RESUMEN
OBJECTIVES: The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area. METHODS: A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and 'all others' (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap. RESULTS: The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments. CONCLUSIONS: Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes.
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Traumatismos en Atletas , Paratletas , Deportes para Personas con Discapacidad , Humanos , Incidencia , Traumatismos en Atletas/epidemiología , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Londres/epidemiología , Persona de Mediana Edad , Brasil/epidemiología , NiñoRESUMEN
To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults.
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Evaluación Geriátrica/estadística & datos numéricos , Mortalidad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Causas de Muerte , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia en Salud Pública , Factores de Riesgo , Factores SocioeconómicosRESUMEN
The parasite Leishmania siamensis is a zoonotic agent of leishmaniasis; infection in animals has been documented in Europe and the United States. Reported authochthonous human infections have been limited to Thailand. We report a case of human visceral Leishmania siamensis infection acquired in Guyana, suggesting colonization in South America.
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Leishmania/clasificación , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/parasitología , Anciano , Anfotericina B/uso terapéutico , Antiprotozoarios/uso terapéutico , ADN Intergénico/genética , ADN Protozoario/genética , Femenino , Guyana/epidemiología , Humanos , Leishmania/genética , Leishmaniasis Visceral/tratamiento farmacológico , Londres/epidemiología , Polimorfismo de Longitud del Fragmento de Restricción , ViajeRESUMEN
Objective: To investigate the unique contribution of narcissism and impulsivity, in addition to callous-unemotional (CU) traits, in explaining concurrent prosocial and antisocial behavior. Method: Two hundred and forty-nine schoolchildren (53% female; age 9-12 years) completed the self-report Strengths and Difficulties Questionnaire (SDQ) and the Antisocial Process Screening Device (APSD). Two statistical models were tested, predicting conduct problems (CP) and prosocial behavior (PB). In the first one, CU traits and gender were entered into the equation. The second model added narcissism and impulsivity. Results: Gender, narcissism and impulsivity, but not CU, were statistically significant predictors of CP in the second model (F3,226 = 45.07, p < 0.001, R2 = 43.7%; betas: gender = -0.20, narcissism = 0.29, impulsivity = 0.36, CU = 0.06). PB was significantly predicted by all domains except gender (F3,226 = 42.57, p < 0.001, R2 = 42.4%; betas: gender = 0.08, narcissism = -0.16, impulsivity = -0.23, CU = -0.41). Conclusion: Our results confirmed that CU traits refer to a distinct manifestation of psychopathy in youth, but we also found that narcissism and impulsivity are equally important when predicting CP. Previous reports of sex differences on APSD and SDQ domains were also corroborated.
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Humanos , Masculino , Femenino , Niño , Trastornos de la Conducta Infantil/psicología , Encuestas Epidemiológicas , Trastorno de la Conducta/psicología , Trastorno de Personalidad Antisocial/psicología , Factores Sexuales , Conducta Impulsiva , Londres/epidemiología , Narcisismo , Trastorno de Personalidad Antisocial/epidemiologíaRESUMEN
OBJECTIVE:: To investigate the unique contribution of narcissism and impulsivity, in addition to callous-unemotional (CU) traits, in explaining concurrent prosocial and antisocial behavior. METHOD:: Two hundred and forty-nine schoolchildren (53% female; age 9-12 years) completed the self-report Strengths and Difficulties Questionnaire (SDQ) and the Antisocial Process Screening Device (APSD). Two statistical models were tested, predicting conduct problems (CP) and prosocial behavior (PB). In the first one, CU traits and gender were entered into the equation. The second model added narcissism and impulsivity. RESULTS:: Gender, narcissism and impulsivity, but not CU, were statistically significant predictors of CP in the second model (F3,226 = 45.07, p < 0.001, R2 = 43.7%; betas: gender = -0.20, narcissism = 0.29, impulsivity = 0.36, CU = 0.06). PB was significantly predicted by all domains except gender (F3,226 = 42.57, p < 0.001, R2 = 42.4%; betas: gender = 0.08, narcissism = -0.16, impulsivity = -0.23, CU = -0.41). CONCLUSION:: Our results confirmed that CU traits refer to a distinct manifestation of psychopathy in youth, but we also found that narcissism and impulsivity are equally important when predicting CP. Previous reports of sex differences on APSD and SDQ domains were also corroborated.
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Trastorno de Personalidad Antisocial/psicología , Trastornos de la Conducta Infantil/psicología , Trastorno de la Conducta/psicología , Encuestas Epidemiológicas , Trastorno de Personalidad Antisocial/epidemiología , Niño , Femenino , Humanos , Conducta Impulsiva , Londres/epidemiología , Masculino , Narcisismo , Factores SexualesRESUMEN
BACKGROUND: Musculoskeletal complaints are frequently diagnosed in Paralympic athletes. Despite the increased professionalism in Paralympic Sports, the documentation of injuries and other health complaints during high-level competition is sparse. With respect to the upcoming Paralympic Summer Games in Rio de Janeiro, the aim of this study was the analysis of all musculoskeletal complaints within the German Paralympic Athletes during the London 2012 Paralympic Games. METHODS: All musculoskeletal complaints (MSC) of the 150 German athletes seeking medical attention, hereby defined as "injury", were recorded during the in-competition period of the London Paralympics Games (22 days), regardless of their severity and consequences. Standardized documentation included the onset of symptoms, the medical diagnoses, the therapeutic measures taken as well as consecutive restrictions in training and competition. Incidence rates and localizations were analyzed by sports discipline. RESULTS: A total of 201 musculoskeletal complaints were recorded for 140 athletes (93.3%), corresponding to 1.4 musculoskeletal complaints per "injured" athlete. The incidence of musculoskeletal complaints in German athletes was 62.9±15.4/1000 athlete-days. High incidence rates (IR) were observed in wheelchair basketball (IR 72/1000 athlete-days, 1.6 injuries per athlete) and equestrian events (IR 72.7, 1.6). Musculoskeletal complaints were mainly located in the upper extremities (37.6%) and the spine (37.6%). The most frequent diagnoses were myalgia (N.=105, 52%). CONCLUSIONS: We noted a high rate of musculoskeletal complaints among German Paralympic athletes across sports and body parts, highlighting the need for prevention programs that focus on the upper extremities and spine.
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Traumatismos en Atletas/epidemiología , Músculo Esquelético/lesiones , Sistema Musculoesquelético/lesiones , Deportes para Personas con Discapacidad/estadística & datos numéricos , Adulto , Baloncesto/lesiones , Brasil , Femenino , Alemania/etnología , Humanos , Incidencia , Londres/epidemiología , Masculino , Persona de Mediana Edad , Silla de RuedasRESUMEN
Os gastos com medicamentos correspondem a uma grande parcela do orçamento em saúde. Sendo assim, a produção de conhecimento sobre o uso desses recursos é essencial na tomada de decisão em saúde pública e melhoria da assistência farmacêutica. Este estudo teve como objetivo analisar o processo de endividamento em um hospital universitário de alta complexidade devido ao gasto crescente com a aquisição de mesilato de imatinibe. Por meio de análise documental e registros no Sistema de Informações Hospitalares (SIH) entre 2002 e 2010, realizou-se um estudo descritivo. A partir do caminho da incorporação do medicamento, foram mapeadas as estratégias da indústria farmacêutica e do governo, assim como as respostas governamentais de redução do preço. A sistematização e publicação de informações guardadas em arquivos e na memória podem contribuir para o acompanhamento dos resultados dos programas mantidos pelo Ministério da Saúde.
Medicine expenditures consume a large share of the health budget, so knowledge on the use of these funds is essential for decision-making in public health and improvement of pharmaceutical care. This study analyzed the indebtedness of a high-complexity university hospital due to increased spending on imatinib mesylate. The descriptive study was based on analysis of documents and records in the Hospital Information System (SIH) from 2002 to 2010. Starting with inclusion of the medicine in the budget, the study mapped strategies by the pharmaceutical industry and government, as well as government responses to reduce the product's price. The systematization and publication of information stored in files and electronic databases can help monitor the results of programs funded by the Brazilian Ministry of Health.
Los gastos en medicamentos representan una gran proporción del presupuesto de salud, por lo que la producción de conocimiento sobre el uso de estos recursos es esencial en la toma de decisiones en salud pública y la mejora de la atención farmacéutica. Este estudio tuvo como objetivo analizar el proceso de endeudamiento en un hospital universitario de alta complejidad, debido al aumento de los gastos en la adquisición de mesilato de imatinib. A través del análisis de los documentos y registros en el Sistema de Información Hospitalaria (SIH) entre 2002 y 2010, se realizó un estudio descriptivo. A partir de la incorporación del medicamento, se mapearon las estrategias de la industria farmacéutica y del gobierno, así como las respuestas del gobierno para reducir el precio. La sistematización y publicación de la información almacenada en los archivos y su memoria puede contribuir para el seguimiento de los resultados de los programas mantenidos por el Ministerio de Salud.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glucemia/metabolismo , Insulina/metabolismo , Estado Prediabético , Medición de Riesgo/métodos , Biomarcadores/metabolismo , /diagnóstico , /epidemiología , /etiología , /metabolismo , Ayuno , Prueba de Tolerancia a la Glucosa , Homeostasis , Resistencia a la Insulina/fisiología , Células Secretoras de Insulina/metabolismo , Modelos Lineales , Londres/epidemiología , Tamizaje Masivo , Estudios Prospectivos , Estado Prediabético/complicaciones , Estado Prediabético/epidemiología , Estado Prediabético/metabolismo , Factores de Riesgo , Factores de TiempoRESUMEN
INTRODUCTION: The presence of American cutaneous leishmaniasis (ACL) in the communities of the Campus FIOCRUZ Mata Atlântica (CFMA) in the City of Rio de Janeiro initiated the investigation of the Phlebotominae fauna in the Atlantic Forest to determine the occurrence of putative ACL vectors associated with the enzootic cycle. METHODS: For 24 consecutive months, sand flies were captured inside the forest and in the border area near the communities. RESULTS: The following sand fly species were identified: Brumptomyia brumpti, Brumptomyia cunhai, Brumptomyia nitzulescui, Lutzomyia edwardsi, Lutzomyia pelloni, and Lutzomyia quinquefer. Other identified sand fly vectors, such as Lutzomyia intermedia (the predominant species), Lutzomyia migonei, Lutzomyia whitmani, Lutzomyia fischeri, and Lutzomyia hirsuta hirsuta, are associated with ACL transmission, and the vector for American visceral leishmaniases (AVL), Lutzomyia longipalpis, was also found. CONCLUSIONS: All sand fly vectors were found in both studied environments except for Lutzomyia whitmani, which was only identified in the forest. This study represents the first identification of Lutzomyia longipalpis in the CFMA, and the epidemiological implications are discussed. .
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Cardiovasculares/psicología , Trastornos del Conocimiento/etiología , Enfermedades Cardiovasculares/epidemiología , Trastornos del Conocimiento/epidemiología , Londres/epidemiología , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
Background: It is important to determine the relative importance of urinary incontinence in terms of its prevalence and how it affects the quality of life of women. Aim: To characterize urinary incontinence and factors associated with it in women aged over 30 years. Material and Methods: A survey about urinary incontinence and associated factors was answered by 289 women aged 30 to 81 years, attending a public primary care clinic. Results: The prevalence of urinary incontinence was 62.2%, and it was significantly associated with obesity, diabetes and a history of episiotomy. Conclusions: The high prevalence of urinary incontinence should prompt the implementation of public health measures to prevent and treat it effectively.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angina de Pecho/etnología , Pueblo Asiatico , Población Blanca , Estudios de Cohortes , Estudios de Seguimiento , Incidencia , Londres/epidemiología , Pronóstico , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
BACKGROUND: The number of malignancies increased alarmingly. Surgery constitutes one of the most efficient therapeutic modalities for the treatment of solid tumors. The neoplastic implant in surgical wound is a complication whose percentage of occurrence reported in the literature is variable, but sets with high morbidity and therapeutic difficulties. Protecting the wound is one of the recommended principles of oncologic surgery. AIM: To evaluate the influence of wound protection in the development of tumor implantation. METHODS: Sarcoma 180 tumor cells were used, with intraperitoneal inoculation in Swiss mice. After the establishment of neoplastic ascites, animals were randomized into two groups of 10, each group consisting of five males and five females. In both groups, laparotomy and manipulation of intra-abdominal organs was performed. In a group laparotomy was performed using the protection of the abdominal wound and the other group without it. On the 9th postoperative day macroscopic evaluation of the operative scar was performed, which was later removed for microscopic evaluation. RESULTS: There was microscopic infiltration of tumor cells in the wound of all animals. However, the group that held the protection, infiltration was less intense when compared to the group without it. The infiltration was also more severe in females than in males of the same group. CONCLUSION: Tumor infiltration into the wound was more intense in the group in which the protection of the surgical site was not performed, and in females when compared to males of the same group. .
RACIONAL: O número de neoplasias vem aumentando de maneira preocupante. O tratamento cirúrgico constitui-se em uma das modalidades terapêuticas mais eficientes para os tumores sólidos. O implante neoplásico em ferida operatória é complicação cujo percentual de ocorrência relatado na literatura é variável, porém configura alta morbidade e grande dificuldade terapêutica. A proteção da ferida operatória é um dos princípios de cirurgia oncológica recomendados, entretanto pouco estudado. OBJETIVO: Avaliar a influência da proteção de ferida operatória no desenvolvimento de implante tumoral na ferida operatória. MÉTODOS: Foram utilizadas linhagens de células tumorais do Sarcoma 180, com inoculação intraperitoneal em camundongos Swiss. Após o estabelecimento da ascite neoplásica, os animais foram randomizados em dois grupos de 10, cada grupo composto por cinco machos e cinco fêmeas. Nos dois grupos foi realizada laparotomia e manipulação de órgãos intra-abdominais. Em um grupo a laparotomia foi realizada utilizando a proteção da ferida abdominal e no outro grupo sem proteção. No 9º dia pós-operatório foi realizada avaliação macroscópica da cicatriz operatória, sendo esta removida posteriormente para avaliação microscópica. RESULTADOS: Houve infiltração microscópica de células tumorais na ferida operatória em todos animais. Porém, no grupo em que se realizou a proteção da ferida a infiltração foi menos intensa quando comparado ao grupo sem proteção. A infiltração também foi mais intensa nas fêmeas do que nos machos do mesmo grupo. CONCLUSÃO: A infiltração tumoral na ferida operatória foi mais intensa no grupo em que não foi realizada a proteção da ferida operatória e nas fêmeas quando comparadas aos machos do mesmo grupo. .
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Humanos , Masculino , Neoplasias Pancreáticas/mortalidad , Factores de Edad , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , /epidemiología , Londres/epidemiología , Actividad Motora , Distribución de Poisson , Factores de Riesgo , Fumar/epidemiología , Clase SocialRESUMEN
OBJECTIVE: Iron deficiency (ID) and iron deficiency anaemia (IDA) are global major public health problems, particularly in developing countries. Whilst an association between H. pylori infection and ID/IDA has been proposed in the literature, currently there is no consensus. We studied the effects of H. pylori infection on ID/IDA in a cohort of children undergoing upper gastrointestinal endoscopy for upper abdominal pain in two developing and one developed country. METHODS: In total 311 children (mean age 10.7±3.2 years) from Latin America--Belo Horizonte/Brazil (nâ=â125), Santiago/Chile (nâ=â105)--and London/UK (nâ=â81), were studied. Gastric and duodenal biopsies were obtained for evaluation of histology and H. pylori status and blood samples for parameters of ID/IDA. RESULTS: The prevalence of H. pylori infection was 27.7% being significantly higher (p<0.001) in Latin America (35%) than in UK (7%). Multiple linear regression models revealed H. pylori infection as a significant predictor of low ferritin and haemoglobin concentrations in children from Latin-America. A negative correlation was observed between MCV (râ=â-0.26; pâ=â0.01) and MCH (râ=â-0.27; pâ=â0.01) values and the degree of antral chronic inflammation, and between MCH and the degree of corpus chronic (râ=â-0.29, pâ=â0.008) and active (râ=â-0.27, pâ=â0.002) inflammation. CONCLUSIONS: This study demonstrates that H. pylori infection in children influences the serum ferritin and haemoglobin concentrations, markers of early depletion of iron stores and anaemia respectively.
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Dolor Abdominal/sangre , Anemia Ferropénica/sangre , Ferritinas/metabolismo , Infecciones por Helicobacter/sangre , Hemoglobinas/metabolismo , Hierro/sangre , Dolor Abdominal/complicaciones , Dolor Abdominal/microbiología , Dolor Abdominal/patología , Adolescente , Anemia Ferropénica/complicaciones , Anemia Ferropénica/microbiología , Anemia Ferropénica/patología , Biopsia , Brasil/epidemiología , Niño , Chile/epidemiología , Duodenoscopía , Duodeno/metabolismo , Duodeno/microbiología , Duodeno/patología , Femenino , Mucosa Gástrica/metabolismo , Gastroscopía , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Helicobacter pylori/metabolismo , Humanos , Londres/epidemiología , Masculino , Prevalencia , Estómago/microbiología , Estómago/patologíaRESUMEN
INTRODUCTION: It has been shown that following laparoscopic adjustable gastric banding (LAGB) procedures, Afro-Caribbeans achieve poorer weight loss compared with Caucasians. The reasons for this are multifactorial. However, studies have been based on mainly female patients from the US and none to date have been from the UK. Furthermore, South Asians have not previously been compared. The aim of this study was to compare excess weight loss percentage (%EWL) outcomes up to five years following LAGB in Afro-Caribbean, Caucasian and South Asian females in a London-based teaching hospital. METHODS: An analysis was carried out of prospectively collected data of female patients aged ≥16 years of Afro-Caribbean, Caucasian or South Asian origin who underwent LAGB between October 2000 and December 2011. Data included demographics, co-morbidities and anthropometrics. RESULTS: Overall, 596 females underwent LAGB; 316 Caucasians (53.0%), 64 Afro-Caribbeans (10.8%) and 27 South Asians (4.5%) formed the majority of those who disclosed ethnicities. Age and initial body mass index (BMI) were comparable between Afro-Caribbeans and Caucasians (mean BMI: 47.3kg/m²[standard deviation [SD]: 7.5kg/m², range: 37.0-78.3kg/m²] vs 45.8kg/m²[SD: 7.1kg/m², range: 24.7-79.8kg/m²], p=0.225). A non-significant trend suggested less %EWL in Afro-Caribbeans than in Caucasians at 6 months, and at 1, 2, 3, 4 and 5 years (21.4% vs 24.4%, p=0.26; 27.4% vs 31.3%, p=0.27; 33.0% vs 36.8%, p=0.15; 39.0% vs 45.8%, p=0.14; 34.2% vs 45.3%, p=0.16; 37.1% vs 47.6%, p=0.67). South Asians and Caucasians had a similar age and preoperative BMI (mean BMI: 43.6kg/m² [range: 32.5-59.1kg/m²] vs 45.8kg/m² [range: 24.7-79.8kg/m²], p=0.08). The %EWL was greatest at three and four years among South Asians although numbers were small (n=4 and n=3 respectively). CONCLUSIONS: A non-significant trend suggests poorer weight loss outcomes in Afro-Caribbeans compared with Caucasians in our cohort. Discussion of realistic weight loss outcomes as well as enhanced follow-up and dietary modifications are required for Afro-Caribbean patients. Low numbers prevent definitive conclusions regarding South Asians. Multicentre studies across England are required to better define any differences between ethnicities.
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Gastroplastia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Pérdida de Peso/etnología , Adulto , Anciano , Asia Occidental/etnología , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Londres/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Indias Occidentales/etnología , Población Blanca/etnologíaRESUMEN
BACKGROUND AND AIMS: Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London. METHODS: Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics. RESULTS: At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings. CONCLUSIONS: In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register.
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Actividades Cotidianas , Evaluación de Resultado en la Atención de Salud , Accidente Cerebrovascular/mortalidad , Anciano , Anciano de 80 o más Años , Barbados/epidemiología , Femenino , Humanos , Modelos Logísticos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores SocioeconómicosRESUMEN
How do people respond to the news that they are HIV positive? To date, there have been few published qualitative studies of HIV diagnosis experiences, and none focusing on Caribbean people. Twenty-five HIV-positive Caribbean people in London, UK, related their diagnosis experience and its immediate aftermath in semi-structured interviews. Diagnosis with HIV caused profound shock and distress to participants, as they associated the disease with immediate death and stigmatisation. The respondents struggled with "biographical disruption", the radical disjuncture between life before and after diagnosis, which led them into a state of liminality, as they found themselves "betwixt and between" established structural and social identities. Respondents were faced with multifaceted loss: of their known self, their present life, their envisioned future and the partner they had expected to play a role in each of these. A minority of accounts suggest that the way in which healthcare practitioners delivered the diagnosis intensified the participants' distress. This research suggests that healthcare practitioners should educate patients in specific aspects of HIV transmission and treatment, and engage closely with them in order to understand their needs and potential reactions to a positive diagnosis.
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Seropositividad para VIH/diagnóstico , Seropositividad para VIH/psicología , Educación del Paciente como Asunto , Estrés Fisiológico , Adaptación Psicológica , Actitud del Personal de Salud , Región del Caribe/etnología , Femenino , Seropositividad para VIH/etnología , Humanos , Londres/epidemiología , Masculino , Aceptación de la Atención de Salud , Conducta Sexual/etnología , Revelación de la VerdadRESUMEN
BACKGROUND: To compare health care utilisation between stroke patients living in a middle-income country with similar patients in a high-income country in terms of the type and amount of health care received following a stroke. METHODS: Data were collected from the population-based South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS) from January 2001 to December 2004. Differences in management and diagnostic procedures used in the acute phase were adjusted for age, sex, ethnic group, living conditions pre-stroke and socio-economic status by multivariable logistic regression. Comparison of subsequent management was made for 3 months and 1 year post-stroke. RESULTS: Patients in BROS were less likely to be admitted to a hospital ward (OR 0.22; 95% CI 0.13-0.37), but the difference for the lower use of brain scans in BROS was smaller (OR 0.62; 95% CI 0.25-1.52). Additional adjustment for stroke severity (Glasgow Coma Score) showed that BROS patients were more likely to have a swallow test on admission (OR 2.95; 95% CI 1.17-7.45). BROS patients were less likely to be in nursing care at 3 months (OR 0.37; 95% CI 0.17-0.81), and less likely to be receiving speech and language therapy at 3 months (OR 0.10; 95% CI 0.03-0.33) and 1 year (OR 0.05; 95% CI 0.00-0.55). CONCLUSIONS: The lower use of hospital admission and nursing care at 3 months suggests that in Barbados, family and friends take greater responsibility for patient care around the time of the stroke and in the medium term thereafter.
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Servicios Médicos de Urgencia/estadística & datos numéricos , Cuidados a Largo Plazo/estadística & datos numéricos , Sistema de Registros , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Barbados/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Accidente Cerebrovascular/epidemiología , Rehabilitación de Accidente CerebrovascularRESUMEN
BACKGROUND AND PURPOSE: Risk of stroke is higher in black Caribbeans in the United Kingdom compared with black Caribbeans in their country of origin. We investigated if these differences were caused by variations in prior-to-stroke risk factors. SUMMARY OF REPORT: Data were collected from the South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS). Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions prestroke, stroke subtype, and socioeconomic status by multivariable logistic regression. Patients in BROS were on average older (mean difference 4 years) and more likely to have a nonmanual occupation. They were less likely to have a prestroke diagnosis of myocardial infarction (OR, 0.39; 95% CI, 0.19 to 0.77) or diabetes (OR, 0.65; 95% CI, 0.46 to 0.92) and were less likely to report smoking (OR, 0.31; 95% CI, 0.19 to 0.49). They were also more likely to receive appropriate prestroke antihypertensive (OR, 1.88; 95% CI, 1.21 to 2.92) and antidiabetic treatment (OR, 3.33; 95% CI, 1.44 to 7.70) and less likely to receive cholesterol-lowering drugs (OR, 0.19; 95% CI, 0.05 to 0.71). CONCLUSIONS: The higher risk of stroke in black Caribbeans in the United Kingdom might be caused by a higher prevalence of major prior-to-stroke risk factors, differences in treatment patterns for comorbid conditions, and less healthy lifestyle practices compared with indigenous black Caribbean populations.
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Población Negra/estadística & datos numéricos , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Barbados/epidemiología , Femenino , Escala de Coma de Glasgow , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Población , Sistema de Registros , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/patologíaRESUMEN
BACKGROUND: Consistent observation of raised rates of psychoses among Black and minority ethnic (BME) groups may possibly be explained by their lower socio-economic status. AIMS: To test whether risk for psychoses remained elevated in BME populations compared with the White British, after adjustment for age, gender and current socio-economic status. METHOD: Population-based study of first-episode DSM-IV psychotic disorders, in individuals aged 18-64 years, in East London over 2 years. RESULTS: All BME groups had elevated rates of a psychotic disorder after adjustment for age, gender and socio-economic status. For schizophrenia, risk was elevated for people of Black Caribbean (incidence rate ratios (IRR)=3.1, 95% CI 2.1-4.5) and Black African (IRR=2.6, 95% CI 1.8-3.8) origin, and for Pakistani (IRR=3.1, 95% CI 1.2-8.1) and Bangladeshi (IRR=2.3, 95% CI 1.1-4.7) women. Mixed White and Black Caribbean (IRR=7.7, 95% CI 3.2-18.8) and White Other (IRR=2.1, 95% CI 1.2-3.8) groups had elevated rates of affective psychoses (and other non-affective psychoses). CONCLUSIONS: Elevated rates of psychoses in BME groups could not be explained by socio-economic status, even though current socio-economic status may have overestimated the effect of this confounder given potential misclassification as a result of downward social drift in the prodromal phase of psychosis. Our findings extended to all BME groups and psychotic disorders, though heterogeneity remains.
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Trastornos Psicóticos/epidemiología , Medio Social , Adolescente , Adulto , África/etnología , Asia/etnología , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/etnología , Factores de Riesgo , Factores Socioeconómicos , Indias Occidentales/etnologíaRESUMEN
OBJECTIVE: To determine the delivery mode preferred by pregnant women with 1 previous cesarean delivery and to investigate the relationship between preferred and actual mode of delivery. METHOD: We reviewed the records of 215 women who were delivered in a London hospital with a history of 1 cesarean delivery. Women who planned an elective repeat cesarean section (ERCS) were compared with those who planned a vaginal birth after cesarean (VBAC). RESULTS: Although 55.3% chose VBAC overall, only 37.8% of those who chose it were delivered by it, whereas 94.8% of those who chose ERCS were delivered by ERCS. Nonwhite women were more likely to choose VBAC than white women (odds ratio, 3.5; 95% confidence interval, 1.9-6.1) but less likely to be deliver by it (odds ratio, 0.31; 95% confidence interval, 0.14-0.68). CONCLUSION: In this study, VBAC was the method of delivery preferred by most women. Nonwhite women were more likely to choose VBAC over ERCS but less likely to be delivered by VBAC.