Population Groups Research Articles

Pneumocystis jirovecii pneumonia in hemato-oncological patients; 10 years of experience at Hospital Infantil Teletón de Oncología

Abstract Background Pneumocystis jirovecii pneumonia is an opportunistic infection that most frequently affects immunocompromised people, especially patients with HIV; clinical presentation is nonspecific and mortality rate in patients without HIV ranges are between 30% and 75%. In the international literature, there are few case reports of pediatric oncology patients. A series of cases is presented with the objective of describing the epidemiological characteristics, clinical presentation, treatment, and outcomes of Pneumocystis jirovecii pneumonia in this population group. Methods An observational, descriptive, and retrospective study was carried out in cancer patients under 18 years, with clinically compatible symptoms, an imaging study suggestive of the pneumonia, and identification of P. jirovecii using a PCR test of bronchial aspirate at Hospital Infantil Teletón de Oncología in Querétaro Mexico, since November 2014 to June 2023. Results A total of 17 events were reported with a median age of 9.8 years, 14/17 (82%) with a diagnosis of acute leukemias, 1/17 (6%) Ewing sarcoma, 1/17 (6%) lymphoma large cell anaplastic and 1/17 (6%) neuroblastoma. Regarding their therapeutic phases, 7/17 (41%) were in consolidation, 4/17 (23%) induction, 3/17 (18%) allogeneic HSCT (Hematopoietic stem-cell transplantation), 2/17 (12%) in surveillance, and 1/17 (6%) in maintenance. The clinical presentation in our patients was characterized by the presence of fever in 15/17 (88%), dry cough in 10/17 (59%) and 17/17 (100%) developed acute respiratory distress syndrome, which was classified as mild in 7/17 (41%), moderate in 5/17 (29%) and severe in 5/17 (29%). 13/17 (75%) presented distributive shock. All our patients underwent chest x-rays, 12/17 (70.5%) presented bilateral interstitial infiltrate, 4/17 (23.5%) consolidation, and 1/17 (6%) pleural effusion. Lung CT (computed tomography) was performed in 4/17 (23.5%), and 4/4 (100%) presented ground glass opacities. All of our patients were admitted to the PICU (Pediatric intensive care unit) and 16/17 (94%) required invasive mechanical ventilation. All receive treatment with TMP-SMX (Trimethoprim-sulfamethoxazole). 4/17 patients died (23%) of whom none received prophylaxis. 3/17 patients (18%) received prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX). Conclusion The present study is the first study in Mexico that compiles cases of Pneumocystis Jirovecii pneumonia in pediatric oncology patients. P. jirovecii pneumonia remains a rare cause, but represents a potentially fatal cause in oncology patients, so it is important to have a high clinical suspicion during the evaluation of an immunocompromised patient with evidence of pneumonia during all treatment phases with chemotherapy, in order to start treatment promptly. Thus, we also emphasize the importance of adequate prophylaxis as the most important preventive measure.

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations. To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities. This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023. COVID-19 PHE period (March 2020 to May 2023). All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE. For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

Risk of Developing Multimorbidity among Previously Healthy Immigrants and Long-term Ontario Residents

Background Multimorbidity is an important health issue associated with a greater risk of adverse health outcomes, more frequent hospitalizations, greater healthcare needs, and premature death. This study examined patterns of and the risk of developing multimorbidity between immigrants and long-term residents of Ontario. Methods We used a 1:1 matched retrospective observational open cohort design from 1995 to 2016, using routinely collected population-based administrative data at ICES. Multimorbidity was defined as two or more and three or more co-occurring chronic conditions. Chronic disease frequencies of dyads and triads were examined. Stratified multivariate Cox Proportional Hazard models examined the risk of developing multimorbidity and further by world regions of origin for immigrants compared to long-term residents. Results Hypertension and diabetes, in combination with chronic obstructive pulmonary disease, were the leading multimorbidity dyad and triad groups. After controlling for age, sex, and neighborhood income quintiles, immigrants from the Caribbean and South Asia had a greater risk of developing 2+ multimorbidity, compared to long-term residents. Refugees from North Africa and the Middle East (HR = 1.22 [95% CI: 1.03-1.42]) as well as refugees (HR = 1.78 [95% CI: 1.59 – 1.98]) and family immigrants from South Asia (HR: 1.08 [95% CI: 1.02-1.14]), had a higher risk of 3+ multimorbidity compared to long-term residents of Ontario. Conclusion These findings highlight the importance of routine population-based data collection on immigration status and world regions of origin to inform public health research. Investments in preventive health services and management of multimorbidity are needed for specific population groups.

Dynamic strategies and optimal control analysis for hepatitis C management: non-invasive liver fibrosis diagnosis

This study proposes a novel model employing nonlinear ordinary differential equations to dissect HCV dynamics. Six distinct population groups are delineated: Susceptible, Treatment, Responder, Non-Responder, Cured, and Fibrosis. A detailed numerical analysis of this model was conducted, tracking the predicted trends over a span of 20 years. The primary objective of this analysis is to assess and confirm the model’s predictive accuracy and its potential to supplant invasive diagnostic methods in monitoring the progression of liver fibrosis. By incorporating various control parameters, namely u 1 ( t ) , u 2 ( t ) , and u 3 ( t ) , the model offers a nuanced perspective on disease progression and treatment outcomes. Parameter u 1 ( t ) modulates treatment-induced fibrosis progression, providing a crucial lever for mitigating treatment-related side effects. u 2 ( t ) reflects treatment effectiveness, capturing the proportion of responders within the treatment cohort. Meanwhile, u 3 ( t ) governs fibrosis progression in non-responders, shedding light on the disease’s natural trajectory without effective treatment.

Immunoglobulin A nephropathy is not what it used to be!

Immunoglobulin A (IgA) nephropathy is the most common primary glomerulonephritis worldwide and thought to be a benign disease. Recent literature review would suggest otherwise, with outcomes remaining generally poor. Few patients do not progress to kidney failure in their lifetime even in population groups previously thought to be low risk. The previously established treatment approach predominantly focuses on supportive care through renin-angiotensin-aldosterone system inhibition and steroid-based immunosuppression in selected cases. However, recent advances in the understanding of the pathogenic mechanisms underlying this disease process have allowed for the development of new target therapies. This brief review provides an overview of improved understanding of IgA nephropathy and novel therapeutic strategies.

Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial

BackgroundDue to poorer exercise tolerance, it may be challenging for frail older adults to engage in moderate- or vigorous-intensity exercise. While low-intensity exercise interventions may be more feasible, its effectiveness for such population group remains unclear. We examined the effectiveness and implementation of community-based Baduanjin Qigong, a low-intensity exercise program in older adults with varying frailty status.MethodsA two-arm, multicenter assessor-blind parallel group randomized controlled trial was conducted at three local senior activity centers. Fifty-six community-dwelling older adults with low handgrip strength were randomly allocated to either the intervention (IG) or wait-list control (CG) group. The IG underwent a supervised 16-week Baduanjin exercise program at a frequency of 2–3 × 60 min sessions/week. The CG was instructed to maintain their usual activity and received a monthly health education talk. The primary outcome measures were knee extension strength, vital exhaustion, and fear of falling. Secondary outcome measures include physiological falls risk, handgrip strength, gait speed, timed up and go test, 30-second sit-to-stand, quality of life, depression, and frailty. All outcome measures were assessed at baseline and 4-month follow-up.ResultsOverall, there were no statistically significant differences in all outcome measures between CG and IG at 4-month follow-up. However, in exploratory compliance analysis, a statistically significant group x time interaction was found for vital exhaustion (B = -3.65, 95% CI [-7.13, -0.16], p = .047) among participants with at least 75% attendance. In post-hoc within-group comparisons, IG showed improved vital exhaustion by 4.31 points (95% CI [1.41, 7.20], d = 0.60). The average participant attendance rate was 81.3%. No major adverse events occurred, and all participants reported positive experiences with the exercise intervention.ConclusionsOur study demonstrated that Baduanjin is a safe, feasible, and acceptable exercise program that can be successfully implemented in community settings for older adults with varying frailty status. With good adherence, Baduanjin exercise could potentially be effective in alleviating vital exhaustion. However, the effectiveness of Baduanjin on physical performance, psychological measures and frailty in community-dwelling older adults remains equivocal.Trial registrationClinicalTrials.gov NCT04549103. Registered September 16, 2020.

HbA1c comparable to fasting glucose in the external validation of the African Diabetes Risk Score and other established risk prediction models in Black South Africans

BackgroundThe use of non-invasive risk scores to detect undiagnosed type 2 diabetes (T2D) ensures the restriction of invasive and costly blood tests to those most likely to be diagnosed with the disease. This study assessed and compared the performance of the African Diabetes Risk Score (ADRS) with three other diabetes risk prediction models for identifying screen-detected diabetes based on fasting plasma glucose (FPG) or glycated haemoglobin (HBA1c).MethodsAge, sex, waist circumference, body mass index, blood pressure, history of diabetes and physical activity levels from the SA-NW-PURE study were used to externally validate the ADRS and other established risk prediction models. Discrimination was assessed and compared using C-statistics and nonparametric methods. Calibration was assessed using calibration plots, before and after recalibration.ResultsNine hundred and thirty-seven participants were included; 14% had prevalent undiagnosed T2D according to FPG and 26% according to HbA1c. Discrimination was acceptable and was mostly similar between models for both diagnostic measures. The C-statistics for diagnosis by FPG ranged from 0.69 for the Simplified FINDRISC model to 0.77 for the ADRS model and 0.77 for the Simplified FINDRISC model to 0.79 for the ADRS model for diagnosis by HbA1c. Calibration ranged from acceptable to good, though over- and underestimation were present. All models improved significantly following recalibration.ConclusionsThe models performed comparably, with the ADRS offering a non-invasive way to identify up to 79% of cases. Based on its ease of use and performance, the ADRS is recommended for screening for T2D in certain Black population groups in South Africa. HbA1c as a means of diagnosis also showed comparable performance with FPG. Therefore, further validation studies can potentially use HbA1c as the standard to compare to.

Phylogeography of Y-chromosome haplogroup I-P37.2 in Serbian population groups originating from distinct parts of the Balkan Peninsula

Genetic structure of the contemporary Serbian population was shaped by a long history of turbulent historical and demographical events. The most important migrations of Serbs towards present day Serbia, in the recent history, occurred between the 15th to the 18th century from the regions of Old Herzegovina and Kosovo and Metohija. Previous haplogroup analysis revealed wide spectrum of main haplogroups, among which haplogroup I-P37.2 was the most frequent one in Serbian population groups originating from the Balkan Peninsula. Within this study 464 Serbian males samples from three geographical regions in the Balkan Peninsula inhabited by Serbs: present-day Serbia, regions of Old Herzegovina and Kosovo and Metohija, previously classified as haplogroup I-P37.2, were genotyped using the 22 Y-single nucleotide polymorphisms (Y-SNPs) in order to determine deeper phylogenetic and phylogeographic analysis of haplogroup I-P37.2. Based on SNP typing all samples in the Old Herzegovina and present-day Serbia dataset and 122 out of 128 samples from Kosovo and Metohija were assigned to haplogroup I-L621. Further SNP typing revealed very similar haplogroup distribution in all datasets, with the predominant haplogroup being I-PH908, followed by haplogroup I-Z17855. Analysis within haplogroup I-PH908 distinguished haplogroup I-FT14506 as the most frequent in the Kosovo and Metohija dataset, while haplogroup I-FT16449 was the most frequent in the Old Herzegovina dataset. In the present-day Serbia dataset, occurrence of haplogroups I-FT14506 and I-FT16449 was almost equal, comprising 40.2 % and 34.4 %, respectively. Low level of differentiation, within haplogroup I-PH908, was detected between all datasets, with the lowest one detected between present-day Serbia and Old Herzegovina datasets and highest one between Kosovo and Metohija and Old Herzegovina datasets. Furthermore, median-joining network analysis and shared haplotypes statistics revealed closer genetic relationship between Old Herzegovina and present-day Serbia haplotypes. Results obtained within this study support the thesis that migrations from historical region of Old Herzegovina and geographical region of Kosovo and Metohija, had great contribution on the present-day Serbian population genetic structure. Furthermore, here presented results, gave insight into geographic distribution of detected haplogroups I-Z17855, I-Y4460, I-PH908, I-Y5596, I-Y4882, I-FT14506, I-FT16449 and I-A5913 and analyzed SNPs, enabling further improvement of the geographic resolution of paternal ancestry inference.

Search for signals of positive selection of circadian rhythm genes PER1, PER2, PER3 in different human populations.

The diversity of geographically distributed human populations shows considerable variation in external and internal traits of individuals. Such differences are largely attributed to genetic adaptation to various environmental influences, which include changes in climatic conditions, variations in sleep and wakefulness, dietary variations, and others. Whole-genome data from individuals of different populations make it possible to determine the specific genetic sites responsible for adaptations and to further understand the genetic structure underlying human adaptive characteristics. In this article, we searched for signals of single nucleotide polymorphisms (SNPs) under selection pressure in people of different populations. To identify selection signals in different population groups, the PER1, PER2 and PER3 genes that are involved in the coordination of thermogenic functions and regulation of circadian rhythms, which is directly reflected in the adaptive abilities of the organism, were investigated. Data were analyzed using publicly available data from the 1000 Genomes Project for 23 populations. The Extended Haplotype Homozygosity Score statistical method was chosen to search for traces of selection. The comparative analysis performed identified points subject to selection pressure. The SNPs were annotated through the GWAS catalog and manually by analyzing Internet resources. This study suggests that living conditions, climate, and other external factors directly influence the genetic structure of populations and vary across races and geographic locations. In addition, many of the selection variants in the PER1, PER2, PER3 genes appear to regulate biological processes that are associated with major modern diseases, including obesity, cancer, metabolic syndrome, bipolar personality disorder, depression, rheumatoid arthritis, diabetes mellitus, lupus erythematosus, stroke and Alzheimer's disease, making them extremely interesting targets for further research aimed at identifying the genetic causes of human disease.

Psychological Distress Among Ethnically Diverse Participants From Eastern and Southern Africa

Psychological distress is characterized by anxiety and depressive symptoms. Although prior research has investigated the occurrence and factors associated with psychological distress in low- and middle-income countries, including those in Africa, these studies' findings are not very generalizable and have focused on different kinds of population groups. To investigate the prevalence and characteristics (sociodemographic, psychosocial, and clinical) associated with psychological distress among African participants. This case-control study analyzed data of participants in the Neuropsychiatric Genetics in African Populations-Psychosis (NeuroGAP-Psychosis) study, which recruited from general outpatient clinics in Eastern (Uganda, Kenya, and Ethiopia) and Southern (South Africa) Africa. Individuals who participated in the control group of NeuroGAP-Psychosis from 2018 to 2023 were analyzed as part of this study. Data were analyzed from May 2023 to January 2024. The prevalence of psychological distress was determined using the Kessler Psychological Distress Scale (K10), which measures distress on a scale of 10 to 50, with higher scores indicating more distress. Participants from the NeuroGAP-Psychosis study were categorized into cases as mild (score of 20-24), moderate (score of 25-29), and severe (score of 30-50), and participants with scores less than 20 were considered controls. Factors that were associated with psychological distress were examined using binomial logistic regression. From the data on 21 308 participants, the mean (SD) age was 36.5 (11.8) years, and 12 096 participants (56.8%) were male. The majority of the participants were married or cohabiting (10 279 participants [48.2%]), most had attained secondary education as their highest form of learning (9133 participants [42.9%]), and most lived with their families (17 231 participants [80.9%]). The prevalence of mild, moderate, and severe psychological distress was 4.2% (869 participants), 1.5% (308 participants), and 0.8% (170 participants), respectively. There were 19 961 participants (93.7%) who served as controls. Binomial logistic regression analyses indicated that the independent associations of psychological distress were experience of traumatic events, substance use (alcohol, tobacco, or cannabis), the physical comorbidity of arthritis, chronic neck or back pain, and frequent or severe headaches. In this case-control study among ethnically diverse African participants, psychological distress was associated with traumatic stress, substance use, and physical symptoms. These findings were observed to be consistent with previous research that emphasizes the importance of traumatic events as a factor associated with risk for psychopathology and notes the frequent co-occurrence of conditions such as physical symptoms, depression, and anxiety.

Environment-related health risks, knowledge and awareness among people in precarious milieus: secondary data analysis from the German "Environmental Awareness Study".

Precarious milieus more frequently suffer from environmental risks and show lower environmental awareness and behavior than other milieus in the German population. This study investigates the factors that influence environmental awareness in precarious milieus and the roles of environmental knowledge and the perception of environment-related health burdens. A quantitative secondary data analysis of the German Environmental Awareness Study 2018 (N = 2017) was used to analyze the perception of environmental health burdens, environmental knowledge, and environmental awareness between precarious milieus (n = 190) and seven other milieus. One-way analysis of variance (ANOVA) and Bonferroni post hoc tests were used for this purpose. More in-depth analyses of the precarious milieus were carried out using multiple regression analyses. There were significant differences in the perceptions of environmental health burdens affected by rail-traffic noise and neighborhood noise. Furthermore, environmental knowledge in precarious milieus was significantly lower than in five out of the seven other milieus (all p < 0.001) and was significantly associated with environmental cognition and gender. Precarious milieus had higher environmental affect than established milieus but less than that of critical-creative milieus and young idealists (all p < 0.001). Environmental cognition and environmental behavior were significantly associated with environmental affect. Environmental cognition was significantly higher in precarious milieus than in established milieus and among young pragmatists but was lower than in critical-creative milieus and among young idealists (all p < 0.001). Environmental affect, environmental knowledge, and gender were significantly associated with environmental cognition. In precarious milieus, environmental behavior was significantly lower than in traditional milieus and critical-creative milieus and among young idealists (all p < 0.001) and was significantly associated with environmental affect. The differences in the perception of environmental health burdens, environmental knowledge, and environmental awareness among precarious milieus indicate that there is a need for specific education and support structures for these population groups. Further research is needed to determine what other factors within the precarious milieus influence environmental knowledge and awareness, as well as the skills needed to understand environmental information, which are included in the framework of environmental (health) literacy.

Epigenetic and Genetic Profiling of Comorbidity Patterns among Substance Dependence Diagnoses.

This study investigated the genetic and epigenetic mechanisms underlying the comorbidity patterns of five substance dependence diagnoses (SDs; alcohol, AD; cannabis, CaD; cocaine, CoD; opioid, OD; tobacco, TD). A latent class analysis (LCA) was performed on 31,197 individuals (average age 42±11 years; 49% females) from six cohorts to identify comorbid DSM-IV SD patterns. In subsets of this sample, we tested SD-latent classes with respect to polygenic burden of psychiatric and behavioral traits and epigenome-wide changes in three population groups. An LCA identified four latent classes related to SD comorbidities: AD+TD, CoD+TD, AD+CoD+OD+TD (i.e., polysubstance use, PSU), and TD. In the epigenome-wide association analysis, SPATA4 cg02833127 was associated with CoD+TD, AD+TD, and PSU latent classes. AD+TD latent class was also associated with CpG sites located on ARID1B , NOTCH1 , SERTAD4, and SIN3B , while additional epigenome-wide significant associations with CoD+TD latent class were observed in ANO6 and MOV10 genes. PSU-latent class was also associated with a differentially methylated region in LDB1 . We also observed shared polygenic score (PGS) associations for PSU, AD+TD, and CoD+TD latent classes (i.e., attention-deficit hyperactivity disorder, anxiety, educational attainment, and schizophrenia PGS). In contrast, TD-latent class was exclusively associated with posttraumatic stress disorder-PGS. Other specific associations were observed for PSU-latent class (subjective wellbeing-PGS and neuroticism-PGS) and AD+TD-latent class (bipolar disorder-PGS). We identified shared and unique genetic and epigenetic mechanisms underlying SD comorbidity patterns. These findings highlight the importance of modeling the co-occurrence of SD diagnoses when investigating the molecular basis of addiction-related traits.

Application of the Decision Tree Method for Differentiating Human Groups

One of the tasks of modern biological anthropology is to develop a system that could objectively classify humanity on the basis of measurements. Here, the decision tree algorithm was chosen to create a classification of groups. The method helps to evaluate the differentiating power of specific dimensions for separating samples and to assess the composition of clusters at each step of the analysis. Standard cranial measurements were used, and the entropy index was chosen as a heterogeneity measure. Classification units were 39 ethno-territorial groups from 13 major regions of the Old World. At the first step, differentiation is made between broad-faced and narrow-faced groups, demonstrating the classificatory value of this trait. The first cluster includes only Mongoloids, admixed Southern Siberian populations, and Ainu. The second cluster is heterogeneous, but its further subdivision is more in line with the traditional classification. Traits underlying the branching of the tree may be the same in different branches, evidencing their taxonomic importance. Capabilities of the decision tree method proved sufficient to construct a system largely similar to the traditional one. Certain traits separate large groups of populations, while others are efficient at the regional level. The method, therefore, can be recommended as a supplementary tool at the intraspecific level.

Working in partnership to reduce re-offending and improve prison leavers’ lives: a process evaluation of a prison leaver pilot project

Prison leavers encounter significant barriers to successfully re-integrating into the community, which can lead to re-offending. Complex interventions which are multi-faceted and involve successful partnerships are needed to meet the distinct health and social needs of this population group. For this study, we conducted a process evaluation of a pilot project, which aimed to offer holistic support to prison leavers through a combination of peer mentoring, sport and physical activity, and signposting, delivered in a community setting. Semi-structured interviews and focus groups were conducted with individuals (n = 14) involved in the delivery and the management of the project to understand how it had been implemented and what factors had influenced the delivery and partnerships involved. Factors that influenced project delivery included safeguarding and risk assessment concerns, lived experience of peer mentors, accessibility of the intervention, and the role of sport and physical activity as a vehicle for community re-integration. Partnership working was influenced by effective information sharing, organizational commitment, building relationships and professional networks, and regular communication between organizations. An intervention involving peer mentoring, sport and physical activity, and signposting, supported by close partnership working, was viewed as a promising approach to support the community re-integration of prison leavers.

Demanda por serviços de saúde durante a pandemia de Covid-19: estudos de base populacional

Objective: To evaluate the demand for health services during the Covid-19 pandemic and its associated factors. Methods: A population-based cross-sectional study was conducted in two cities in southern Brazil: Criciúma, in the state of Santa Catarina, and Rio Grande, in the state of Rio Grande do Sul. The study included individuals aged 18 years and older residing in urban areas of these municipalities. Participants self-reported their health service utilization and the type of service sought. Sociodemographic, behavioral, and health-related variables were examined as exposures. Poisson regression was used to analyze the adjusted associationsbetween service demand and exposure variables. Results were presented as prevalence ratios (PR) with 95% confidence intervals (95% CI). Results: A total of 2,167 individuals were analyzed. Approximately 25% of participants reported experiencing at least one Covid-19-related symptom. Among these, 51.3% soughthealth services, with Basic Health Units being the most frequently sought (46.7%). Health service demand was higher among individuals aged 50 to 59 years (PR=1.60; 95% CI 1.18, 2.17), those with higher education (PR=1.52; 95% CI 1.13, 2.03), those who engaged in physical activity (PR=1.29; 95% CI 1.07, 1.59), and those who had contact with someone who tested positive for Covid-19 (PR=1.76; 95% CI 1.40, 2.21). Conclusion: The results highlight two distinct population groups: those with greater exposureto Covid-19 and those more attentive to health care. Additionally, the Basic Health Unit was the most sought-after service, underscoring the importance of Primary Care and the Unified Health System in addressing the pandemic in Brazil.

Consequences of acute and long-term excessive iodine intake: A literature review focusing on seaweed as a potential dietary iodine source.

Macroalgae, also called seaweed, are becoming more widespread as food in Western diets. Seaweed can accumulate iodine, an essential nutrient for humans. However, some species of seaweed may contain very high amounts of iodine, and therefore, iodine has been identified as one of the major hazards in the seaweed food chain. Macroalgae may be consumed regularly, though many consumers report eating macroalgae only occasionally. The aim of this paper is to explore possible health consequences of excessive iodine intake according to long-term (chronic) or occasional (acute) excessive exposure to iodine, relating to a regular (chronic) or occasional (acute) seaweed intake, respectively. Furthermore, through a modeling exercise, we add different amounts of seaweed to the diet in a population group to explore the possible safe amounts that can be added without exceeding excessive iodine intakes and risking detrimental health effects. Chronic excessive iodine intakes were associated with several negative health outcomes at variable doses in various studies. For acute excessive iodine exposure, negative health effects seemed to be associated with higher iodine exposures. However, the research on this topic was limited. The chronic and acute iodine exposures needed to result in negative health outcomes may easily be ingested by macroalgae consumption. Adding seaweed to the diet must be done thoughtfully to avoid the risk of exceeding thresholds for excessive iodine intake.

Welcoming pregnant women as a strategy for adherence to dental prenatal care and health promotion in early childhood

This research deals with implementing Dental Prenatal Care as a public policy in the Brazilian Unified Health System (SUS) to care for pregnant women and their future babies. The legal framework that assures pregnant women's rights of priority in accessing services is usually not enough to guarantee the health promotion coverage goals for this population group, who frequently have low adherence to dental care. Brazilian Unified Healthcare System (SUS) recommends monitoring pregnant women through eight mensal consultations during healthy pregnancy. Oral health is usually not monitored to the same extent, and many pregnant women still go through pregnancy without any dental consultation. This study was proposed to improve dental prenatal care and program adherence by mothers and children in the Basic Healthcare Unit Amaro José de Souza, in the municipality of Barueri, through the increased participation of the dental surgeon in the pregnant women welcoming team. A cross-sectional cohort study was designed to identify and meet the demands of low-risk pregnant women. For six months, all the women attending prenatal care at BHU Amaro José de Souza in Barueri were invited to participate and receive personal guidance from the multi-professional team. Information on dental health was investigated through questions targeting previous knowledge about the recommended moments for the first dental appointment of a child, the importance of exclusive nasal respiration, the identification of craniofacial asymmetries at birth, and general baby care. Attitudes and self-care were also investigated, including prenatal program adherence. Answers were collected in a Google Form platform and analyzed to characterize the group's literacy about prenatal care and breastfeeding and identify information needs about dental health care during pregnancy. At the same time, a welcoming expanded listening, educational, and preventive health action was developed: conversation and sharing experience groups were promoted monthly for pregnant women, breastfeeding mothers, and their families. 90 pregnant women out of the 104 attending the BHU in the six months of the research were invited, and 83 agreed to participate. All the participants declared at least one previous appointment with the healthcare team, 92.8 % of them, with a gynecologist. The nursing team was involved in 53.0 % of the appointments, but only 6.0 % were reported to have been conducted exclusively by a nurse. A dental surgeon appointment was mentioned by 30.1 % of the research participants. The dental health literacy investigation revealed that 57.8 % believed they should only take their babies to a dental appointment after teething, and 27.7 % were aware of the child's craniofacial asymmetries at birth. Only 28.9 % had previous knowledge about the importance of exclusive nasal respiration. Despite only 34.9 % having their first pregnancy, 78.3 % declared they would appreciate receiving information about pregnancy. After the guidance, 72.0 % of the pregnant women had undergone dental prenatal care. Workshops for pregnant women and breastfeeding mothers provided a convenient welcoming space, to listen and provide guidance to pregnant women and their families, in addition to demystifying the fear of dental care during pregnancy and breastfeeding. The intervention to guide pregnant women to perceive the BHU as an educational and health promotion space, not just a curative intervention, effectively increased adherence to dental prenatal care. The contact with the Specialist in Functional Jaw Orthopedics in this first phase of life facilitated dental health education and access to more complex cases. The prenatal program adherence, the pregnant woman’s self-care, and the care of the baby were favored by the welcoming, expanded listening, and personalized service.

'Monkeypox, where is your rage?': The racialization, sexualization, and securitization of global health

With the purposes of identifying the underlying challenges of global and public health governance of outbreaks, this paper explores three key themes that emerged in response to the 2022 mpox epidemic: the belated change of disease nomenclature from monkeypox to mpox; the classification of mpox as a sexually transmitted infection (STI); and the unpreparedness of health agencies to vaccinate impacted populations. The paper makes the case that, because of the global and public health tensions arising from racialized nomenclatures, sexualized classifications, biosecuritized borders, and monopolized vaccines, national and international agencies failed in providing an adequate and comprehensive response to the latest mpox pandemic, which contributed further to the pathologization of already vulnerable and stigmatized population groups.

Risk of death from hematological malignancies in the South Urals Population Exposed to Radiation cohort

The results of studies of long-term effects of population exposure in the South Urals in the 1950s were based for a long time on studies of the effects of exposure in the Techa River cohort and later in the East Urals Radioactive Trace cohort. After the creation of the South Urals Population Exposed to Radiation cohort, combining all persons exposed in the South Urals in the period from January 1, 1950, to December 31, 1960 the size of the cohort doubled, follow-up period reached 71 years, and the number of person-years at risk increased to 1,964,333. The average dose to red bone marrow for all cohort members was 231mGy. Regression analysis using a simple parametric excess relative risk model was performed using the EPICURE statistical package. The analysis resulted in confirmation of a statistically significant (p &lt;0.001) linear doseresponse relationship of mortality for all hemoblastoses, and leukemia. The excess relative risk and 95% confidence intervals of death at 2-year latency period from all hemoblastoses were 0.71/Gy (0.28;1.31); from all leukemias - 1.28/Gy (0.55-2.39) and from leukemias excluding chronic lymphocytic leukemia -1.52/Gy (0.64-2.94). The quadratic model also significantly described the dose dependence; (the differences between the models were not significant). Increasing the follow-up period to 71 years resulted in a slight decrease in risk estimates. The width of the confidence intervals of the risk estimates decreased by more than a factor of 3 compared to earlier studies in the Techa River cohort, which indicates a decrease in uncertainties of risk estimates. Increasing the size of the cohort made it possible to obtain significant risk values for individual population groups (by sex, age, etc.). Analysis of risk values modification did not reveal significant differences in dose dependence on the studied factors, including attained age and age at exposure. The study will be continued to investigate in more detail the influence of time-dependent factors on dose dependence, as well as to assess the risk of death from different cellular forms of leukemia.

Applying Deep Generative Neural Networks to Data Augmentation for Consumer Survey Data with a Small Sample Size

Questionnaire consumer survey research is primarily used for marketing research. To obtain credible results, collecting responses from numerous participants is necessary. However, two crucial challenges prevent marketers from conducting large-sample size surveys. The first is cost, as organizations with limited marketing budgets struggle to gather sufficient data. The second involves rare population groups, where it is difficult to obtain representative samples. Furthermore, the increasing awareness of privacy and security concerns has made it challenging to ask sensitive and personal questions, further complicating respondent recruitment. To address these challenges, we augmented small-sized datawith synthesized data generated using deep generative neural networks (DGNNs). The synthesized data from three types of DGNNs (CTGAN, TVAE, and CopulaGAN) were based on seed data. For validation, 11 datasets were prepared: real data (original and seed), synthesized data (CTGAN, TVAE, and CopulaGAN), and augmented data (original + CTGAN, original + TVAE, original + CopulaGAN, seed + CTGAN, seed + TVAE, and seed + CopulaGAN). The large-sample-sized data, termed “original data”, served as the benchmark, whereas the small-sample-sized data acted as the foundation for synthesizing additional data. These datasets were evaluated using machine learning algorithms, particularly focusing on classification tasks. Conclusively, augmenting and synthesizing consumer survey data have shown potential in enhancing predictive performance, irrespective of the dataset’s size. Nonetheless, the challenge remains to minimize discrepancies between the original data and other datasets concerning the values and orders of feature importance. Although the efficacy of all three approaches should be improved in future work, CopulaGAN more accurately grasps the dependencies between the variables in table data compared with the other two DGNNs. The results provide cues for augmenting data with dependencies between variables in various fields.