In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are ...reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.
•Fundamental Cause Theory (FCT) explains health inequality persistence.•Preventive innovations influence health disparities over time.•Study uses data from U.S. health surveys to analyze innovation diffusion.•Educational inequalities in health outcomes change with innovation diffusion.•Findings support the idea of substitution in mediating mechanisms.
To gather consensus on professional competencies and basic public health content for the degree program in Human Nutrition and Dietetics (HND).
In 2018, the Fifth Meeting of University Public Health ...Professors took place in Zaragoza (Spain). Fourteen lecturers in the HND degree program participated from 11 Spanish universities. They identified competencies and basic content for training for the HND degree using group dynamics and consensus strategies.
The professors identified 51 basic competencies, distributed in the areas of "evaluation of population health needs" (n = 20), "development of health policies" (n = 23), and "guaranteeing provision of health care services" (n = 8). In order to reach these competencies, 35 topics were proposed organized into six thematic blocks: foundations of public health, nutritional epidemiology, health problems and diet and nutrition strategies, food security, health in all policies and health promotion and education.
The consensus reached serves as a reference to orient and update public health education as a part of the HND degree.
Empiric circumferential pulmonary vein isolation (CPVI) has become the therapy of choice for drug-refractory atrial fibrillation (AF). Although results are suboptimal, it is unknown whether ...mechanistically-based strategies targeting AF drivers are superior.
This study sought to determine the efficacy and safety of localized high-frequency source ablation (HFSA) compared with CPVI in patients with drug-refractory AF.
This prospective, multicenter, single-blinded study of 232 patients (age 53 ± 10 years, 186 males) randomized those with paroxysmal AF (n = 115) to CPVI or HFSA-only (noninferiority design) and those with persistent AF (n = 117) to CPVI or a combined ablation approach (CPVI + HFSA, superiority design). The primary endpoint was freedom from AF at 6 months post-first ablation procedure. Secondary endpoints included freedom from atrial tachyarrhythmias (AT) at 6 and 12 months, periprocedural complications, overall adverse events, and quality of life.
In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months after a single procedure but, after redo procedures, was noninferior to CPVI at 12 months for freedom from AF and AF/AT. Serious adverse events were significantly reduced in the HFSA group versus CPVI patients (p = 0.02). In persistent AF, there were no significant differences between treatment groups for primary and secondary endpoints, but CPVI + HFSA trended toward more serious adverse events.
In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months but was noninferior to CPVI at 1 year in achieving freedom of AF/AT and a lower incidence of severe adverse events. In persistent AF, CPVI + HFSA offered no incremental value. (Radiofrequency Ablation of Drivers of Atrial Fibrillation RADAR-AF; NCT00674401).
Tilt testing remains a valuable asset Sutton, Richard; Fedorowski, Artur; Olshansky, Brian ...
European heart journal,
05/2021, Letnik:
42, Številka:
17
Journal Article
Recenzirano
Odprti dostop
Abstract
Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, ...and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.
Graphical Abstract
Literature suggests that urban regeneration policies might contribute towards improving mental health of residents, but to date there is a lack of empirical research on how these policies and ...downward social mobility can interact and influence health outcomes. The current study aims to explicitly test whether regeneration policies implemented in deprived Andalusian urban places (southern Spain) moderate the use of anxiolytics and/or antidepressants, taking into consideration families’ downward social mobility during the recent period of economic crisis in Spain. We designed a post intervention survey to retrospectively compare the evolution of psychotropic drug consumption in target and comparison areas. We observe a general increase in the use of anxiolytics and/or antidepressants from 2008 to 2015, specifically for people in whose families the economic crisis had the greatest impact (odds ratio = 2.18;
p
value < 0.001). However, better evolution is observed among residents of the target areas compared with residents of similar urban areas where this kind of polices have been not in force (odds ratio = 0.50;
p
value < 0.05). Therefore, urban regeneration policies might act as moderators of the risk of mental health, particularly when people are subject to the loss of individual/family resources in urban vulnerable contexts.
In this study, the characteristic frequencies of the electrochemical impedance of ion-exchange membrane systems constituted by the membrane and two diffusion boundary layers adjacent to the membrane ...were investigated. Approximations of the impedance of the Randles equivalent electric circuit in multiple frequency ranges were considered, and the characteristic frequencies of the zeros and poles of orders ½ and 1 were derived. The characteristic geometric frequencies, those associated with the interfacial charge transfer and the diffusive transport processes, as well as those associated with the transitions between processes, were identified by means of analytical expressions.
A growing research agenda shows the importance of local welfare systems in understanding socio-spatial inequalities in health. Welfare services provided by local governments overlap with those ...provided by other levels of government. Thus, differences in the provision of welfare services between municipalities could explain differences in residents' health, moderating the magnitude of health inequalities if local governments deploy actions capable of positively influencing the social determinants of health. This article attempts to analyse this idea in the Spanish case, exploring the influence of local policies according to the orientation of municipal spending on three indicators of the population's health status: self-perceived health, healthy practices and activity limitations due to health problems. A multilevel cross-sectional study was designed using information from two waves of the 2006-2007 and 2011-2012 National Health Survey for the population aged 15 years and older (N = 31,378) residing in Spanish municipalities of 20,000 inhabitants or over (N = 373). The results show that the magnitude of inequalities in self-perceived health, in the adoption of healthy practices and in daily activity limitations by social class are smaller as municipalities" spending was oriented towards policy areas considered as redistributive. Therefore, the proposed institutional overlap thesis could help understand the role of subnational governments on the magnitude of health inequalities, as well as in comparative analysis between countries with institutional systems in which local governments have a greater or lesser capacity to provide welfare services.
To explore trends in childhood overweight/obesity according to socio-economic status and in relation to the preventive effort developed by the Spanish autonomous regions.
A series of multilevel ...cross-sectional studies were conducted using data from different waves of the Spanish National Health Survey, namely 2003, 2006, 2011 and 2017. Hierarchical logistic regression models were estimated, with individuals (level 1) nested within the region-period of study (level 2) and these, in turn, within the region (level 3). The main independent variables were the average effort made by the Spanish autonomous regions in child overweight-obesity prevention policies and the change in the effort made in these policies over the periods studied.
The likelihood of obesity and/or overweight increases substantially if the adult respondent in the household is also obese or overweight. The joint effect of the policies implemented by the autonomous regions is associated with a significant decrease in prevalence only for children belonging to high and middle social classes (odds ratio OR: 0.89, 95% confidence interval 95%CI: 0.82-0.96, and OR: 0.93, 95%CI: 0.88-0.97, respectively).
The policies implemented by the Spanish autonomous regions seem to have a limited capacity to achieve significant reductions in the prevalence of childhood overweight and obesity. The results suggest that it is the middle and upper-middle class groups that seem to benefit most from these policies, which could indirectly contribute to increasing inequalities in childhood obesity.
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