Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries...Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r<sup>2</sup> = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r<sup>2</sup> = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.展开更多
The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public Uni...The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.展开更多
Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examine...Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examined whether symptoms of anxiety and depression are associated with colorectal cancer (CRC) screening perceptions and behaviors among older adults in a primary care setting. A cross-sectional study was conducted by using a sample of 143 family medicine patients who completed an 88-item anonymous self-administered questionnaire covering symptoms of anxiety and depression as well as CRC screening perceptions (defined based on the Health Belief Model) and behaviors (defined as ever use of or adherence to CRC testing). Moderate-to-clinically significant anxiety and depressive symptoms were, respectively, prevalent in 47% and 42% of participants. Perceived benefits and barriers were the only Health Belief Model constructs associated with anxiety. Perceived barriers were positively associated with anxiety symptoms after adjustment for confounders, including age, gender, race/ ethnicity, marital status, education, smoking history, body mass index and self-rated health. By contrast, perceived benefits were negatively associated with anxiety symptoms only in the unadjusted model. Neither anxiety nor depression was associated with ever use of or adherence to CRC testing. Symptoms of anxiety, but not depression, may potentially influence CRC screening perceptions, with implications for behavioral interventions targeting CRC testing.展开更多
An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated ...An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.展开更多
Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of l...Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of lipoprotein (a) [Lp (a)] and C-reactive protein (CRP) are associated with increased risk of cardiovascular diseases. Objectives: To verify the change in the levels of Lp (a) and ultrasensitive CRP and its relationship with the nutritional status of adolescents. Methods: Cross-sectional study conducted with overweight children and adolescents between August 2012 and July 2013 attended at the Center for Childhood Obesity. The measurement of inflammatory markers was performed in the Clinical Laboratory of the State University of Paraiba. Comparison of sociodemographic variables by sex was tested by chi-square;the association of the risk markers according to age was evaluated by Student’s t test, and the body mass index by analysis of Pearson correlation. The normality distribution was tested by the Kolmogorov-Smirnov test. Confidence interval of 95% was adopted in all analyses. The study was approved by the Ethics Research Committee of UEPB (CAAE 0256.0.133.000-11). Results: Of the 133 children and adolescents evaluated, 60.9% were female and 72.2% were adolescents. Body Mass Index, lipo (a) and u-CRP showed statistically significant association with age (p < 0.01). There was a positive ascending correlation (r = 0.273, p < 0.01) of u-CRP with BMI, which was not verified for lipoprotein (a). Conclusion: As a cardiovascular risk marker already established in literature, the association of u-CRP with the nutritional status of adolescents, proportionally, shows the need for losing weight in this population, especially at early age. A deeper and long-term investigation should be carried out for more effective and consistent contribution to public health.展开更多
Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes ...Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes the installation of atheromatous plaques and, therefore, is considered as an emerging cardiovascular risk factor. Objective: To evaluate the plasma homocysteine levels (Hy) in overweight or obese children and adolescents and their relation with cardiovascular risk factors. Methods: A cross-sectional study was conducted from July 2011 to May 2012 with overweight or obesity children and adolescents aged 2 to 18 years followed at the Center for Childhood Obesity (IOC), Campina Grande-PB. A structured form was used to record demographic, socioeconomic and clinics variables and the patients underwent laboratory tests to define their lipid and glucose profiles and measurement of plasma Hy levels. Results: The study evaluated a total of 165 children and adolescents with mean age of 12.5 (±2.5) years;the majority were female (57.0%). Regarding the lipid profile, there was more individuals with low HDL cholesterol (88.5%). Plasma Hy levels were high in 24.2% of the sample. The mean Hy levels ranged from 4.3 to 18.9 μmol/L, being higher in males, obese adolescents and also in patients with high insulin levels and resistance. Conclusions: The results shown in this study emphasize the importance of detecting and controlling the plasma Hy levels as an independent cardiovascular risk factor, and the need for further studies to evaluate the clinical and biological factors related to alterations in its metabolism.展开更多
Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing ...Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.展开更多
In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to...In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to 19 years from public schools of Campina Grande, Paraiba, Brazil. The following variables were analyzed: age, gender, ethnicity, maternal education, socioeconomic status, nutritional status, the practice of PA and lipid profile. The variables were obtained through validated form, anthropometry (weight and height) and blood collection by contract laboratory. Double entry and SPSS (Statistical Package for Social Sciences) 22.0 were performed. First, a descriptive analysis of all variables was conducted, as well as measures of central tendency and dispersion for continuous variables. Accordingly, distribution was tested for normality using the Kolmogorov-Smirnov test. According to results, correlation was evaluated by Pearson/Spearman tests. Significance level of 5% was adopted for all analyses. The study was approved by the Ethics Approach Committee (EAC) of the State University of Paraíba. The most prevalent sex in the sample was female and regarding maternal education, 35.4% had complete high school. Regarding serum lipoproteins, 16% showed elevated total cholesterol and HDL (High Density Lipoprotein) 66% below the desired value. With regard to physical activity, 60.8% had insufficient PA levels. The sample showed changes in lipid profile and insufficiently active life style, besides having overpowered the eutrophic nutritional status. No statistically significant correlations between variables of the lipid profile and the time of PA were observed. These findings highlight the importance of physical exercise for maintaining health and suggest studies with larger populations in order to check the scientific literature regarding this topic.展开更多
This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had...This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had catastrophic effects in Peru. Such a localized El Nio was not documented since 1925. An initial review suggests that in addition to the characteristics of the event(surprise),government responses may have been inadequate(as media reported) because of conflicting forecast reports(U.S. and Peru), which provoked a hydrometeorological debate and stifled decision making. Partly to blame was the El Nio definition problem, which can cause uncertainty and affect perception of risk, depending on which region of the equatorial Pacific one uses to identify an event. Responses were further complicated by the fact that some regions within Peru were experiencing drought prior to the El Nio costero's onset and impacts from the El Nio 2015–2016 were less than expected. Furthermore, a new government was in place, which may have hindered action. Thus, El Nio costero provides lessons to heed, not only with respect to the forecast information, but also with reference to the context of the forecast and disaster setting, which can influence disaster responses to hydrometeorological threats.展开更多
文摘Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r<sup>2</sup> = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r<sup>2</sup> = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.
文摘The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.
文摘Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examined whether symptoms of anxiety and depression are associated with colorectal cancer (CRC) screening perceptions and behaviors among older adults in a primary care setting. A cross-sectional study was conducted by using a sample of 143 family medicine patients who completed an 88-item anonymous self-administered questionnaire covering symptoms of anxiety and depression as well as CRC screening perceptions (defined based on the Health Belief Model) and behaviors (defined as ever use of or adherence to CRC testing). Moderate-to-clinically significant anxiety and depressive symptoms were, respectively, prevalent in 47% and 42% of participants. Perceived benefits and barriers were the only Health Belief Model constructs associated with anxiety. Perceived barriers were positively associated with anxiety symptoms after adjustment for confounders, including age, gender, race/ ethnicity, marital status, education, smoking history, body mass index and self-rated health. By contrast, perceived benefits were negatively associated with anxiety symptoms only in the unadjusted model. Neither anxiety nor depression was associated with ever use of or adherence to CRC testing. Symptoms of anxiety, but not depression, may potentially influence CRC screening perceptions, with implications for behavioral interventions targeting CRC testing.
文摘An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.
文摘Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of lipoprotein (a) [Lp (a)] and C-reactive protein (CRP) are associated with increased risk of cardiovascular diseases. Objectives: To verify the change in the levels of Lp (a) and ultrasensitive CRP and its relationship with the nutritional status of adolescents. Methods: Cross-sectional study conducted with overweight children and adolescents between August 2012 and July 2013 attended at the Center for Childhood Obesity. The measurement of inflammatory markers was performed in the Clinical Laboratory of the State University of Paraiba. Comparison of sociodemographic variables by sex was tested by chi-square;the association of the risk markers according to age was evaluated by Student’s t test, and the body mass index by analysis of Pearson correlation. The normality distribution was tested by the Kolmogorov-Smirnov test. Confidence interval of 95% was adopted in all analyses. The study was approved by the Ethics Research Committee of UEPB (CAAE 0256.0.133.000-11). Results: Of the 133 children and adolescents evaluated, 60.9% were female and 72.2% were adolescents. Body Mass Index, lipo (a) and u-CRP showed statistically significant association with age (p < 0.01). There was a positive ascending correlation (r = 0.273, p < 0.01) of u-CRP with BMI, which was not verified for lipoprotein (a). Conclusion: As a cardiovascular risk marker already established in literature, the association of u-CRP with the nutritional status of adolescents, proportionally, shows the need for losing weight in this population, especially at early age. A deeper and long-term investigation should be carried out for more effective and consistent contribution to public health.
文摘Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes the installation of atheromatous plaques and, therefore, is considered as an emerging cardiovascular risk factor. Objective: To evaluate the plasma homocysteine levels (Hy) in overweight or obese children and adolescents and their relation with cardiovascular risk factors. Methods: A cross-sectional study was conducted from July 2011 to May 2012 with overweight or obesity children and adolescents aged 2 to 18 years followed at the Center for Childhood Obesity (IOC), Campina Grande-PB. A structured form was used to record demographic, socioeconomic and clinics variables and the patients underwent laboratory tests to define their lipid and glucose profiles and measurement of plasma Hy levels. Results: The study evaluated a total of 165 children and adolescents with mean age of 12.5 (±2.5) years;the majority were female (57.0%). Regarding the lipid profile, there was more individuals with low HDL cholesterol (88.5%). Plasma Hy levels were high in 24.2% of the sample. The mean Hy levels ranged from 4.3 to 18.9 μmol/L, being higher in males, obese adolescents and also in patients with high insulin levels and resistance. Conclusions: The results shown in this study emphasize the importance of detecting and controlling the plasma Hy levels as an independent cardiovascular risk factor, and the need for further studies to evaluate the clinical and biological factors related to alterations in its metabolism.
文摘Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.
文摘In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to 19 years from public schools of Campina Grande, Paraiba, Brazil. The following variables were analyzed: age, gender, ethnicity, maternal education, socioeconomic status, nutritional status, the practice of PA and lipid profile. The variables were obtained through validated form, anthropometry (weight and height) and blood collection by contract laboratory. Double entry and SPSS (Statistical Package for Social Sciences) 22.0 were performed. First, a descriptive analysis of all variables was conducted, as well as measures of central tendency and dispersion for continuous variables. Accordingly, distribution was tested for normality using the Kolmogorov-Smirnov test. According to results, correlation was evaluated by Pearson/Spearman tests. Significance level of 5% was adopted for all analyses. The study was approved by the Ethics Approach Committee (EAC) of the State University of Paraíba. The most prevalent sex in the sample was female and regarding maternal education, 35.4% had complete high school. Regarding serum lipoproteins, 16% showed elevated total cholesterol and HDL (High Density Lipoprotein) 66% below the desired value. With regard to physical activity, 60.8% had insufficient PA levels. The sample showed changes in lipid profile and insufficiently active life style, besides having overpowered the eutrophic nutritional status. No statistically significant correlations between variables of the lipid profile and the time of PA were observed. These findings highlight the importance of physical exercise for maintaining health and suggest studies with larger populations in order to check the scientific literature regarding this topic.
文摘This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had catastrophic effects in Peru. Such a localized El Nio was not documented since 1925. An initial review suggests that in addition to the characteristics of the event(surprise),government responses may have been inadequate(as media reported) because of conflicting forecast reports(U.S. and Peru), which provoked a hydrometeorological debate and stifled decision making. Partly to blame was the El Nio definition problem, which can cause uncertainty and affect perception of risk, depending on which region of the equatorial Pacific one uses to identify an event. Responses were further complicated by the fact that some regions within Peru were experiencing drought prior to the El Nio costero's onset and impacts from the El Nio 2015–2016 were less than expected. Furthermore, a new government was in place, which may have hindered action. Thus, El Nio costero provides lessons to heed, not only with respect to the forecast information, but also with reference to the context of the forecast and disaster setting, which can influence disaster responses to hydrometeorological threats.
