, 8.3% became overweight, and 10.3% developed obesity. Children living in the most deprived quintile increased their BMI z-score by 0.13 units more than those in the least deprived quintile (95% CI: 0.08-0.19). Home-based deprivation displayed associations with change in BMI status. (Relative risk for the most deprived quintile: become overweight 1.47, 1.21-1.78, remain obese 1.82, 1.34-2.40, become obese 2.07, 1.73-2.48.) School-based deprivation was not associated with change in BMI z-score or BMI status. Moving home to a more deprived quintile was associated with developing obesity (1.22, 1.04-1.43). CONCLUSIONS: More children living in deprived areas developed obesity over time. Home-based deprivation level is more strongly associated with adverse change in childhood weight than school-based deprivation. Scholarly settings can provide opportunities for interventions, however obesity prevention interventions should tackle the obesogenic environment combining family and area-based measures.
Assuntos
Índice de Massa Corporal , Obesidade Infantil/epidemiologia , Estudantes/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Reino Unido/epidemiologia , População Urbana/estatística & dados numéricosRESUMO
Background: Health researchers may struggle to choose suitable validated dietary assessment tools (DATs) for their target population. The aim of this review was to identify and collate information on validated UK DATs and validation studies for inclusion on a website to support researchers to choose appropriate DATs.Design: A systematic review of reviews of DATs was undertaken. DATs validated in UK populations were extracted from the studies identified. A searchable website was designed to display these data. Additionally, mean differences and limits of agreement between test and comparison methods were summarized by a method, weighting by sample size.Results: Over 900 validation results covering 5 life stages, 18 nutrients, 6 dietary assessment methods, and 9 validation method types were extracted from 63 validated DATs which were identified from 68 reviews. These were incorporated into www.nutritools.org. Limits of agreement were determined for about half of validations. Thirty four DATs were FFQs. Only 17 DATs were validated against biomarkers, and only 19 DATs were validated in infant/children/adolescents.Conclusions: The interactive www.nutritools.org website holds extensive validation data identified from this review and can be used to guide researchers to critically compare and choose a suitable DAT for their research question, leading to improvement of nutritional epidemiology research.