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INTRODUCTION: Witnessing violence and violent victimization have detrimental effects on adolescents' emotional functioning and ability to envision and plan for their futures. However, research is limited on the impact of violence that occurs in adolescents' communities-whether or not it was witnessed or experienced firsthand. This paper investigated the associations between community exposure to gun homicide and adolescents' high school and college graduation aspirations. METHODS: We analyzed data from the Future of Families and Child Wellbeing Study (N = 3031), a cohort study of children born 1998-2000 in 20 large US cities, merged with incident-level data on deadly gun violence from the Gun Violence Archive (2014-2017). Outcomes were reported by adolescents (girls and boys) during wave 6 (2014-2017) of the study, conducted when the children were 15 years of age. We employed ordinary least squares regression, ordered logistic regression, and multilevel stratification to examine the average and heterogeneous impacts of community exposure to gun homicide on adolescents' educational aspirations. RESULTS: Community exposure to gun homicide was associated with reduced high school graduation aspirations, particularly among adolescents with the lowest risk of exposure to gun homicide. Gun homicide exposure was also associated with increased college graduation aspirations; this association was concentrated among adolescents with moderate-high risk of exposure. CONCLUSIONS: Given the importance of education for job opportunities and the better health that accompanies education and occupational attainment, preventing early exposure to gun violence and providing institutional supports to help adolescents facing adversity realize their goals is essential to their long-term health and success.
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Homicídio , Humanos , Adolescente , Masculino , Feminino , Homicídio/estatística & dados numéricos , Homicídio/psicologia , Estados Unidos/epidemiologia , Violência com Arma de Fogo/estatística & dados numéricos , Violência com Arma de Fogo/psicologia , Escolaridade , Aspirações Psicológicas , Exposição à Violência/estatística & dados numéricos , Exposição à Violência/psicologia , Armas de Fogo/estatística & dados numéricosRESUMO
BACKGROUND: Population studies suggest cancer morbidity may be different in Turner syndrome (TS) compared to the background female population. However, significant variability is observed in cancer associations likely due to heterogeneity in patient cohorts. We explored the prevalence and patterns of cancer amongst a cohort of women with TS attending a dedicated TS clinic. METHODS: Retrospective analysis of the patient database was performed to identify TS women who developed cancer. Population data (available before 2015) from the National Cancer Registration and Analysis Service database were used for comparison. RESULTS: Out of 156 TS women, median age of 32 (range 18-73) years, 9 (5.8%) had a recorded cancer diagnosis. Types of cancers were, bilateral gonadoblastoma, type 1 gastric neuroendocrine tumour (NET), appendiceal-NET, gastrointestinal stromal tumour, plasma cell dyscrasia, synovial sarcoma, cervical cancer, medulloblastoma and aplastic anaemia. Median age at cancer diagnosis was 35 (range 7-58) years and two were detected incidentally. Five women had 45,X karyotype, three received growth hormone treatment and all except one received oestrogen replacement therapy. The cancer prevalence of the background age-matched female population was 4.4%. CONCLUSIONS: We confirm the previous observations that women with TS do not appear to be at overall increased risk of common malignancies. Our small cohort showed a spectrum of rare malignancies that are not typically associated with TS, except for a single patient with a gonadoblastoma. The slightly higher prevalence of cancer in our cohort might simply represent increased cancer prevalence in the background population, or might be related to small sample size and regular monitoring of these women due to TS per se.
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Neoplasias Ovarianas , Síndrome de Turner , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Estudos RetrospectivosRESUMO
OBJECTIVE: Increasing referrals to Endocrinology with nonspecific symptoms of suspected adrenal insufficiency (AI) has increased use of the short-synacthen test (SST). Prevailing resource and safety concerns emphasise importance of patient selection criterion to optimise SST use. This study aimed to (1) document the adverse event profile of the SST (2) identify any pretest predictors of SST outcome. DESIGN, PATIENTS AND MEASUREMENTS: Retrospective data analysis of all patients referred for SST in Oxford from 2017 to 2021. Pretest clinical variables (age, sex, BMI, blood pressure and electrolytes), symptoms (fatigue, dizziness, weight loss) and pretest morning cortisol were included in the statistical model with the aim of identifying any variables that could predict SST outcome in Group 1 primary AI, Group 2 central AI and Group 3 glucocorticoid induced AI. Symptoms and signs during and post SST were also noted with the aim of describing adverse effects to synacthen across a large cohort. RESULTS: A total 1480 SSTs (Males:38%, age 52 [39-66] years) were performed: 505 (34.1%) in Group 1, 838 (57%) in Group 2, and 137 (9.3%) in Group 3. Adverse-effects were recorded in 1.8% of tests, including one episode of anaphylaxis. Pretest morning-cortisol was the only predictor for an "SST pass" (whole cohort: B = 0.015, p < 0.001, Group 1: B = 0.018, p < .001; Group 2: B = 0.010, p < 0.012; Group 3: B = 0.018, p = <.001). A threshold of ≥343 nmol/l (receiver-operating characteristic [ROC] area under the curve [AUC] = 0.725, 95% confidence interval [CI] 0.675-0.775, p < 0.001) for the whole cohort, ≥300 nmol/L (ROC AUC = 0.763, 95% CI 0.675 to 0.850, p < 0.001) for Group 1, ≥340 nmol/L (ROC AUC = 0.688, 95% CI 0.615 to 0.761, p < 0.001) for Group2, and ≥376 nmol/L [baseline cortisol] (ROC AUC = 0.783, 95% CI 0.708 to 0.859, p < 0.001) for Group 3, predicted an 'SST pass' with 100% specificity. CONCLUSIONS: Adverse effects to synacthen are rare. Pretest morning cortisol is a reliable predictor for SST outcome and is a helpful tool to rationalise use of the SST. Predictive morning-cortisol thresholds vary according to the aetiology of AI.
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Insuficiência Adrenal , Hidrocortisona , Masculino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Glucocorticoides/efeitos adversos , CosintropinaRESUMO
Objectives. To describe associations between neighborhood racial and economic segregation and violence during the COVID-19 pandemic. Methods. For 13 US cities, we obtained zip code-level data on 5 violence outcomes from March through July 2018 through 2020. Using negative binomial regressions and marginal contrasts, we estimated differences between quintiles of racial, economic, and racialized economic segregation using the Index of Concentration at the Extremes as a measure of neighborhood privilege (1) in 2020 and (2) relative to 2018 through 2019 (difference-in-differences). Results. In 2020, violence was higher in less-privileged neighborhoods than in the most privileged. For example, if all zip codes were in the least privileged versus most privileged quintile of racialized economic segregation, we estimated 146.2 additional aggravated assaults (95% confidence interval = 112.4, 205.8) per zip code on average across cities. Differences over time in less-privileged zip codes were greater than differences over time in the most privileged for firearm violence, aggravated assault, and homicide. Conclusions. Marginalized communities endure endemically high levels of violence. The events of 2020 exacerbated disparities in several forms of violence. Public Health Implications. To reduce violence and related disparities, immediate and long-term investments in low-income neighborhoods of color are warranted. (Am J Public Health. 2022;112(1):144-153. https://doi.org/10.2105/AJPH.2021.306540).
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COVID-19/epidemiologia , Violência com Arma de Fogo/estatística & dados numéricos , Fatores Raciais , Características de Residência/classificação , Segregação Social , Fatores Socioeconômicos , Violência/estatística & dados numéricos , Cidades/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Humanos , Estupro/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Roubo/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths' mental health and whether those impacts vary by characteristics that shape youths' risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation.
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Armas de Fogo , Suicídio , Criança , Masculino , Feminino , Adolescente , Humanos , Estados Unidos/epidemiologia , Homicídio , Depressão/epidemiologia , Violência , Ansiedade/epidemiologiaRESUMO
Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2-18% of youth resided within 600 m of a gun homicide occurring in the past 14-365 days. These percentages were 3-25% for incidents within 800 m and 5-37% for those within a 1300-m radius. Black and Latinx youth were 3-7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5-10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.
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Violência com Arma de Fogo , Adolescente , Cidades , Etnicidade , Humanos , Características da Vizinhança , PobrezaRESUMO
OBJECTIVE: To estimate the long-term impact of Safe Streets Baltimore, which is based on the Cure Violence outreach and violence interruption model, on firearm violence. METHODS: We used synthetic control methods to estimate programme effects on homicides and incidents of non-fatal penetrating firearm injury (non-fatal shootings) in neighbourhoods that had Safe Streets' sites and model-generated counterfactuals. Synthetic control analyses were conducted for each firearm violence outcome in each of the seven areas where Safe Streets was implemented. The study also investigated variation in programme impact over time by generating effect estimates of varying durations for the longest-running programme sites. RESULTS: Synthetic control models reduced prediction error relative to regression analyses. Estimates of Safe Streets' effects on firearm violence varied across intervention sites: some positive, some negative and no effect. Beneficial programme effects on firearm violence reported in prior research were found to have attenuated over time. CONCLUSIONS: For highly targeted interventions, synthetic control methods may provide more valid estimates of programme impact than panel regression with data from all city neighbourhoods. This research offers new understanding about the effectiveness of the Cure Violence intervention over extended periods of time in seven neighbourhoods. Combined with existing Cure Violence evaluation literature, it also raises questions about contextual and implementation factors that might influence programme outcomes.
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Armas de Fogo , Ferimentos por Arma de Fogo , Baltimore/epidemiologia , Homicídio/prevenção & controle , Humanos , Violência/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controleRESUMO
INTRODUCTION: Policing strategies to deter illegal gun carrying by high-risk people are associated with reductions in gun violence. Many factors influence decisions to use or carry a gun in public, but it is unclear whether perceptions of the criminal justice system's response influence those decisions. METHODS: We used a 2016 cross-sectional survey of criminal justice system-involved men in Baltimore City (n=195) to assess their recent frequency of gun carrying and perceptions of criminal justice system responses. RESULTS: Forty-two per cent of respondents reported carrying a gun at least once; 15% carried a gun at least monthly. Those who carried at least monthly were significantly less likely than others to report that it was likely they would be caught carrying a gun on the street (31% vs 53%). CONCLUSIONS: Challenges with holding accountable those who illegally possess or carry guns in public may influence behaviours and perceptions of the effectiveness of the criminal justice system.
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OBJECTIVE: To examine whether firearm ownership and ownership-related motivations and practices can be classified into reasonably distinct types. METHODS: Cross-sectional data on firearm owners (n=429) were obtained from the 2018 California Safety and Well-Being Survey, a state-representative web-based survey. We conducted a latent class analysis using six self-reported indicators of firearm ownership: (1) number of firearms owned, (2) types of firearms owned, (3) primary reason for firearm ownership, (4) firearm storage, (5) loaded handgun carrying and (6) high-capacity magazine ownership. RESULTS: We identified five markedly different classes of firearm ownership. There were two classes of single-firearm owners and three classes of multiple-firearm owners. Only members of one class (9% of owners) were likely to have carried a loaded handgun and to own high-capacity magazines or assault-type weapons. Members of this class were also likely to own 5+ firearms, own for protection against people, and store a firearm in the least secure manner (loaded and unlocked). CONCLUSION: There were distinct classes of firearm ownership in California, and all higher-risk behaviours studied were exhibited disproportionately by members of a single class. This latent class structure, which may help identify higher-risk groups of firearm owners, could inform future research on risk assessment and on focused interventions to reduce firearm injury and death.
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Armas de Fogo , Ferimentos por Arma de Fogo , California , Estudos Transversais , Humanos , Análise de Classes Latentes , Propriedade , SegurançaRESUMO
Among youth 15 to 24 years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1 year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43 % of the attitudes assessed in the intervention community post-intervention compared to 13 % of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p < 0.001) and control community (b = -0.204, p < 0.032). Exposure to the intervention (e.g., seeing stop shooting signs in your neighborhood) was also associated with the nonviolent attitudes toward conflict scale. Overall, the study found greater improvement in attitudes toward violence in the intervention community following the implementation of the Safe Streets program. These findings offer promising insights into future community violence prevention efforts.
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Atitude , Armas de Fogo , Homicídio/prevenção & controle , Política Pública , Segurança , Violência/prevenção & controle , Adolescente , Baltimore , Humanos , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
Epidermolysis bullosa simplex (EBS) is the most common form of EB. Eight different genes have been implicated in the pathogenesis of different types of EBS, but a substantial portion of the cases cannot be attributed to mutations in known genes. Recently, recessive mutations in the gene EXPH5 (encoding exophilin-5, also known as Slac2-b) were identified in patients affected with a mild form of EBS. We used immunohistochemistry, Sanger sequencing and PCR-restriction fragment length polymorphism analysis to identify the cause of mild congenital skin fragility in a 3-year-old girl. No mutations were detected in KRT5 or KRT14, but we identified a novel homozygous deletion in EXPH5, which was found to cosegregate with the disease phenotype in the family. Our results further expand the spectrum of mutations in EXPH5. Appraisal of the present case against previously reported patients indicate that EXPH5 mutations result in a distinctive skin fragility phenotype, with minimal blistering compared with other forms of basal EBS.
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Proteínas Adaptadoras de Transdução de Sinal/genética , Epidermólise Bolhosa Simples/genética , Deleção de Sequência , Pré-Escolar , Feminino , HumanosRESUMO
PURPOSE: To assess the knowledge, attitude and utilisation regarding fissure sealants (FS) and preventive resin restorations (PRR) among Malaysian dentists. MATERIALS AND METHODS: A questionnaire consisting of 35 questions was distributed by mail or an online survey to 425 registered dentists selected according to place of work by stratified random sampling. RESULTS: One hundred fifty-three dentists responded to the survey. A positive attitude towards FS and PRR was noted among most Malaysian dentists. About half of the respondents used FS/PRR occasionally (48.4%), while few (13.7%) applied them routinely. The majority of the dentists agreed that minimally invasive dentistry is important and FS are effective in caries prevention, using them on high caries-risk individuals. Most of the dentists used pumice or paste to clean teeth before placing FS/PRR. A significant number of dentists used a bonding agent prior to placing FS. Although only 57.5% dentists were aware of guidelines for FS use, most dentists agreed that guidelines are important. CONCLUSION: Although there was a positive attitude towards FS/PRR, few dentists applied them routinely. Some of the steps undertaken for placement of FS and PRR were outdated. Updating local guidelines for dentists to ensure uniform practice of FS and PRR is justified.
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Atitude do Pessoal de Saúde , Resinas Compostas/química , Tratamento Dentário Restaurador sem Trauma/métodos , Cárie Dentária/prevenção & controle , Materiais Dentários/química , Odontólogos/psicologia , Selantes de Fossas e Fissuras/uso terapêutico , Padrões de Prática Odontológica , Condicionamento Ácido do Dente/métodos , Adulto , Fatores Etários , Suscetibilidade à Cárie Dentária , Cimentos Dentários/química , Profilaxia Dentária/métodos , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prática Profissional , Preparo do Dente/métodos , Adulto JovemRESUMO
The photophysical properties of gold nanoparticles, AuNPs, with sizes of 13, 50 and 100 nm in diameter, coated with surface-active ruthenium complexes have been studied to investigate the effect of the distance of the ruthenium luminescent centre from the gold surface. Luminescence lifetimes of the three ruthenium probes, RuS1, RuS6 and RuS12, with different length spacer units between the surface active groups and the ruthenium centre were taken. The metal complexes were attached to AuNP13, AuNP50 and AuNP100 via thiol groups using a method of precoating the nanoparticles with a fluorinated surfactant. The luminescence lifetime of the longer spacer unit complex, RuS12, was enhanced by 70% upon attachment to the AuNP when compared to the increase of the short and medium linker unit complexes, RuS1 (20%) and (RuS6 40%) respectively. The effect of the surfactant in the lifetime increase of the ruthenium coated AuNPs was shown to be larger for the medium spacer probe, RuS6. There was no effect of the change of the size of the AuNPs from 13 to 50 or 100 nm.
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Plant growth-promoting rhizobacterium Bacillus subtilis UD1022 has been shown to trigger an induced systemic response in Arabidopsis thaliana. This interaction causes plant stomata to close, protecting the plant from infection by plant pathogens and thereby increasing crop yield. The purpose of this study was to determine whether UD1022 applied to the roots of plants is able to induce stomata closure in leafy greens as well as influence the persistence of human pathogens (Listeria and Salmonella) on plants. UD1022 induced stomata closure in the presence of human pathogens on both lettuce and spinach 3 h post-inoculation (p<0.0001). Results were confirmed by root inoculation with heat-killed UD1022, which did not induce stomata closure. Presence of UD1022 on lettuce roots significantly reduced the persistence of Listeria on plants after 3 days post-inoculation (p=0.02) but had less of an effect on the persistence of Salmonella. The results of this study indicate that plant growth-promoting rhizobacterium B. subtilis UD1022 may be able to prevent contamination by some human pathogens. This is the first study to investigate the use of plant growth-promoting rhizobacteria to control the persistence of human pathogens on plants.
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Bacillus subtilis/metabolismo , Lactuca/fisiologia , Raízes de Plantas/metabolismo , Estômatos de Plantas/fisiologia , Spinacia oleracea/fisiologia , Contaminação de Alimentos/prevenção & controle , Humanos , Lactuca/microbiologia , Listeria/crescimento & desenvolvimento , Raízes de Plantas/microbiologia , Estômatos de Plantas/microbiologia , Salmonella/crescimento & desenvolvimento , Spinacia oleracea/microbiologiaRESUMO
Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.
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Negro ou Afro-Americano , Armas de Fogo , Fatores de Proteção , Ferimentos por Arma de Fogo , Humanos , Masculino , Negro ou Afro-Americano/estatística & dados numéricos , Fatores de Risco , Ferimentos por Arma de Fogo/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologia , Armas de Fogo/estatística & dados numéricos , Armas de Fogo/legislação & jurisprudência , Estados Unidos/epidemiologia , Violência/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Homicídio/etnologiaRESUMO
BACKGROUND: There is evidence linking use of controlled substances with perpetration of interpersonal violence. While the United States constitution protects the right to own a firearm, federal law prohibits firearm purchase and possession by persons believed to be at high risk for violence, including those who use controlled substances unlawfully. METHODS: We report here the results of a 13-year prospective observational study on the risk of violent crime associated with a history of criminal drug charges in a cohort of 79,678 legal purchasers of handguns in California in 2001. The main outcomes were post-purchase charges for any violent crime, violent Crime Index crimes (murder, rape, robbery, aggravated assault), and firearm-related violent crimes. The main exposure of interest was a history of pre-purchase charge(s) for drug-related offenses; we examined as a secondary exposure a history of marijuana-related charges. We estimated adjusted hazard ratios (aHR) with 95 % confidence intervals (CI) using Cox proportional hazards multiple events models. RESULTS: We found that legal handgun purchasers in California with a history of drug-related charges, even those with marijuana charges only, had triple the risk of a post-purchase violent crime charge compared to purchasers with no criminal charges (drug charges only: aHR=2.9, 95 % CI 2.2-3.8; marijuana charges only: aHR=3.3, 95 % CI 1.8-6.0). In addition, a criminal history of drug charges only vs. no criminal history was associated with increased risk of one or more violent crime charges after the first post-purchase arrest event (aHR=1.6, 95 % CI 1.2-2.3). CONCLUSION: It is incumbent on researchers and policy makers to understand the nature and causes of this risk in order to take effective steps towards mitigation.
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Crime , Armas de Fogo , Violência , Humanos , California/epidemiologia , Violência/estatística & dados numéricos , Masculino , Crime/estatística & dados numéricos , Armas de Fogo/legislação & jurisprudência , Armas de Fogo/estatística & dados numéricos , Feminino , Adulto , Estudos Prospectivos , Adulto Jovem , Adolescente , Pessoa de Meia-IdadeRESUMO
Background: Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments. Methods: The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Results: Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient. Conclusion: It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.
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Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation." Encompassed in this definition are multiple, interrelated forms of violence, including interpersonal firearm death and injury, but also the systems, policies, and practices enacted by those with power to advantage some groups while depriving others of meaningful opportunities for meeting their basic needs-known as "structural violence". Yet dominant violence prevention narratives too often ignore or deemphasize the deeply intertwined threads of structural violence with other forms of violence, leading to policies and practices that are frequently insufficient, and often harmful, for reducing interpersonal firearm violence and building community safety, particularly in minoritized and structurally marginalized communities. We highlight ways in which limited scrutiny of structural violence, the omission of its defining characteristics-power and deprivation-from functional characterizations and frameworks of interpersonal firearm violence, and the inadequate distribution of power and resources to those most impacted by violence to self-determine narratives of and solutions to interpersonal firearm violence grossly impacts how interpersonal firearm violence is collectively conceived, discussed, and addressed. Expanding dominant narratives of interpersonal firearm violence, guided by the wisdom and determination of those most impacted, such that the goal of prevention and intervention efforts is not merely the absence of violence but rather the creation of a community safety and health ecosystem is essential to meet this critical moment in firearm violence research and prevention.
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Ecossistema , Armas de Fogo , Humanos , Estados Unidos , Distribuição por Idade , Distribuição por Sexo , Violência/prevenção & controleRESUMO
The purpose of this study was to examine psychosocial, experiential, and demographic correlates of firearm ownership, carrying, and storage methods. We used a representative survey of 3,510 people living in five US states (Colorado, Minnesota, Mississippi, New Jersey, and Texas) conducted in 2022. Individuals provided information on past experiences with firearms, perceptions of threat and neighborhood safety, discrimination, and tolerance of uncertainty alongside demographic items. The analysis was conducted in November 2022. Past experiences with firearms and prior victimization are associated with increased firearm ownership and carrying practices. Threat sensitivity is associated with owning more guns while poorer perceptions of neighborhood safety correspond with owning fewer guns but greater risk for unsafe storage practices like storing a loaded gun in a closet or drawer. Intolerance of uncertainty is associated with owning fewer guns and lower risk for carrying outside of the home but greater risk for unsafe storage. Prior experience of discrimination is associated with risk for carrying firearms outside of the home. Demographic characteristics related to sex, rurality, military service, and political conservatism predict risky firearm-related behaviors related to firearm ownership, carrying frequency, and unsecure storage. Taken together, we find firearm ownership and risky firearm behaviors (e.g. carrying, unsafe storage) are more prominent among groups such as politically conservative males living in rural areas while also being influenced by threatening experiences, uncertainty, and perceptions of safety.
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OBJECTIVE: To elicit Head Start (HS) families' and employees' perspectives on family experiences with food and nutrition insecurity (FNI) and identify how HS addresses them. METHODS: Four moderated virtual focus groups with 27 HS employee and family participants occurred from August 2021 to January 2022. Qualitative analysis used an iterative inductive/deductive approach. RESULTS: Findings were summarized in a conceptual framework and suggested that HS's current 2-generational approach is useful for families when addressing multilevel factors affecting FNI. The role of the family advocate is essential. In addition to increasing access to nutritious foods, emphasis should also be placed on skills and education to decrease generational unhealthy behaviors. CONCLUSIONS AND IMPLICATIONS: Head Start intervenes in generational cycles of FNI by using the family advocate to add to skills building for 2-generational health. Other programs targeting underserved children can use a similar structure for the greatest impact on FNI.