RESUMO
PURPOSE: To assess and compare uncorrected binocular distance visual impairment rates in U.S. Hispanic children and adolescents. METHODS: Data from the Hispanic Health and Nutrition Examination Survey, 1982-1984, were analyzed for 6-19 year-old Cuban-Americans (n = 317), Mexican-Americans (n = 2519), and Puerto Ricans (n = 988). Visual acuity was assessed using Sloan Letters or Landolt Rings. RESULTS: Prevalence rates of uncorrected binocular distance visual impairment (20/30 or worse) were 15.5%, 14.9%, and 23.6% for Cuban-Americans, Mexican-Americans, and Puerto Ricans, respectively. After adjusting for age and gender, the differences between Puerto Ricans and both Cuban-Americans and Mexican-Americans were significant (p < 0.05). Children 6-12 years of age had lower visual impairment rates than 13-19 year-old adolescents. Girls had higher age-adjusted visual impairment rates than boys; these gender differences were statistically significant among Mexican-Americans (OR = 1.6, 95% CI = 1.1, 2.2) and Puerto Ricans (OR = 1.7, 95% CI = 1.2, 2.4). CONCLUSIONS: Among Hispanics, Puerto Rican children and adolescents have the highest prevalence rate of uncorrected binocular distance visual impairment; older age and female gender are associated with higher rates of uncorrected visual impairment.
Assuntos
Hispânico ou Latino , Disparidade Visual , Visão Binocular , Baixa Visão/etnologia , Adolescente , Adulto , Distribuição por Idade , Criança , Cuba/etnologia , Feminino , Humanos , Masculino , México/etnologia , Prevalência , Porto Rico/etnologia , Estudos Retrospectivos , Distribuição por Sexo , Inquéritos e Questionários , Estados Unidos/epidemiologia , Baixa Visão/fisiopatologiaRESUMO
OBJECTIVE: To determine the influence of prenatal zidovudine (ZDV) prophylaxis on the course of HIV- 1 infection in children by comparing the clinical outcome of infants born to HIV- 1-seropositive mothers who did versus those who did not receive ZDV during pregnancy. METHODS: Medical records of HIV-1-seropositive mothers and their infants were reviewed retrospectively. Participants were divided according to maternal ZDV use: no ZDV (n = 152); ZDV (n = 139). The main outcome measure was rapid disease progression (RPD) in the infant, defined as occurrence of a category C disease or AIDS-related death before 18 months of age. RESULTS: HIV vertical transmission rates were significantly different (no ZDV versus ZDV: 22.3% versus 12.2%; p = .034). Among infected infants, the RPD rate was 29.4% in the no ZDV group compared with 70.6% in the ZDV group (p = .012), and prematurity was significantly associated with a higher risk of RPD (p = .027). CONCLUSIONS: The rate of RPD was significantly higher among perinatally infected infants born to HIV-infected mothers treated with ZDV than among infected infants born to untreated mothers. The decreased proportion of infected infants with nonrapid disease progression in the former group might be related to the ability of ZDV to block intrapartum transmission preferentially and also to nonrapid disease progression resulting from intrapartum transmission.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Soropositividade para HIV/tratamento farmacológico , HIV-1 , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Efeitos Tardios da Exposição Pré-Natal , Zidovudina/uso terapêutico , Contagem de Linfócito CD4 , Progressão da Doença , Feminino , Idade Gestacional , Infecções por HIV/mortalidade , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVES: The purpose of this study was to perform comparative analyses of the population-based prevalence of usual-corrected binocular distance visual acuity impairment among Hispanics and non-Hispanics in the United States. METHODS: Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, and the National Health and Nutrition Examination Augmentation Survey I (NHANES I-A), 1974-1975, were analyzed to investigate the epidemiology of usual-corrected binocular distance acuity in adults 25 to 74 years of age among Cuban-Americans (N=396), Mexican-Americans (N=1,381), Puerto Ricans (N=513), African-Americans (N=250), and non-Hispanic white Americans (N=2, 660). Binocular distance acuity was assessed using Sloan Letters or Landolt Rings with the participants wearing their corrective lenses, if any. RESULTS: Prevalences of 20/50 or worse usual-corrected binocular distance acuity were 3.5%, 4.6%, and 6.6% for Cuban-Americans, Mexican-Americans, and Puerto Ricans, respectively, in the HHANES; and 7.7% and 4.1% for African-Americans and non-Hispanic whites, respectively, in the NHANES I-A. Within the HHANES, after adjustment for gender and age, Puerto Rican adults were found to have a significantly higher prevalence of visual impairment (20/50 or worse) and were significantly less likely to become unimpaired with usual correction than Cuban-American adults. Within the NHANES I-A, African-Americans were found to have a higher prevalence of visual impairment (20/50 or worse) and were significantly less likely to become unimpaired with usual correction than non-Hispanic whites. Higher prevalences of visual impairment (20/50 or worse) were associated with increasing age for all ethnic groups. After controlling for age, odds of usual-corrected visual impairment (20/50 or worse) were significantly higher in women than in men for Cuban-Americans and Mexican-Americans (odds ratios: 4.5 and 2.6, respectively). CONCLUSIONS: The results from this study suggest that compared to other Hispanic groups and non-Hispanic whites, Puerto Rican and African-American adults may not be receiving similar eye care services and/or may have more severe eye diseases.
Assuntos
Hispânico ou Latino , Transtornos da Visão/etnologia , Visão Binocular , Acuidade Visual , Adulto , Negro ou Afro-Americano , Cuba/etnologia , Etnicidade , Óculos , Feminino , Humanos , Masculino , México/etnologia , Razão de Chances , Prevalência , Porto Rico/etnologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Transtornos da Visão/terapia , População BrancaRESUMO
OBJECTIVES: To compare the physiologic efficacy and safety aspects of proportional assist (PA), assist/control (A/C), and intermittent mandatory ventilation (IMV) in very low birth weight infants with acute respiratory illness and to test the hypothesis that ventilatory pressure requirements are lower and arterial oxygenation is improved during PA when compared with IMV or A/C at an equivalent inspired oxygen fraction. STUDY DESIGN: Randomized, 3-period, crossover design. METHODS: Thirty-six infants were stratified by birth weight (600 to 750, 751 to 900, and 901 to 1200 g) and exposed to consecutive 45-minute epochs of the 3 modalities in a sequence chosen at random. Tidal volumes of 4 to 6 mL/kg were targeted during A/C and IMV. The IMV rate was matched to the rate during an A/C test period. PA was adjusted to unload the resistance of the endotracheal tube and the disease-related increase in lung elastic recoil. RESULTS: Compared with A/C and IMV, PA maintained similar arterial oxygenation with lower airway and transpulmonary pressures (15% to 44% reduction depending on the index variable). The oxygenation index decreased by 28% during PA. No adverse events were observed. The number and severity of apneic episodes and periods of arterial oxygen desaturations were similar with the 3 modes. Similar results were obtained within each birth weight subgroup. CONCLUSIONS: PA safely maintains gas exchange with smaller transpulmonary pressure changes compared with A/C and IMV. It may therefore offer a way of reducing the incidence of chronic lung disease in low birth weight infants.
Assuntos
Recém-Nascido de Baixo Peso , Ventilação com Pressão Positiva Intermitente/métodos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Doença Aguda , Resistência das Vias Respiratórias , Pressão Sanguínea , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Complacência Pulmonar , Masculino , Troca Gasosa Pulmonar , Pressão Propulsora Pulmonar , Síndrome do Desconforto Respiratório do Recém-Nascido/metabolismo , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Volume de Ventilação PulmonarRESUMO
We compared population-based prevalence rates of unilateral hearing loss among African-American, Cuban-American, Mexican-American, Puerto Rican, and non-Hispanic White children 6 to 19 yr of age. The prevalence (per thousand) of overall hearing loss (average decibel HTL >30) ranged from 6.4 in Mexican-Americans to 12.3 in Cuban-Americans. The prevalence of moderate to profound unilateral hearing loss (average decibel HTL >50) ranged from 0.0 in Cuban-Americans to 5.2 in Puerto Ricans. No statistically significant age or gender differences were found within any of the ethnic groups. Among these five ethnic groups, it is estimated that approximately 391,000 school-aged children in the United States have unilateral hearing loss.
Assuntos
Nível de Saúde , Perda Auditiva/epidemiologia , Hispânico ou Latino , Estado Nutricional , Inquéritos e Questionários , Adolescente , Audiometria de Tons Puros , Limiar Auditivo , Criança , Cuba/etnologia , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etnologia , Humanos , Masculino , México/etnologia , Prevalência , Porto Rico/etnologia , Índice de Gravidade de Doença , Estados Unidos/epidemiologiaRESUMO
Reports on the relationship between diabetes and hearing loss have been controversial. The present study examined this relationship in 1,740 Mexican American adults using data from the Hispanic Health and Nutrition Examination Survey. Hearing threshold levels were obtained for each participant at the following frequencies: 500, 1000, 2000, and 4000 Hertz (Hz). The thresholds from the worse hearing ear were used in the analyses. Diabetes and insulin use were assessed by self-report. The mean crude hearing thresholds in diabetics were significantly higher than in non-diabetics at each of the four frequencies. However, after adjustment for age, gender, and socioeconomic status, diabetics had a significantly higher mean threshold than non-diabetics only at 500 Hz (mean difference +/- SE: 2.8 +/- 1.2, p = 0.04). Diabetics who were not using insulin had significantly higher thresholds than those who were using insulin at 2000 (mean difference +/- SE: 5.6 +/- 2.6, p = 0.03) and 4000 Hz (7.7 +/- 3.3, p = 0.02). Also, at 4000 Hz, insulin users had a significantly lower mean threshold than non-diabetics (mean difference +/- SE: -4.9 +/- 1.6, p = 0.02). Our data suggest that associations between diabetes and decreased hearing acuity in the higher frequencies are present only amongst diabetic Mexican-Americans who do not use insulin.
Assuntos
Complicações do Diabetes , Transtornos da Audição/complicações , Hispânico ou Latino , Insulina/uso terapêutico , Adulto , Fatores Etários , Audiometria , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Classe SocialRESUMO
Sociodemographic and educational correlates of hearing loss were examined in Cuban-American, Mexican-American and Puerto Rican children 6-19 years of age. Logistic regression analyses indicated a greater risk of bilateral hearing loss among children living in crowded housing conditions or without health insurance, as well as among those who were below expected school grade level and whose parents reported low educational attainment levels. However, the strengths of these associations were small to moderate in magnitude and were not always consistent across the ethnic subgroups. These findings provide some evidence that hearing-impaired Hispanic children are more likely to reside in economically disadvantaged families and to be below their expected school grade level.
Assuntos
Transtornos da Audição/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Classe Social , Adolescente , Adulto , Criança , Estudos Transversais , Cuba/etnologia , Feminino , Inquéritos Epidemiológicos , Transtornos da Audição/etnologia , Humanos , Modelos Logísticos , Masculino , México/etnologia , Razão de Chances , Prevalência , Porto Rico/etnologia , Estudos Retrospectivos , Fatores de Risco , Estudos de Amostragem , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
Death rates due to Ischemic Heart Disease (IHD) are widely used to assess regional and national cardiovascular health status. However, their validity is questionable, essentially because they are based on death certificates (DCs). The present study was conducted in the Greater Metropolitan Area of Barquisimeto (Lara State, Venezuela), from June 1991 to July 1992. The purpose was to establish the validity of the diagnosis of myocardial infarction in DCs of intrahospital deaths. Efforts were made to locate all clinical charts and any other relevant information. To validate the diagnosis of MI in the DC we used the MONICA project criteria. During the study period a total of 247 eligible DCs were recorded. Sufficient clinical information was located for 136 cases (55%). The results were as follows: definite MI - 62 cases (45.6%); probable MI - 31 cases (22.8%); and non MI - 43 cases (31.6%). These results may indicate an overestimation of MI death rates of about 32% [95% Confidence Interval = 23.8% - 39.4%]. Since these data are from a region with an organized cardiovascular health system, it is expected that the overestimation for the rest of the country may be even higher. Thus, in order to enhance quality and accuracy of DCs, it is necessary to develop a system to improve adherence to existing norms for filling out and processing such forms.
RESUMO
The South Florida Program on Aging and Health was initiated in 1992 with the aim to assess physical and mental health of the elderly in Dade County and provide a basis for public health policy. This report describes the methodology applied in the study and preliminary screening results in a probability sample of 2,400 African American, Cuban American and white non-Hispanic American elderly men and women. Of 2,013 participants screened by May 1995, 11.5% had cognitive impairment. An increase in prevalence from 4-7% to 25-36% with advancing age was found among men and women of each group, from the youngest (65-74) to the oldest (85+ years). Male and female prevalences were similar but vary by ethnic group and age.
Assuntos
Doença de Alzheimer/epidemiologia , Etnicidade/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Doença de Alzheimer/prevenção & controle , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/prevenção & controle , Cuba/etnologia , Feminino , Florida/epidemiologia , Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento , Prevalência , Saúde Pública , Política Pública , População Branca/estatística & dados numéricosRESUMO
Blood pressure (BP) data obtained during a BP screening program were analyzed to determine the prevalence of "significant" hypertension, defined by the Second National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children-1987 as the level of BP above which medical evaluation and intervention are recommended. In 14,686 black and white St. Paul and Minneapolis schoolchildren aged 10 to 15 years, BP was measured twice during an initial screening examination. Children with systolic BP in the upper 30 percentiles of distribution after the initial screening had their BP remeasured two additional times at a rescreening examination. The prevalence of significant hypertension was determined according to BP criteria established by the Task Force report. After the two screening BP measurements were averaged, significant systolic hypertension was found in 1.0%, significant diastolic hypertension in 3.5%, and significant systolic or diastolic hypertension, or both, in 4.2% of the students. After the rescreening examination, the percentage of students remaining with significant hypertension was reduced to 0.3% for systolic, 0.8% for diastolic, and 1.1% for systolic or diastolic hypertension, or both. These results show that significant hypertension is uncommon in pre-high-school students and confirm the need for repeated BP measurements to make an accurate diagnosis of hypertension. However, the results should not detract from current recommendations to monitor BP in children on a yearly basis to detect longitudinal BP tracking patterns that may be consistent with early essential hypertension.