Housing Characteristics and Satisfaction of the Elderly in Low-Income Rural Areas

Housing, Design and Consumer Resource

Estudio del valor turístico de los Recursos Naturales y Culturales de la comunidad de Iruguincho, parroquia San Blas, cantón Urcuquí, Provincia de Imbabura

Diagnosticar el valor turístico de los recursos naturales y culturales de la comunidad.El presente trabajo de investigación se enfocó en el estudio del valor turístico de los recursos naturales y culturales de la comunidad de Iruguincho mediante la identificación y análisis de las características intrínsecas y extrínsecas de los diferentes recursos, ya que uno de los inconvenientes que se reflejó es el desconocimiento de este lugar por parte de la comunidad y ciudadanía, debido a la no promoción y difusión de los atractivos que esta posee por la falta de gestión de las autoridades locales, problemática identificada durante la investigación. Para la realización de este trabajo se utilizó el tipo de investigación documental, de campo y descriptiva a través de la aplicación de encuestas y fichas de observación como instrumentos principales, mismos que permitieron recolectar información para determinar las dificultades de la comunidad en el aspecto turístico. Los resultados obtenidos en esta investigación son: Recursos turísticos con gran potencial que no han sido aprovechados por desconocimiento, por esta razón se procede a diseñar una propuesta que permita corregir los problemas identificados para de esta manera dar a conocer a esta comunidad como destino turístico con objetivos claros y precisos. El aprovechar todo el potencial turístico como es la flora, fauna que se pueden observar desde que inicia su recorrido hasta llegar al destino turístico motiva a valorar, conservar los recursos turísticos naturales y culturales a propios y extraños. Propuesta plasmada en una revista documentada y digitalizada permite dar a conocer a propios y extraños los recursos turísticos de la comunidad con emprendimientos y actividades turísticas que contribuye a mejorar la calidad de vida de los pobladores a través de alternativas de aprovechamiento razonable conservando la riqueza cultural y natural, pensando en las futuras generaciones. Iruguincho de esta manera será considera como destino turístico, con un gran potencial que le va a generar recursos económicos a los habitantes de la comunidad. El diseño de esta propuesta guía a los habitantes de la comunidad a beneficiarse de los recursos turísticos y darlos a conocer dentro y fuera de la provincia.Ingenierí

Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

The Role of Health Promotion in Physical Therapy

Purpose: The purpose of this study was to investigate physical therapy practice patterns in four focus areas of Healthy People 2010 (focus area #6, disability and secondary conditions by looking at psychological well-being; focus area #19, nutrition and overweight; focus area #22, physical fitness and activity; focus area #27, tobacco use) and identify self-efficacy and outcome expectations related to those practice patterns across California, New York and Tennessee using Bandura’s Social Cognitive Theory as a framework. It was hypothesized that physical therapists’ self-efficacy and outcome expectations in the four focus areas of Healthy People 2010 would be significantly associated with and predict health promotion practice patterns. Method: The study employed a cross-sectional observational design and utilized a survey designed, pilot-tested, and distributed to 3,500 randomly selected, licensed physical therapists from three states in two waves of data collection: 1,050 from California, 1,200 from New York, and 1,250 from Tennessee. Interviews to saturation were conducted randomly via phone within all three states to facilitate creation of the survey and the pilot test was conducted with 23 physical therapists in the Loma Linda area. Results: The health promotion behavior most commonly practiced by physical therapists was assisting patients to increase physical activity (54%), followed by psychological well-being (41%), nutrition and/or overweight issues (19%) and smoking cessation (17%). Physical therapists health promotion behaviors varied between states in the area of psychological well-being (p=.011), with CA being significantly higher than NY. No significant differences in the areas of physical activity, nutrition and overweight and smoking cessation were noted. Self-efficacy was significantly associated with all four behaviors beyond age, gender, ethnicity, hours/week working, year of graduation, number of years working in current setting, patients seen per hour. highest PT degree obtained and school setting with pediatric type patients. Conclusion: Physical therapists address health promotion topics during practice in varying degrees and in lower than desirable percentages. This study demonstrated that a physical therapist’s confidence in being able to perform a specific behavior (selfefficacy) and the expected results of that behavior (outcome expectation) were related to the frequency the health promotion behavior occurred in each of the four focus areas of Healthy People 2010. Furthermore, self-efficacy alone predicted behavior in all four focus areas when all other variables were controlled. By targeting the factors that improve self-efficacy and outcome expectation in the four focus areas, the potential to increase the percentage of physical therapists that practice health promotion behaviors with patients is high

Household transmission of SARS, 2003

BACKGROUND: In the 2003 outbreak in Toronto (in Ontario, Canada) of severe acute respiratory syndrome (SARS), about 20% of cases resulted from household transmission. The purpose of our study was to determine characteristics associated with the transmission of SARS within households. METHODS: A retrospective cohort of SARS-affected households was studied to determine risk factors for household transmission. Questionnaires addressed characteristics of the index case, the household and behaviours among household members. Potential risk factors for secondary transmission of infection were assessed in regression models appropriate to the outcome (secondary cases) and nonindependence of household members. RESULTS: The 74 households that participated included 18 secondary cases and 158 uninfected household members in addition to the 74 index cases. The household secondary attack rate was 10.2% (95% confidence interval [CI] 6.7%–23.5%). There was a linear association between the time the index patient spent at home after symptom onset and the secondary attack rate. Infected health care workers who were index cases had lower rates of household transmission. INTERPRETATION: SARS transmission in households is complex and increases with the length of time an ill person spends at home. Risk of transmission was lower when the index case was a health care worker. Rapid case identification is the public health measure most useful in minimizing exposure in the home

Supplemental Material - Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment

Supplemental Material for Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment by John H. Kelly, MD, MPH, DipABLM, FACLM, Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM, Dexter Shurney, MD, MBA, MPH, FACLM, DipABLM, Sley Tanigawa Guimarães, MD, DipIBLM, Mechelle Palma, MD, MMHA, DipIBLM, FACLM, Caldwell Esselstyn, MD, FACLM, Scott Stoll, MD, FABPMR, Padmaja Patel, MD, FACLM, DipABLM, Brenda Rea, MD, DrPH, PT, RD, FACLM, Koushik Reddy, MD, FACC, FACLM, DipABLM, George Guthrie, MD, MPH, CDCES, CNS, FAAFP, FACLM, Michelle Reiss, MBChB, LMCC, CCFP, FRACGP, FASLM, and Micaela C. Karlsen, PhD, MSPH in American Journal of Lifestyle Medicine.</p