RESUMO

OBJECTIVES: Indigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among indigenous and non-indigenous populations at national and sub-national levels in Mexico. METHODS: We obtained data from the Ministry of Health, Mexico, on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000 person-weeks, mortality rate ratio (RR) among indigenous vs. non-indigenous groups, and hazard ratio (HR) for COVID-19 deaths across four waves of the pandemic, from February 2020 to March 2022. We also assessed differences in the reproduction number (Rt). RESULTS: The mortality rate among indigenous populations of Mexico was 68% higher than that of non-indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among indigenous groups (P < 0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the Rt among the two groups was comparable. CONCLUSION: Indigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks), and COVID-19 vaccination interventions among indigenous and non-indigenous populations in Mexico.

Assuntos

RESUMO

BACKGROUND: We examined the prevalence of and relationships between violence victimization and negative health correlates of Haitian youth exposed to the 2010 earthquake. METHODS: Participants were randomly selected 13-24 year-old youth (1457 females; 1459 males) living in Haiti following the 2010 earthquake. Data collected via Haiti's 2012 Violence against Children Survey (VACS) were analyzed. RESULTS: Participants reported violence victimization in the past 12 months (females: 49.93%; males: 41.68%), moderate-to-severe mental distress (females: 76.56%; males: 66.41%), and suicidal ideation (females: 26.79%; males: 8.05%). Compared to participants without experiences of violence, victims of violence had significantly higher mean number of sexual partners (females: 1.99, 95% CI: 1.81-2.16, p = .02; males: 4.33, 95% CI: 3.50-5.16, p = .03), mental distress (females: 80.39%, p = .01; males: 72.95%, p = .002), and suicidal ideation (females: 36.09%, p < .0001; males: 12.02%, p < .0001). Male victims of violence were more likely to have sex without a condom (26.02%, p = .01) and female victims of violence were more likely to report histories of STIs (28.04%, p = .01), when compared to participants without history of violence. LIMITATIONS: Data were collected via self-report. Disaster exposure experiences were not assessed. Analysis was correlational and did not control for potential confounding variables. CONCLUSIONS: Disaster-exposed youth endorsed high levels of violence victimization and negative health correlates. Earthquake survivors who experienced violence were more likely to report negative health correlates. Greater attention to downstream sequelae of natural disasters is needed.

Assuntos

RESUMO

Child maltreatment is a significant public health problem best addressed through evidence-based parent-support programs. There is a wide range of programs with different strengths offering a variety of options for families. Choosing one single evidence-based program often limits the range of services available to meet the unique needs of families. This paper presents findings from a study to examine the systematic braiding of two evidence-based programs, Parents as Teachers and SafeCare at Home (PATSCH), with the goal to provide a more robust intervention for higher risk families. A cluster randomized effectiveness trial was conducted to examine if PATSCH improved parenting behaviors known to decrease the risk for child maltreatment compared to Parents as Teachers (PAT) Alone. Parents (N= 159; 92 PAT Alone; 67 PATSCH) were enrolled to complete a baseline, 6-month and 12-month assessment. Results indicate the groups did not differ on number of environmental hazards in the home, parents' health care decision-making abilities, child abuse potential, and physical assault over time. However, with regard to the potential for child abuse, the PATSCH group showed a decrease in nonviolence discipline and increase in psychological aggression compared to the PAT group. Further research is needed to better examine this concept and its implications for the field.

Assuntos

RESUMO

BACKGROUND: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools. METHODS: The initiative utilized a learning collaborative approach and the Model for Improvement to promote best practice about developmental screening outlined by the American Academy of Pediatrics. Also, the project emphasized interagency collaboration to improve communication between medical providers and state and community agencies that provide services to children with developmental delays. RESULTS: A total of 1139 medical records were reviewed by the 7 practices, at 5 intervals during the intervention. At baseline, there were dramatic differences among the practices, with some not engaged in screening at all. Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Assuntos

RESUMO

BACKGROUND: Sublingual immunotherapy (SLIT) has become established in Europe, and its efficacy is being evaluated in the United States. The doses used for SLIT in Europe today are difficult to evaluate, because each manufacturer expresses the potency of its extracts differently. OBJECTIVES: To compare in vitro European SLIT maintenance solutions against US licensed standardized allergenic extract concentrates and to determine the monthly SLIT doses delivered expressed in bioequivalent allergy units ([B]AU). METHODS: We studied Dermatophagoides pteronyssinus, timothy grass pollen, cat (hair) and short ragweed pollen allergen extracts. The SLIT maintenance solutions of 4 leading European manufacturers and standardized concentrate extracts of 3 US manufacturers were analyzed with the following assays: protein content, relative potency (immunoglobulin E [IgE]-binding enzyme-linked immunosorbent assay [ELISA] inhibition) and major allergen content. The relative monthly allergen dose in (B)AU was calculated for each recommended SLIT schedule. RESULTS: Relative potency was approximately 10 times higher for US concentrate standardized extracts-which are meant to be diluted-than for European SLIT maintenance solutions of D pteronyssinus and timothy grass pollen. For cat (hair) and short ragweed pollen, the difference was less. Measurements of relative potency and major allergen content correlated well. In our assays, European mite extracts contain a very low quantity of Der p 2 compared with US mites. CONCLUSION: Recommended SLIT doses in Europe vary widely among the manufacturers, but are consistently lower (Eur1) or higher (Eur4) over all four allergens tested. SLIT efficacy probably depends on additional factors apart from the exact dose. SLIT dose finding studies should be done for each product.

Assuntos