RESUMO
Prevalence estimates of sibling bullying indicate it occurs more frequently and with more negative consequences than peer bullying, yet many countries do not track or investigate the phenomenon. University students from Argentina, Estonia, and the United States were surveyed to investigate their retrospective experiences involving sibling bullying, how often it occurred, the roles held, and the forms communicated. In the aggregated data, roughly 50 % of the sampled emerging adults (N = 3477) reported experience with sibling bullying, with the dual role of bully-victim being the most frequently reported role held by males and females, with the second role being bully for males and victim for females. Verbal forms of bullying were most frequently reported by males and females, with physical, relational, and technological forms occurring less frequently, indicating the importance of studying the messages conveyed during bullying incidents. Variations between biological sex, bullying role and form were detected that indicate siblings experience bullying in ways that are unique from peer bullying. Country comparisons revealed bullying frequencies varied among males and females, suggesting sibling bullying experiences are likely to be culturally influenced. More research is warranted to examine the negative impact bullying has on sibling psycho-social development and the potential transfer to non-familial relationships and contexts. Discussion of these findings and the implications for academics and practitioners alike is provided.
Assuntos
Bullying , Humanos , Masculino , Feminino , Bullying/estatística & dados numéricos , Adulto Jovem , Prevalência , Adulto , Estados Unidos/epidemiologia , Argentina/epidemiologia , Adolescente , Estônia/epidemiologia , Relações entre Irmãos , Estudantes/estatística & dados numéricos , Estudantes/psicologia , Comparação Transcultural , Irmãos , Vítimas de Crime/estatística & dados numéricos , Vítimas de Crime/psicologiaRESUMO
OBJECTIVE: The COVID-19 pandemic has caused a global public health crisis with social, psychological and long-lasting economical damages. Weather-related dynamics have an impact on the pattern of human health and disease. The present study aimed to investigate the impact of heat and humidity on daily basis incidence and mortality due to COVID-19 pandemic in ten of the world's hottest countries compared to ten of the coldest ones. MATERIALS AND METHODS: Worldwide, we selected 20 countries; 10 hottest countries with the highest temperatures and 10 coldest countries with the lowest temperature. The selection of the countries was based on the daily basis mean temperature from the date of appearance of the initial cases of COVID-19, Dec 29, 2019 to May 12, 2020. In the world's 10 hottest countries, the mean temperature was (26.31±1.51) and humidity (44.67±4.97). However, in the world's 10 coldest countries the mean temperature was (6.19±1.61) and humidity (57.26±2.35). The data on the global outbreak of COVID-19, daily new cases and deaths were recorded from World Health Organization, and daily information on temperature and humidity was obtained from metrological web "Time and Date". RESULTS: In countries with high temperatures and low humidity, the mean daily cases incidence were (407.12±24.33); cumulative cases (9094.34±708.29); and cumulative deaths (452.84±43.30) were significantly low compared to countries with low temperatures and high humidity: daily cases (1876.72±207.37); cumulative cases (44232.38±5875.11); and cumulative deaths (2008.29±310.13). Moreover, COVID-19 cases and deaths per million population were significantly low in countries with high temperatures (cases 711.23, and deaths 16.27) compared to countries with low temperatures (cases 1685.99; and deaths 86.40). Furthermore, in hottest countries, a 1% increase in humidity reduced number of cases and deaths by (ß = -5.40, p<0.001) and (ß = -0.187, p=0.004) respectively. A similar trend was seen with a 1°C increase in temperature, reducing the number of deaths by (ß = -1.35. p<0.001). CONCLUSIONS: The results revealed a significant decrease in incidence of daily cases and deaths in countries with high temperatures and low humidity (warmest countries), compared to those countries with low temperatures and high humidity (coldest countries). The findings could be of interest to the policymakers and the health officials on the epidemiological trends of COVID-19 pandemic and weather changes.
Assuntos
Clima , Infecções por Coronavirus/epidemiologia , Temperatura Alta , Umidade , Pneumonia Viral/epidemiologia , Argélia/epidemiologia , Áustria/epidemiologia , Betacoronavirus , COVID-19 , Canadá/epidemiologia , Infecções por Coronavirus/mortalidade , Estônia/epidemiologia , Finlândia/epidemiologia , Gana/epidemiologia , Humanos , Incidência , Índia/epidemiologia , Irã (Geográfico)/epidemiologia , Cazaquistão/epidemiologia , Kuweit/epidemiologia , México/epidemiologia , Mortalidade , Noruega/epidemiologia , Omã/epidemiologia , Paquistão/epidemiologia , Pandemias , Pneumonia Viral/mortalidade , Análise de Regressão , República de Belarus/epidemiologia , Federação Russa/epidemiologia , SARS-CoV-2 , Arábia Saudita/epidemiologia , Suécia/epidemiologia , Emirados Árabes Unidos/epidemiologia , Estados Unidos/epidemiologiaRESUMO
We studied cognitive inhibitory processes and verbal regulation of behavior of individuals with different levels of education (including adult illiterates) in Brazil (N = 136) and in Estonia (N = 560) with person-oriented methods of data analysis. Our aim was to discover whether dominant type of word meaning structure (WMS) can define the "Great Divide", the single breaking point that universally defines certain direction of subsequent to it cultural evolution. We found that both cognitive inhibition of irrelevant for the task at hand information or actions as well as correct activation of relevant information or actions is significantly more common in individuals who rely predominantly on logical concepts in their thinking. The higher level of education was also associated with more efficient cognitive inhibition and activation. The patterns of test performance also suggest that there can be a qualitative difference in the efficiency of cognitive inhibition-activation processes between everyday conceptual and logical conceptual thinkers. The former group of individuals may achieve much higher performance levels than any individual in the former group. We also discuss cognitive similarities and differences between adults with low or no formal education on the one hand and children and educated adults with brain damage on the other. The results are in agreement with the theory of unilineal hierarchic cultural evolution. Individual psychic development and cultural evolution can be both understood in terms of the WMS development.
Assuntos
Inibição Psicológica , Alfabetização , Adulto , Brasil , Criança , Cognição , Estônia , Humanos , Comportamento VerbalRESUMO
We studied visual-perceptual abilities of individuals with different levels of education (including adult illiterates) in Brazil (N = 136) and in Estonia (N = 560) with person-oriented methods of data analysis. Our aim was to discover whether dominant type of word meaning structure (WMS) can define the "Great Divide", the single breaking point that universally defines certain direction of subsequent to it cultural evolution. We particularly focused on the everyday concept-logical concept shift that takes place in the formal education system. We found that logical concepts were rarely available for illiterates; availability of logical conceptual thought increases together with the level of education. Most illiterates were able to find figures of concrete objects from complex overlapping and embedded contour figures but none of them could find all abstract figures from the same complex figures. Also none of the illiterates could perform beyond chance level in both mental rotation tasks together. Ability to perform correctly on all visual-spatial tasks increased with the increase in logical concepts and with the increasing level of education. The distribution of respondents according to the WMS level, level of education, and performance on the visual-spatial tasks indicated that individuals are developmentally heterogeneous: achievement of the tertiary level of education and logical conceptual thinking mechanisms does not guarantee high level performance on the visual-spatial tasks. The results are in agreement with the theory of unilineal hierarchic cultural evolution. Individual psychic development and cultural evolution can be both understood in terms of the WMS development.
Assuntos
Alfabetização , Percepção Visual , Adulto , Brasil , Escolaridade , Estônia , HumanosRESUMO
PURPOSE: Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. METHODS: The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan-Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. RESULTS: Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan-Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). CONCLUSION: In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Quimiorradioterapia , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Carcinoma Pulmonar de Células não Pequenas/terapia , Intervalo Livre de Doença , Estônia , Feminino , Fluordesoxiglucose F18 , Humanos , Processamento de Imagem Assistida por Computador , Índia , Jordânia , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Paquistão , Estudos Prospectivos , Controle de Qualidade , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Resultado do Tratamento , Turquia , VietnãRESUMO
BACKGROUND: Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India. METHODS: This study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective. RESULTS: Adding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability. CONCLUSIONS: Adding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.
Assuntos
Antituberculosos/administração & dosagem , Diarilquinolinas/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/economia , China , Protocolos Clínicos , Análise Custo-Benefício , Diarilquinolinas/economia , Estônia , Custos de Cuidados de Saúde/tendências , Humanos , Índia , Cadeias de Markov , Avaliação de Resultados em Cuidados de Saúde , Peru , Filipinas , Anos de Vida Ajustados por Qualidade de Vida , Federação Russa , África do SulRESUMO
Estonia has a population of 1.3 million, which makes it one of the least populous member states of the European Union. The fertility rate was 1.65 in 2011, and the average age of women at first child birth was 4 years higher than in the early 1990s. Medical care is free for all children in Estonia. For the last 20 years, family doctors have been responsible for the primary care of children. Pediatric subspecialists work mainly in 2 children's hospitals: the Children's Clinic of Tartu University Hospital and Tallinn Children's Hospital. The average duration of hospital stay has decreased year by year. Pediatric subspecialists take care of children with long-term conditions and chronic diseases. In recent years, electronic case reports and digital receipts have been in use in Estonia. New diagnostic tests and expensive medications, which are available, make the cost of medical care very high.
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Serviços de Saúde da Criança , Saúde da Criança , Adolescente , Criança , Pré-Escolar , Estônia , HumanosRESUMO
We summarize the pediatric health care system in Georgia. In the 1990s, the socialist health insurance system was abandoned and replaced by a private health insurance system. In general, Georgia has a relatively high number of physicians per capita, and there are 3 times as many physicians per unit of population in Tbilisi than in other region. Furthermore, the country's universities produce far more physicians than needed. Currently, there are approximately 3000 pediatricians. The Georgian National Center of Disease Control provides guidelines for early detection and screening of diseases, immunization, and mother and child health care. Although Georgia has a limited health budget, it has performed major health reforms. It aims at achieving the highest possible standard of care for children with chronic and disabling conditions, however, future development will depend on the access to more advanced diagnostic and therapeutic technologies.
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Serviços de Saúde da Criança , Atenção à Saúde , Criança , Pré-Escolar , Estônia , HumanosRESUMO
Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ART among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33 to 97 %; mean weighted adherence was 72 %. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ART.