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1.
BJPsych Open ; 10(4): e130, 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39051453

RESUMEN

BACKGROUND: The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes. AIM: The aim of this paper is to describe the educational evaluation of the National Extension for Community Healthcare Outcomes - Adults with Intellectual and Developmental Disabilities (ECHO-AIDD), a programme for service providers working with adults with IDD during COVID-19. METHOD: The programme consisted of six sessions, conducted weekly, over two cycles. Each session included didactic teaching by hub team members, COVID-19 news updates, wellness check-ins and a brief mindfulness activity, followed by a 30 to 45 min case-based discussion. The hub structure had an inter-professional approach to team expertise. Those with lived experience were an integral part of the content experts' hub. Pre-, post- and follow-up evaluation data were collected. RESULTS: Care providers from health and social care sectors (n = 230) participated in the programme. High levels of engagement and satisfaction were reported. Self-efficacy ratings improved from pre- to post-, and were maintained at 8-week follow-up; improvement from pre- to post- was significant (P < 0.0001). CONCLUSION: Exposure to National ECHO-AIDD educational intervention led to improvement in perceived competencies. This study also shows the valuable role of people with lived experience in fostering adaptive expertise in learners. The outreach and scalability support the feasibility of building a national virtual community of practice for IDD service providers. Future studies should focus on studying the impact of these programmes on the health outcomes of people with IDD.

2.
Int J Equity Health ; 22(1): 259, 2023 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-38087341

RESUMEN

In the last three decades, a cohort of genomicists have intentionally sought to include more racially diverse people in their research in human genomics and precision medicine. How such efforts to be inclusive in human genomic research and precision medicine are modeled and enacted, specifically if the terms of inclusion are equitable for these communities remains to be explored. In this commentary, we review the historical context in which issues of racial inclusion arose with early genome and genetics projects. We then discuss attempts to include racialized peoples in more recent human genomics research. In conclusion, we raise critical issues to consider in the future of equitable human genomics and precision medicine research involving racialized communities, particularly as it concerns working towards what we call Precision Health Equity (PHE). Specifically, we examine issues of genetic data governance and the terms of participation in inclusive human genomics and precision health research. We do so by drawing on insights and protocols developed by researchers investigating Indigenous Data Sovereignty and propose exploring their application and adaptation to precision health research involving racialized communities.


Asunto(s)
Equidad en Salud , Medicina de Precisión , Humanos , Medicina de Precisión/métodos , Grupos Raciales/genética , Predicción , Genómica
3.
Nutr. clín. diet. hosp ; 43(1): 64-72, Mar 23, 2023. tab, graf
Artículo en Español | IBECS | ID: ibc-217974

RESUMEN

Introducción: El retorno a la nueva presencialidad requiere de asumir estilos de vida saludables en los estudiantes, los apoderados de familia deben inculcar la práctica de la actividad física en edades tempranas y regular el tiempo frente a la pantalla de los escolares, para así reducir el sobrepeso y la obesidad. Objetivo: Determinar la asociación entre los estilos de vida con la actividad física, tiempo frente a la pantalla y el índice de masa corporal en adolescentes de 12 a 18 años de la región de Puno en retorno a la presencialidad. Materiales y Métodos: Se realizó un estudio descriptivo correlacional múltiple de corte transversal, que comprendió a 876 adolescentes (451 mujeres y 425 varones) con promedio de edad de 15,26 ± 1,76. El trabajo de campo se realizó de manera presencial aplicando los cuestionarios: estilos de vida, actividad física, tiempo frente a la pantalla y la medición antropométrica del peso corporal y la estatura. Resultados: Los estudiantes presentan estilos de vida medios (53,5%), las mujeres sobresalen en los niveles medio y excelente (28,7%) y (11,6%), frente a los varones (24,9%) y (7,9%). El tiempo frente a la pantalla durante la semana permanecen más horas (45,9%) de 4-5 horas y el (24,9%) de 6-7 horas. Las mujeres tienen tendencia al sobrepeso y la obesidad (31,1%) y (4,9%) en contraste con los varones (19,3%) y (3,7%). Las adolescentes muestran niveles de actividad física baja y moderada (20,5%) y (19,6%), frente a los varones (6,6%) y (29,2%). Conclusiones: Se estableció que los estudiantes en retorno a la presencialidad asumen estilos de vida medianamente satisfactorios, las mujeres muestran tendencia al sobrepeso y la obesidad, en los niveles de actividad física sobresale el nivel moderado y los varones presentan mayor adherencia a la práctica intensa.(AU)


ntroduction: The return to the new presentiality requiresassuming healthy lifestyles in students, family parents shouldinculcate the practice of physical activity at early ages and re-gulate screen time of schoolchildren, in order to reduce over-weight and obesity.Objective: To determine the association between lifestylesand physical activity, screen time and body mass index in ado-lescents aged 12 to 18 years in the Puno region in return topresentiality. Materials and Methods: A descriptive correlational mul-tiple cross-sectional study was carried out, involving 876 ado-lescents (451 females and 425 males) with an average age of15.26 ± 1.76. The field work was carried out in person, appl-ying the following questionnaires: lifestyles, physical activity,time in front of the screen and anthropometric measurementof body weight and height.Results: Students had average lifestyles (53.5%), with fe-males excelling in the average and excellent levels (28.7%)and (11.6%), compared to males (24.9%) and (7.9%). Thetime spent in front of the screen during the week is more(45.9%) 4-5 hours and (24.9%) 6-7 hours. Females have atendency to overweight and obesity (31.1%) and (4.9%) incontrast to males (19.3%) and (3.7%). Adolescent femalesshow low and moderate levels of physical activity (20.5%)and (19.6%) compared to males (6.6%) and (29.2%).Conclusions: It was established that students in return topresentiality assume moderately satisfactory lifestyles, fema-les show tendency to overweight and obesity, in the levels ofphysical activity the moderate level stands out and malesshow greater adherence to intense practice.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Tiempo de Pantalla , Conducta Sedentaria , Actividad Motora , Índice de Masa Corporal , Sobrepeso , Obesidad , Nutrición del Adolescente , Salud del Adolescente , Epidemiología Descriptiva , Estudios Transversales
4.
Artículo en Inglés | MEDLINE | ID: mdl-35742745

RESUMEN

The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization's (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations' citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities' conceptions of health and its determinants beyond the SDH.


Asunto(s)
Determinantes Sociales de la Salud , Factores Sociales , Estado de Salud , Humanos
5.
J Infect Dis ; 219(6): 908-915, 2019 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-30321371

RESUMEN

BACKGROUND: High-risk human papillomavirus (hrHPV) causes cervical cancer. In the United States, approximately 40% of women aged 14-59 years from all racial and ethnic groups are infected with HPV, and prevalence typically declines with age. However, American Indian (AI) women are insufficiently sampled to permit a population-specific estimate of hrHPV prevalence. METHODS: Vaginal swabs were self-collected by 698 AI women aged 21-65 years from a tribal community in the Great Plains. We estimated the population prevalence of hrHPV and identified predominant genotypes. RESULTS: The combined prevalence of hrHPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 was 34.8%. HPV-51 (7.6%), HPV-58 (5.3%), HPV-52 (4.3%), HPV-18 (4.3%), and HPV-16 (3.9%) were most prevalent. hrHPV prevalence declined with age, from 42.2% in women aged 21-24 years to 27.9% in women aged 50-65 years. CONCLUSIONS: HPV-51 was the single most prevalent oncogenic genotype. The combined prevalence of hrHPV among AI women in our sample was high, particularly among women aged 50-65 years, for whom hrHPV prevalence was approximately triple that of other races. Cervical cancer screening efforts should be increased, particularly among women from the community aged 30 years and older.


Asunto(s)
Indígenas Norteamericanos , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Adulto , Anciano , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Medio Oeste de Estados Unidos/epidemiología , Papillomaviridae/genética , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/virología , Prevalencia
6.
Can Fam Physician ; 64(Suppl 2): S44-S50, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29650744

RESUMEN

OBJECTIVE: To provide tips and tools for primary care practitioners carrying out health checks for adult patients with intellectual and developmental disabilities (IDD) and for implementing a systematic program of health checks in a group or team practice. SOURCES OF INFORMATION: The "Primary Care of Adults with Intellectual and Developmental Disabilities. 2018 Canadian Consensus Guidelines" literature review and interdisciplinary input. Experience in implementing health checks in family practices was obtained through the primary care project of H-CARDD (Health Care Access Research and Developmental Disabilities). MAIN MESSAGE: Annual comprehensive health assessments ("health checks") are a recommendation of the 2018 Canadian consensus guidelines for primary care of adults with IDD because of evidence of benefit in this population. Although health checks might require more time to complete for people with IDD than is usual for encounters in primary care, family physicians are in an ideal position to provide this service because of the attributes of family medicine, which include both an orientation to proactive care and the ability to provide continuity of care. Tips and tools are provided for carrying out health checks for adult patients with IDD and for implementing a systematic program of health checks in a group or team practice. CONCLUSION: Health checks can help enhance a family physician's approach to providing care for adults with IDD.


Asunto(s)
Discapacidades del Desarrollo/terapia , Discapacidad Intelectual/terapia , Examen Físico/métodos , Atención Primaria de Salud/métodos , Adulto , Canadá , Femenino , Examen Ginecologíco/métodos , Humanos , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto
7.
J Community Health ; 41(5): 1049-61, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27048284

RESUMEN

We evaluated the feasibility and acceptability of self-sampling for human papillomavirus (HPV) testing and calculated the prevalence of and risk factors for high-risk (hr) HPV infections in a community-based sample of American Indian women. To this end, we recruited 329 Hopi women aged 21-65 years to self-collect vaginal samples for hrHPV testing. Samples were tested by polymerase chain reaction for 14 hrHPV genotypes. We used Chi square tests to identify correlates of preference for clinician Pap testing versus HPV self-sampling, and age-adjusted Poisson regression to evaluate correlates of hrHPV prevalence. We found that satisfaction with HPV self-sampling was high, with 96 % of women reporting that the sample was easy to collect and 87 % reporting no discomfort. The majority (62 %) indicated that they preferred HPV self-sampling to receiving a Pap test from a clinician. Preference for Pap testing over HPV self-sampling was positively associated with adherence to Pap screening and employment outside the home. All samples evaluated were satisfactory for HPV testing, and 22 % were positive for hrHPV. HrHPV prevalence peaked in the late 20 s and declined with increasing age. HrHPV positivity was inversely associated with having children living the household. In conclusion, HPV self-sampling is feasible and acceptable to Hopi women, and could be effective in increasing rates of cervical cancer screening in Hopi communities. HrHPV prevalence was similar to estimates in the general United States population.


Asunto(s)
Indígenas Norteamericanos , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Aceptación de la Atención de Salud , Autocuidado , Manejo de Especímenes , Adulto , Anciano , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/prevención & control , Adulto Joven
8.
J Community Health ; 41(2): 274-81, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26399648

RESUMEN

We evaluated whether delivering educational presentations on human papillomavirus (HPV) to American Indian mothers affected HPV vaccination rates in their adolescent daughters. In March-April 2012, we recruited Hopi mothers or female guardians with daughters aged 9-12 years for a cluster-randomized intervention study on the Hopi Reservation. Participants attended mother-daughter dinners featuring educational presentations for mothers on either HPV (intervention) or juvenile diabetes (control) and completed baseline surveys. Eleven months later, we surveyed mothers on their daughters' HPV vaccine uptake. We also reviewed aggregated immunization reports from the Indian Health Service to assess community-level HPV vaccination coverage from 2007 to 2013. Ninety-seven mother-daughter dyads participated; nine mothers reported that their daughters completed the three-dose HPV vaccination series before recruitment. Among the remaining mothers, 63 % completed the follow-up survey. Adjusting for household income, the proportion of daughters completing vaccination within 11 months post-intervention was similar in the intervention and control groups (32 vs. 28 %, adjusted RR = 1.2, 95 % confidence interval (CI) 0.6-2.3). Among unvaccinated daughters, those whose mothers received HPV education were more likely to initiate vaccination (50 vs. 27 %, adjusted RR = 2.6, 95 % CI 1.4-4.9) and complete three doses (adjusted RR = 4.0, 95 % CI 1.2-13.1) than girls whose mothers received diabetes education. Community-level data showed that 80 % of girls aged 13-17 years and 20 % of girls aged 11-12 completed the vaccination series by 2013. HPV vaccine uptake in Hopi girls aged 13-17 years is significantly higher than the U.S. national average. Brief educational presentations on HPV delivered to American Indian mothers might increase HPV vaccination rates in daughters aged 9-12 years.


Asunto(s)
Educación en Salud , Esquemas de Inmunización , Indígenas Norteamericanos , Relaciones Madre-Hijo , Vacunas contra Papillomavirus , Adulto , Niño , Análisis por Conglomerados , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
9.
J Immigr Minor Health ; 14(6): 975-82, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22402926

RESUMEN

American Indians have one of the lowest colorectal cancer (CRC) screening rates for any racial/ethnic group in the U.S., yet reasons for their low screening participation are poorly understood. We examine whether tribal language use is associated with knowledge and use of CRC screening in a community-based sample of American Indians. Using logistic regression to estimate the association between tribal language use and CRC test knowledge and receipt we found participants speaking primarily English were no more aware of CRC screening tests than those speaking primarily a tribal language (OR = 1.16 [0.29, 4.63]). Participants who spoke only a tribal language at home (OR = 1.09 [0.30, 4.00]) and those who spoke both a tribal language and English (OR = 1.74 [0.62, 4.88]) also showed comparable odds of receipt of CRC screening. Study findings failed to support the concept that use of a tribal language is a barrier to CRC screening among American Indians.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , Lenguaje , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Arizona/epidemiología , Colonoscopía/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos
10.
Ethn Dis ; 20(4): 458-62, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21305837

RESUMEN

OBJECTIVE: Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-prevention research. We investigate associations between perceived cancer risk and selected cancer risk factors in a population-based sample of American Indians. STUDY DESIGN AND POPULATION: Data for this cross-sectional study come from a random sample of 182 American Indian adults, aged > or = 40 years, residing on the Hopi Reservation in northeastern Arizona. OUTCOME MEASURES: Perception of cancer risk was ascertained with the 5-point Likert scale question, "How likely do you think it is that you will develop cancer in the future?" dichotomized into low perceived risk and high perceived risk. RESULTS: Participants reporting a family member with cancer were more likely, by greater than five times, to report the perception that they would get cancer (OR = 5.3; 95% CI: 2.3, 12.3). After controlling for age and family history of cancer, knowledge of cancer risk factors and attitude about cancer prevention were not significantly associated with risk perception. CONCLUSIONS: Perceived cancer risk was significantly associated with self-reported family history of cancer, supporting the importance of personal knowledge of cancer among American Indians. Further research is needed to obtain a more complete picture of the factors associated with perceptions of cancer risk among American Indians in order to develop effective interventions.


Asunto(s)
Indígenas Norteamericanos/estadística & datos numéricos , Neoplasias/etnología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo
12.
Arthritis Rheum ; 58(11): 3309-18, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18975322

RESUMEN

OBJECTIVE: Spleen tyrosine kinase (Syk) has been identified as an important modulator of immune signaling in B cells and cells bearing Fcgamma-activating receptors. R788, a prodrug of active metabolite R406, has been shown to be an inhibitor of Syk kinase, active in a variety of in vitro and in vivo models, suggesting potential activity in the treatment of rheumatoid arthritis (RA). METHODS: We enrolled 189 patients with active RA despite methotrexate therapy in a 3-month, multicenter, ascending-dose, double-blind, placebo-controlled trial. The primary end point was the American College of Rheumatology 20% improvement criteria (ACR20) response rate at week 12. RESULTS: Twice-daily oral doses of 100 mg and 150 mg of R788 were significantly superior to placebo or twice-daily oral doses of 50 mg at week 12 (ACR20 achieved in 65% and 72% versus 38% and 32% of patients, respectively [P < 0.01]). ACR50 (achieved in 49% and 57% versus 19% and 17% of patients, respectively) and ACR70 (achieved in 33% and 40% versus 4% and 2% of patients, respectively) scores showed a similar pattern. Clinical effect was noted as early as 1 week after initiation of therapy. Reductions in serum interleukin-6 and matrix metalloproteinase 3 levels also occurred as early as week 1 in the groups receiving 100 mg and 150 mg R788. The major adverse effects were gastrointestinal side effects (predominantly diarrhea) and neutropenia (<1,500/mm3), both of which were dose related. CONCLUSION: These results indicate that an inhibitor of Syk kinase produces significant clinical benefits at 12 weeks in a population of patients with active RA receiving methotrexate therapy. Syk kinase may be an important new therapeutic target in RA and related autoimmune conditions.


Asunto(s)
Artritis Reumatoide/tratamiento farmacológico , Péptidos y Proteínas de Señalización Intracelular/antagonistas & inhibidores , Oxazinas/uso terapéutico , Profármacos/uso terapéutico , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Piridinas/uso terapéutico , Administración Oral , Adulto , Anciano , Aminopiridinas , Método Doble Ciego , Humanos , Interleucina-6/sangre , Masculino , Metaloproteinasa 3 de la Matriz/sangre , Metotrexato/uso terapéutico , Persona de Mediana Edad , Morfolinas , Oxazinas/administración & dosificación , Oxazinas/efectos adversos , Profármacos/administración & dosificación , Profármacos/efectos adversos , Piridinas/administración & dosificación , Piridinas/efectos adversos , Pirimidinas , Quinasa Syk
13.
Public Hist ; 29(3): 53-67, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-18175451

RESUMEN

Although research on the history of the eugenics movement in the United States is legion, its impact on state policies that identified and defined American Indians has yet to be fully addressed. The exhibit, Our Lives: Comtemporary Life and Identities (ongoing until September 21, 2014) at the National Museum of the American Indian provides a provocative vehicle for examining how eugenics-informed public policy during the first quarter of the twentieth century served to "remove" from official records Native peoples throughout the Southeast. One century after Indian Removal of the antebellum era, Native peoples in the American Southeast provide an important but often overlooked example of how racial policies, this time rooted in eugenics, effected a documentary erasure of Native peoples and communities.


Asunto(s)
Eugenesia/historia , Exposiciones como Asunto , Indígenas Norteamericanos/historia , Historia del Siglo XX , Humanos , Sudeste de Estados Unidos
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