Struggling to Stay Out of High-Poverty Neighborhoods: Lessons From the Moving to Opportunity Experiment

Analyzes the later relocation patterns of families who moved out of high-poverty areas in the Moving to Opportunity program, and explores the reasons why many returned to poorer neighborhoods over time while others remained in low-poverty areas

A concordância verbal de primeira pessoa do plural em áreas rurais do Rio de Janeiro

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The psychiatric phenotype in Huntington's disease

Psychiatric symptoms are more prevalent in Huntington's disease (HD) than the general population, but reasons for this are unknown. The primary aim of this research was to investigate possible familial influences on the psychiatric phenotype in HD. 96 gene positive and 5 gene negative siblings were recruited from 50 HD families throughout the UK and underwent a lifetime psychiatric history assessment using semi-structured interview and case-note review. Gene positive index individuals had high lifetime rates of depressive (56%) and anxiety (38%) disorders. Their depressive episodes were less severe and more frequent with an older age of onset and fewer biological symptoms than individuals with depression without HD. Within gene positive sibling-pairs (n=53), there was significant familial aggregation of the presence (ĸ=0.46, $p$=0.004) and course (ICC=0.47, $p$=0.002) of depressive disorders and the presence of irritability (ĸ=0.357, $p$=0.024) and aggression (ĸ=OJ84, $p$=O.Ol6). Two gene negative siblings had lifetime psychiatric diagnoses. The high prevalence of psychiatric co-morbidity in HD cannot be entirely explained by the HD gene. Familial factors, most likely other genetic factors, are likely to play a role. Further research into the contribution of biological and environmental factors to the psychiatric phenotype in large samples of individuals with HD is warranted

O standard probatório para a decisão de recebimento da denúncia

The Federal Constitution represents the guiding scope of our legal system, so that all legal rules must observe their precepts to be considered constitutional, especially the principle of the Presumption of Innocence, in the case of the criminal procedural system. The mere outbreak of a criminal action has the ability to change the dignitatis status of individuals, so that it can only be managed when justified, which, in terms of logical probability, should occur when the politically chosen standard of evidence is reached. by the legal system Thus, based on a diversified bibliographic review on the subject, the present work aims to immerse in the contours necessary for a decision that chooses to receive the complaint offered by the accusatory body. In this context, there is a need to investigate the probative standard to be operationalized in the decision to receive the complaint, in order to allow the initial accusatory hypothesis to be considered as sufficiently demonstrated, which, in general, is close prevailing probability - more likely than not.A Constituição Federal representa o escopo orientativo de nosso ordenamento jurídico, de modo que todas as normas jurídicas deverão observar os seus preceitos para serem consideradas constitucionais, em especial o princípio da Presunção da Inocência, no caso do sistema processual penal. A mera deflagração de uma ação penal tem o condão de alterar o status dignitatis dos indivíduos, de modo que somente pode ser manejada quando justificada, o que, em termos de probabilidade lógica, deverá ocorrer quando se alcançar o standard de prova escolhido, politicamente, pelo sistema jurídico. Assim, a partir de uma revisão bibliográfica diversificada sobre o tema, o presente trabalho tem o objetivo de imiscuir nos contornos necessários para uma decisão que optar por receber a denúncia oferecida pelo órgão acusatório. Nesse contexto, surge-se a necessidade de se investigar qual o standard probatório a ser operacionalizado na decisão de recebimento da denúncia, de modo a permitir que seja considerado como suficientemente demonstrada a hipótese acusatória inicial, o qual, em linhas gerais, aproxima-se da probabilidade prevalente - mais provável que não

Análise de lesões de furca em molares por tomografia computadorizada de feixe cônico

Furcation lesions are characterized by bone resorption and attachment loss into the interradicular space. Accurate diagnosis of periodontal disease affecting the furcation area requires periodontal examination and imaging. Cone beam computed tomography (CBCT) is capable of generating accurate and reliable submillimeter resolution images in all space dimensions and plays a role in the evaluation and treatment planning of molars with furcation (FL) damage. PROPOSITION: Evaluate tomographic aspects of furcation lesions, measure attachment loss and rank the FL. METHODOLOGY: retrospective observational crosssectional study, CBCT scans were analyzed with a sample consisting of 560 teeth of patients of both sexes, aged between 30 and 70 years. Bone loss in height/width/depth of the interradicular area was analyzed, based on this measurement, it was classified into degrees I, II and III and its prevalence was evaluated according to its distribution by sex and age, and the most affected teeth. RESULTS: FL grade II were the most observed in both upper and lower molars. The group of teeth most affected by FL were the upper molars, most frequently in females in group I (41-50 years), classified as grade II in buccal and distal furcations and grade I in mesial furcations. In lower molars, the highest frequency was FL grade II in females in groups 1 (30- 40 years) and 2 (41-50 years) and, FL grade III in males in group III (51-70 years). CONCLUSION: CBCT proved to be effective for the diagnosis of FL and may contribute to an accurate diagnosis and consequent better treatment plan.As lesões de furca (LF) se caracterizam pela reabsorção óssea e perda de inserção no espaço interradicular. O diagnóstico preciso da doença periodontal que afeta a área da furca requer exame periodontal e de imagem. Tomografia computadorizada de feixe cônico (TCFC) é capaz de gerar imagens de resolução submilimétricas precisas e confiáveis em todas as dimensões espaciais, desempenhando um papel na avaliação e planejamento do tratamento em molares com LF. PROPOSIÇÃO: Avaliar os aspectos tomográficos da LF, mensurar a perda de inserção e classificá-las. METODOLOGIA: estudo retrospectivo observacional transversal, foram analisados exames de TCFC com amostra de 560 dentes de pacientes de ambos os sexos, com idade de 30 a 70 anos. Foram analisadas a perda óssea em altura/largura/profundidade da região interradicular, a partir desta mensuração foram classificadas em graus I, II, III e sua prevalência foi avaliada de acordo com sua distribuição por sexo, idade e dentes mais afetados. RESULTADO: LF grau II foram mais observadas em molares superiores inferiores. O grupo de dentes mais acometido foram os molares superiores com maior frequência no sexo feminino no grupo I (41-50anos), classificadas em grau II nas furcas vestibulares e distais e grau I nas furcas mesiais. Nos molares inferiores, maior frequência foi de grau II do sexo feminino nos grupos 1(30-40 anos) e 2 (41-50 anos) e grau III no sexo masculino no grupo III (51-70 anos). CONCLUSÂO: TCFC se mostrou efetiva para o diagnóstico das LF, podendo contribuir para um preciso diagnóstico e melhor plano de tratamento

A scoping umbrella review to identify anti-racist interventions to reduce ethnic disparities in health and care

Objectives: To identify anti-racist interventions which aim to reduce ethnic disparities in health and care. / Eligibility criteria for selecting studies: Only studies reporting systematic reviews of anti-racist interventions were included. Studies were excluded if no interventions were reported, no comparators reported, or the paper was primarily descriptive. / The following databases were searched: Embase, Medline, Social Policy and Practice, Social care online and Web of Science. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. Due to the nature of the selected reviews, the lack of meta-analyses and heterogeneity of included studies, a narrative synthesis using an inductive thematic analysis approach was conducted to integrate and categorise the evidence on anti-racist interventions for health and care. / Results: A total of 18 systematic reviews are included in the final review. 15 are from the healthcare sector and three are from education and criminal justice. 17 reviews are focused on interventions and one focused on implementation. All 18 reviews described interventions which targeted individuals and their communities, and 11 reviews described interventions targeting both individuals and communities, and healthcare organisations. On an individual level, the most promising interventions reviewed include group-based health education led by professional staff and providing culturally tailored or adapted interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority groups may provide an effective approach to reducing ethnic health disparities. Targeted interventions to improve clinician patient interactions and quality of care for conditions with disproportionately worse outcomes in ethnic minority groups show promise. / Discussion: Many of the included studies were low or critically low quality due to methodological or reporting limitations. The heterogeneity of intervention approaches, study designs, and limited reporting of cultural adaptation, implementation and lack of comparison with White ethnic groups limited our understanding of the impact on ethnic health inequalities. In summary, for programme delivery, different types of pathway integration and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on patient education and individual behaviour change rather than organisational change, and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multi-level approach

ASSOCIATION BETWEEN FUNCTIONAL CAPACITY AND HANDGRIP STRENGTH IN PEOPLE WITH DIABETES MELLITUS

Objective: to investigate the association between handgrip strength and functional capacity in people with diabetes.Method: observational cross-sectional study with 168 participants seen at an outpatient clinic in Curitiba, Brazil, in 2019. Clinical, sociodemographic, and socioeconomic data were collected, and the following protocols were applied: World Health Organization Disability Assessment Schedule; Timed Up and Go; and dynamometry. For the analysis, multiple linear regression models were adjusted for the dependent variables related to functional capacity.Results: we observed mild disability, borderline functional mobility, and higher correlation between functional mobility scale and handgrip strength (r=-0.384; p < 0.01). Handgrip strength with other covariates explained less than 30% of the functional variability.Conclusion: these results contribute to the problem-solving of clinical practice in that they show that muscle strength and functional capacity should be considered in the evaluation of the patient in combination, making it clearer and more comprehensive.

The burden of psychotropic and anticholinergic medicines use in care homes:population-based analysis in 147 care homes

Background: older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. Methods: anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. Results: 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23–1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51–0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20–1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56–0.79). There was no association with care-home regulator quality scores. Conclusion: care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed