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1.
JAMA Netw Open ; 7(3): e242388, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38488794

RESUMO

Importance: Screening unselected populations for clinically actionable genetic disease risk can improve ascertainment and facilitate risk management. Genetics visits may encourage at-risk individuals to perform recommended management, but little has been reported on genetics visit completion or factors associated with completion in genomic screening programs. Objective: To identify factors associated with postdisclosure genetics visits in a genomic screening cohort. Design, Setting, and Participants: This was a cohort study of biobank data in a health care system in central Pennsylvania. Participants' exome sequence data were reviewed for pathogenic or likely pathogenic (P/LP) results in all genes on the American College of Medical Genetics and Genomics Secondary Findings list. Clinically confirmed results were disclosed by phone and letter. Participants included adult MyCode biobank participants who received P/LP results between July 2015 and November 2019. Data were analyzed from May 2021 to March 2022. Exposure: Clinically confirmed P/LP result disclosed by phone or letter. Main Outcomes and Measures: Completion of genetics visit in which the result was discussed and variables associated with completion were assessed by electronic health record (EHR) review. Results: Among a total of 1160 participants (703 [60.6%] female; median [IQR] age, 57.0 [42.1-68.5] years), fewer than half of participants (551 of 1160 [47.5%]) completed a genetics visit. Younger age (odds ratio [OR] for age 18-40 years, 2.98; 95% CI, 1.40-6.53; OR for age 41-65 years, 2.36; 95% CI, 1.22-4.74; OR for age 66-80 years, 2.60; 95% CI, 1.41-4.98 vs age ≥81 years); female sex (OR, 1.49; 95% CI, 1.14-1.96); being married (OR, 1.74; 95% CI, 1.23-2.47) or divorced (OR, 1.80; 95% CI, 1.11-2.91); lower Charlson comorbidity index (OR for score of 0-2, 1.76; 95% CI, 1.16-2.68; OR for score of 3-4, 1.73; 95% CI, 1.18-2.54 vs score of ≥5); EHR patient portal use (OR, 1.42; 95% CI, 1.06-1.89); living closer to a genetics clinic (OR, 1.64; 95% CI, 1.14-2.36 for <8.9 miles vs >20.1 miles); successful results disclosure (OR for disclosure by genetic counselor, 16.32; 95% CI, 8.16-37.45; OR for disclosure by research assistant, 20.30; 95% CI, 10.25-46.31 vs unsuccessful phone disclosure); and having a hereditary cancer result (OR, 2.13; 95% CI, 1.28-3.58 vs other disease risk) were significantly associated with higher rates of genetics visit completion. Preference to follow up with primary care was the most common reported reason for declining a genetics visit (68 of 152 patients [44.7%]). Conclusions and Relevance: This cohort study of a biobank-based population genomic screening program suggests that targeted patient engagement, improving multidisciplinary coordination, and reducing barriers to follow-up care may be necessary for enhancing genetics visit uptake.


Assuntos
Genômica , Neoplasias , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Idoso , Idoso de 80 Anos ou mais , Masculino , Estudos de Coortes , Genômica/métodos , Exoma , Pennsylvania
2.
BMC Health Serv Res ; 24(1): 336, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481315

RESUMO

BACKGROUND: Recruiting large cohorts efficiently can speed the translation of findings into care across a range of scientific disciplines and medical specialties. Recruitment can be hampered by factors such as financial barriers, logistical concerns, and lack of resources for patients and clinicians. These and other challenges can lead to underrepresentation in groups such as rural residents and racial and ethnic minorities. Here we discuss the implementation of various recruitment strategies for enrolling participants into a large, prospective cohort study, assessing the need for adaptations and making them in real-time, while maintaining high adherence to the protocol and high participant satisfaction. METHODS: While conducting a large, prospective trial of a multi-cancer early detection blood test at Geisinger, an integrated health system in central Pennsylvania, we monitored recruitment progress, adherence to the protocol, and participants' satisfaction. Tracking mechanisms such as paper records, electronic health records, research databases, dashboards, and electronic files were utilized to measure each outcome. We then reviewed study procedures and timelines to list the implementation strategies that were used to address barriers to recruitment, protocol adherence and participant satisfaction. RESULTS: Adaptations to methods that contributed to achieving the enrollment goal included offering multiple recruitment options, adopting group consenting, improving visit convenience, increasing the use of electronic capture and the tracking of data and source documents, staffing optimization via leveraging resources external to the study team when appropriate, and integrating the disclosure of study results into routine clinical care without adding unfunded work for clinicians. We maintained high protocol adherence and positive participant experience as exhibited by a very low rate of protocol deviations and participant complaints. CONCLUSION: Recruiting rapidly for large studies - and thereby facilitating clinical translation - requires a nimble, creative approach that marshals available resources and changes course according to data. Planning a rigorous assessment of a study's implementation outcomes prior to study recruitment can further ground study adaptations and facilitate translation into practice. This can be accomplished by proactively and continuously assessing and revising implementation strategies.


Assuntos
Detecção Precoce de Câncer , Testes Hematológicos , Humanos , Pennsylvania , Estudos Prospectivos , Neoplasias
3.
Crit Care Nurs Q ; 47(2): 102-110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38419173

RESUMO

In Pittsburgh, Pennsylvania, the skies have become a battleground against time in a world where every second counts. Since its inception in 1978, a revolution has occurred in emergency medical services, with LifeFlight Helicopters soaring to new heights in emergency treatment and transport. This article will explore the transformation of helicopter emergency medical services through the decades, where every rotor blade spins with a mission to save lives and rewrite the rules of survival. Allegheny Health Network's LifeFlight is a rotor-wing (helicopter) aeromedical transport service that provides rapid emergent transport for critically ill and injured persons. The program hub of operations is primarily in Western Pennsylvania. Since its inception in 1978, the program has grown and transformed into the sophisticated, highly technical, expanded scope of practice, critical care transport service it is today. The crews spend a significant portion of clinical care focusing on preparing the patient to survive the transport and ensure stability during transit; this phase of transport is equally crucial as the patient care during the actual flight. This article introduces the evolution and innovations that LifeFlight's medical crews and aviation practices have undergone since the program started.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Cuidados Críticos , Pennsylvania , Estado Terminal
4.
Health Aff (Millwood) ; 43(2): 287-296, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38315934

RESUMO

Landlords are essential actors within the rental housing market, and there is much to be learned about their willingness to participate in rental assistance programs that improve access to stable housing. Because the success of these programs, such as the Mobility (Location-Based) Voucher program in Pittsburgh, Pennsylvania, can be derailed by landlord opposition, it is important to test strategies that increase landlords' participation. Using data from a unique survey of Pittsburgh landlords, we found that exposing landlords to an asset-framing narrative that highlighted the social, economic, and health benefits of receiving a mobility voucher increased landlords' reported willingness to rent to a mobility voucher recipient by 21 percentage points. Reported willingness was also higher among landlords who believed that housing affordability was connected to health. Our findings offer insight into how to increase landlords' participation in affordable housing programs that require their engagement to succeed.


Assuntos
Habitação , Humanos , Custos e Análise de Custo , Pennsylvania
5.
Pediatrics ; 153(2)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38192230

RESUMO

BACKGROUND AND OBJECTIVES: There are well-documented links between structural racism and inequities in children's opportunities. Yet, when it comes to understanding the role of the built environment, a disproportionate focus on redlining obscures other historical policies and practices such as blockbusting, freeway displacement, and urban renewal that may impact contemporary child development. We hypothesized that historical structural racism in Allegheny County, Pennsylvania's, built environment would be associated with fewer contemporary educational, socioeconomic, and health opportunities. We also hypothesized that these measures would explain more collective variance in children's opportunities than redlining alone. METHODS: We used geospatial data from the US Census, Mapping Inequality Project, and other archival sources to construct historical measures of redlining, blockbusting, freeway displacement, and urban renewal in ArcGIS at the census tract level. These were linked with data from the Child Opportunity Index 2.0 to measure children's opportunities across domains of education, socioeconomic status, and health. We ran spatial regression analyses in Stata 18.0 to examine individual and collective associations between structural racism and children's opportunities. RESULTS: Historical redlining, blockbusting, and urban renewal were largely associated with fewer contemporary educational, socioeconomic, and health opportunities, and explained up to 47.4% of the variance in children's opportunities. The measures collectively explained more variance in children's opportunities than redlining alone. CONCLUSIONS: In support of our hypotheses, novel measures of structural racism were related to present-day differences in children's opportunities. Findings lay the groundwork for future research focused on repairing longstanding harm perpetuated by structural racism.


Assuntos
Racismo , Racismo Sistêmico , Criança , Humanos , Desenvolvimento Infantil , Classe Social , Pennsylvania , Ambiente Construído , Características de Residência
6.
J Surg Res ; 296: 249-255, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38295712

RESUMO

INTRODUCTION: Geriatric patients (GeP) often experience increased morbidity and mortality following traumatic insult and as a result, require more specialized care due to lower physiologic reserve and underlying medical comorbidities. Motorcycle injuries (MCCI) occur across all age groups; however, no large-scale studies evaluating outcomes of GeP exist for this particular subset of patients. Data thus far are limited to elderly participation in recreational activities such as water and alpine skiing, snowboarding, equestrian, snowmobiles, bicycles, and all-terrain vehicles. We hypothesized that GeP with MCCI will have a higher rate of mortality when compared with their younger counterparts despite increased helmet usage. METHODS: We performed a multicenter retrospective review of MCCI patients at three Pennsylvania level I trauma centers from January 2016 to December 2020. Data were extracted from each institution's electronic medical records and trauma registry. GeP were defined as patients aged more than or equal to 65 y. The primary outcome was mortality. Secondary outcomes included ventilator days; hospital, intensive care unit, and intermediate unit length of stays; complications; and helmet use. 3:1 nongeriatric patients (NGeP) to GeP propensity score matching (PSM) was based on sex, abbreviated injury scale (AIS), and injury severity score (ISS). P ≤ 0.05 was considered significant. RESULTS: One thousand five hundred thirty eight patients were included (GeP: 7% [n = 113]; NGP: 93% [n = 1425]). Prior to PSM, GeP had higher median Charlson Comorbidity Index (GeP: 3.0 versus NGeP: 0.0; P ≤ 0.001) and greater helmet usage (GeP: 73.5% versus NGeP: 54.6%; P = 0.001). There was a statistically significant difference between age cohorts in terms of ISS (GeP: 10.0 versus NGeP: 6.0, P = 0.43). There was no significant difference for any AIS body region. Mortality rates were similar between groups (GeP: 1.7% versus NGeP: 2.6%; P = 0.99). After PSM matching for sex, AIS, and ISS, GeP had significantly more comorbidities than NGeP (P ≤ 0.05). There was no difference in trauma bay interventions or complications between cohorts. Mortality rates were similar (GeP: 1.8% versus NGeP: 3.2%; P = 0.417). Differences in ventilator days as well as intensive care unit length of stay, intermediate unit length of stay, and hospital length of stay were negligible. Helmet usage between groups were similar (GeP: 64.5% versus NGeP: 66.8%; P = 0.649). CONCLUSIONS: After matching for sex, ISS, and AIS, age more than 65 y was not associated with increased mortality following MCCI. There was also no significant difference in helmet use between groups. Further studies are needed to investigate the effects of other potential risk factors in the aging patient, such as frailty and anticoagulation use, before any recommendations regarding management of motorcycle-related injuries in GeP can be made.


Assuntos
Motocicletas , Ferimentos e Lesões , Idoso , Humanos , Pennsylvania/epidemiologia , Tempo de Internação , Centros de Traumatologia , Estudos Retrospectivos , Escala de Gravidade do Ferimento , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
7.
Vaccine ; 42(3): 564-572, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38195264

RESUMO

OBJECTIVES: To identify strategies community pharmacists utilized to support equitable vaccination in their communities. STUDY DESIGN: Qualitative, descriptive design. METHODS: Key informant interviews were conducted virtually via teleconference using a mix of purposeful and snowball sampling of Pennsylvania community pharmacy personnel who participated in COVID-19 vaccination efforts. Interviews were conducted from March until August 2022 when thematic saturation was reached. A qualitative, inductive thematic data analysis was utilized to identify major themes and strategies that emerged from the data. RESULTS: Pharmacists utilized three philosophies: (1) prioritizing trust, (2) meeting people where they are at, and (3) building capacity within their teams and communities to create "safe spaces" for people to receive vaccinations. Nine discrete strategies used in practice exemplify how respondents implemented these philosophies: (1) Build Community Partnerships; (2) Establish Trust to Build Credibility; (3) Address Transportation Issues; (4) Provide Patient Education and Address Health Literacy Barriers; (5) Address Language Barriers; (6) Create a Safe and Accessible Space for Those with Individualized Needs; (7) Provide Patient-Centered and Culturally-Sensitive Care; (8) Train Staff on Health Equity and Patient Engagement; and (9) Advocate for Community Pharmacy Policy and Payment Reform. Definitions for these philosophies and key examples that illustrate how each strategy was employed in practice are provided. CONCLUSION: The findings highlight unique strategies respondent community-based pharmacy teams use to contribute to equitable vaccination efforts in communities and further emphasizes the importance of their role in public health initiatives.


Assuntos
Serviços Comunitários de Farmácia , Farmácias , Humanos , Vacinas contra COVID-19 , Farmacêuticos , Pennsylvania , Vacinação
8.
JAMA Otolaryngol Head Neck Surg ; 150(3): 217-225, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38236596

RESUMO

Importance: Single sensory impairment is associated with reduced functional resilience and increased mortality, though the effects of multiple sensory deficits are not known. Objective: To investigate longitudinal associations of the type, severity, and number of sensory impairments with physical function trajectories and mortality in older adults. Design, Setting, and Participants: This retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporated data from April 1997 to July 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort comprised 3075 men and women, aged 70 to 79 years at baseline, residing in Memphis, Tennessee, and Pittsburgh, Pennsylvania. All participants with complete sensory testing and covariate data at analytical baseline (year 5, 2002) were included. The data were analyzed September 1, 2022. Exposures: Visual, olfactory, auditory, and touch sensory functions were assessed between 2000 and 2002. Main Outcomes: The main outcomes included physical functioning trajectories and mortality risk. Physical function was assessed longitudinally using the Health ABC physical performance battery (HABCPPB). Results: A total of 1825 individuals (mean [SD] age, 77.4 [3.2] years; 957 [52%] female) were included in this study. Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (ß estimate, -0.01 [95% CI, -0.02 to -0.001]); 2 sensory impairments (ß estimate, -0.01 [95% CI, -0.02 to -0.01]); 3 sensory impairments (ß estimate, -0.03 [95% CI, -0.04 to -0.02]); or 4 sensory impairments (ß estimate, -0.04 [95% CI, -0.05,-0.03]) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner. Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35 [95% CI, 1.01-1.81]), 2 sensory impairments (HR, 1.58 [95% CI, 1.19-2.11]), 3 sensory impairments (HR, 1.79 [95% CI, 1.33-2.42]), or 4 sensory impairments (HR, 1.97 [95% CI, 1.39-2.79]) was significantly associated with increased mortality risk in a similarly dose-dependent manner. Conclusion: In this retrospective cohort study, the degree and number of multiple sensory impairments were associated with worse physical functioning and increased mortality risk. These findings represent an opportunity for further investigation into the value of screening, prevention, and treatment of sensory impairments to reduce morbidity and mortality in older adults.


Assuntos
Estudos Longitudinais , Masculino , Humanos , Feminino , Idoso , Estudos Retrospectivos , Estudos de Coortes , Modelos de Riscos Proporcionais , Pennsylvania/epidemiologia
9.
Public Health Rep ; 139(1): 66-71, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-36927265

RESUMO

OBJECTIVES: Before the 2017-2018 school year, Pennsylvania shortened the grace period for provisional entrants-kindergarteners who are not up-to-date on vaccination and do not have medical or nonmedical exemption-from 8 months to 5 days. We analyzed the impact of this change on school-entry vaccination status. METHODS: Using data from the Pennsylvania Department of Health for school years 2015-2016 through 2018-2019, we examined state-level trends in Pennsylvania kindergarteners' vaccination status, including the percentage who were up-to-date on each required vaccine, provisionally enrolled, medically exempted from vaccination, and nonmedically exempted from vaccination. Using the Spearman correlation coefficient, we assessed associations at the school level among changes in kindergarteners' vaccination status after the grace period was shortened. RESULTS: From 2016-2017 to 2017-2018, the provisional entrance rate of kindergarteners in Pennsylvania decreased substantially after the change in the grace period (from 8.1% to 2.2%), the medical exemption rate remained stable, and the nonmedical exemption rate increased slightly (from 1.8% to 2.5%). The percentage of kindergarteners up-to-date on required vaccines increased or remained stable across the study period except for polio, which decreased from 97.9% in 2015-2016 to 96.2% in 2018-2019. The change in provisional entrance rate was negatively associated with change in kindergarteners up-to-date on required vaccines (ρ range, -0.30 to -0.70) but not with change in medical or nonmedical exemptions (ρ range, -0.01 to -0.08). CONCLUSIONS: Efforts to reduce provisional entrants may increase the percentage of kindergarteners up-to-date on vaccinations at school entry without a corresponding increase in exemptions.


Assuntos
Vacinação , Vacinas , Humanos , Pennsylvania/epidemiologia , Instituições Acadêmicas
10.
J Sch Health ; 94(3): 235-242, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36928540

RESUMO

BACKGROUND: The whole school, whole community, whole child (WSCC) model suggests wellness councils, ongoing review of wellness policy, and a plan for evaluating set objectives are some of the key features needed to support school wellness infrastructure. This study explored the relationship between implementation of these infrastructure features and overall school wellness environment assessment scores among a sampling of Pennsylvania schools. METHODS: The Healthy Champions program provides Pennsylvania schools an opportunity to self-assess their wellness environments across several school wellness topics. Staff enrolled their school in the program by completing a self-report electronic assessment. Enrollment data from the 2020/2021 program year were analyzed using the Kruskal-Wallis test and linear fixed model to identify the impact of varied implementation levels across 3 wellness infrastructure activities. Interactions between these variables and overall assessment score were also analyzed. RESULTS: Of the 645 Pennsylvania schools enrolled and analyzed, we observed higher mean wellness environment assessment scores (∆ 0.74 95% CI 0.40-1.07; p < 0.001) among schools that reported some frequency of all 3 wellness infrastructure activities, compared to schools that reported no frequency for the activities. IMPLICATIONS: Schools with existing policies and practices related to the 3 wellness infrastructure activities should consider the degree of implementation to best support overall wellness in their school setting. Additional research to explore implementation barriers and supports is needed. CONCLUSIONS: Analyses indicated that overall wellness environment assessment scores are impacted by implementation thresholds for wellness council meeting frequency, revision of wellness policy, and review of student health promotion objectives.


Assuntos
Política de Saúde , Promoção da Saúde , Criança , Humanos , Estudantes , Instituições Acadêmicas , Pennsylvania , Serviços de Saúde Escolar
11.
Vet Parasitol ; 325: 110090, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38043480

RESUMO

Invasive wild pigs (Sus scrofa) are a reservoir for over 100 viral, bacterial, and parasitic pathogens that are transmissible to humans, livestock, domestic animals, and wildlife in North America. Numerous historical local surveys and results from a nation-wide survey (2006-2010) indicated that wild pigs in the United States act as reservoirs for Trichinella spp. and Toxoplasma gondii, two zoonotic pathogens of importance for human and animal health. Since that time, wild pig populations have expanded and increased in density in many areas. Population expansion of wild pigs creates opportunities for the introduction of pathogens to new areas of the country, increasing health risks. The goal of this study was to investigate the current geographic distribution and prevalence of Trichinella spp. and T. gondii antibodies in wild pigs using serum samples collected from 2014 to 2020. Serum samples from 36 states were tested for antibodies to Trichinella spp. (n = 7467) and T. gondii (n = 5984) using commercially available enzyme-linked immunosorbent assays. Seroprevalence for Trichinella spp. (12.4%, 927/7467) and T. gondii (40.8%, 2444/5984) are significantly higher compared to a previous 2006-2010 study across all regions. Results from this study also showed a lower seroprevalence (4.8%) for Trichinella spp. in the West region compared to the other regions (South: 13.4%; Midwest: 18.4%; Northeast: 19.1%). There were new detection records for antibodies to Trichinella spp. in 11 states, mostly in the West, Midwest, and Northeast regions compared to a previous study in 2014. Males and juveniles were less likely to be positive for Trichinella spp. antibodies, compared to females and older animals, respectively. Seroprevalence was similar for T. gondii across the regions (31.8-56%) with some states having particularly high seroprevalence (e.g., Hawaii 79.4% and Pennsylvania 68%). There were new T. gondii antibody detection records for 12 states, mostly in the West, Midwest, and Northeast regions. Adults were more likely than juveniles and subadults to be seropositive. These data confirm that the distribution and prevalence of antibodies for Trichinella spp. and T. gondii are increasing in the United States, likely driven by wild pig population growth and range expansion.


Assuntos
Doenças dos Suínos , Toxoplasma , Toxoplasmose Animal , Trichinella , Triquinelose , Masculino , Feminino , Suínos , Animais , Estados Unidos/epidemiologia , Humanos , Triquinelose/epidemiologia , Triquinelose/veterinária , Prevalência , Estudos Soroepidemiológicos , Anticorpos Antiprotozoários , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/parasitologia , Toxoplasmose Animal/parasitologia , Anticorpos Anti-Helmínticos , Pennsylvania , Sus scrofa
12.
J Environ Qual ; 53(1): 101-111, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37949440

RESUMO

Concentrations of the fecal indicator bacteria (FIB) Escherichia coli and enterococci are used to assess microbial impairment in irrigation and recreation water sources. Although the FIB concentrations' variability at large temporal scales, such as seasons, and large spatial scales encompassing different land use has been studied, the knowledge about smaller scale variability remains sparse. This work aimed to research the small-scale variability of E. coli and enterococci in a montane creek with sandy bottom sediments. Sediment samples were collected weekly for a year in triplicate at sampling sites in a forested headwater, an agricultural area, and a mixed urban-agricultural area. The average weekly change in concentrations was from two times at the forested site to five times at the urban-agricultural site. Mean relative deviations from averages across sampling locations increased from -25% at the forested site to 45% at the urban-agricultural site. This trend was also observed separately over the cold and warm seasons. Over a week without precipitation, E. coli concentrations decreased on average by 20% in warm period and by 45% in cold period; the enterococci concentration declined by 12% in both cold and warm periods. The sediment particle size distributions were significantly different among the three sites and between the cold and warm seasons. Rankings of sediment fine mass fractions and FIB concentrations were positively correlated at two of three sampling sites in more than 70% of observation dates. The results of this work indicate the need to evaluate the uncertainty of sediment FIB concentrations before designing sediment FIB monitoring quality.


Assuntos
Escherichia coli , Areia , Pennsylvania , Tamanho da Partícula , Sedimentos Geológicos , Bactérias , Enterococcus , Fezes/microbiologia , Microbiologia da Água , Monitoramento Ambiental/métodos
13.
J Trauma Acute Care Surg ; 96(1): 62-69, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-37789517

RESUMO

BACKGROUND: Air medical transport (AMT) improves outcomes for severely injured patients. The decision to fly patients is complex and must consider multiple factors. Our objective was to evaluate the interaction between geography, patient and environmental factors, and emergency medical services (EMS) system resources on AMT after trauma. We hypothesize that significant geographic variation in AMT utilization will be associated with varying levels of patient, environmental, and EMS resources. METHODS: Patients transported by EMS in the Pennsylvania state trauma registry 2000 to 2017 were included. We used our previously developed Air Medical Prehospital Triage (AMPT; ≥2 points triage to AMT) score and Geographic Emergency Medical Services Index (GEMSI; higher indicates more system resources) as measures for patient factors and EMS resources, respectively. A mixed-effects logistic regression model determined the association of AMT utilization with patient, system, and environmental variables. RESULTS: There were 195,354 patients included. Fifty-five percent of variation in AMT utilization was attributed to geographic differences. Triage to AMT by the AMPT score was associated with nearly twice the odds of AMT utilization (adjusted odds ratio, 1.894; 95% confidence interval, 1.765-2.032; p < 0.001). Each 1-point increase in GEMSI was associated with a 6.1% reduction in odds of AMT (0.939; 0.922-0.957; p < 0.001). Younger age, rural location, and more severe injuries were also associated with increased odds of AMT ( p < 0.05). When categorized by GEMSI level, the AMPT score and patient factors were more important for predicting AMT utilization in the middle tercile (moderate EMS resources) compared with the lower (low EMS resources) and higher tercile (high EMS resources). Weather, season, time-of-day, and traffic were all associated with AMT utilization ( p < 0.05). CONCLUSION: Patient, system, and environmental factors are associated with AMT utilization, which varies geographically and by EMS/trauma system resource availability. A more comprehensive approach to AMT triage could reduce variation and allow more tailored efforts toward optimizing resource allocation and outcomes. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.


Assuntos
Serviços Médicos de Emergência , Ferimentos e Lesões , Humanos , Triagem , Pennsylvania/epidemiologia , Sistema de Registros , Geografia , Centros de Traumatologia , Estudos Retrospectivos , Ferimentos e Lesões/terapia
14.
Acad Med ; 99(3): 325-330, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37816217

RESUMO

PURPOSE: The United States Medical Licensing Examination (USMLE) comprises a series of assessments required for the licensure of U.S. MD-trained graduates as well as those who are trained internationally. Demonstration of a relationship between these examinations and outcomes of care is desirable for a process seeking to provide patients with safe and effective health care. METHOD: This was a retrospective cohort study of 196,881 hospitalizations in Pennsylvania over a 3-year period (January 1, 2017 to December 31, 2019) for 5 primary diagnoses: heart failure, acute myocardial infarction, stroke, pneumonia, or chronic obstructive pulmonary disease. The 1,765 attending physicians for these hospitalizations self-identified as family physicians or general internists. A converted score based on USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 scores was available, and the outcome measures were in-hospital mortality and log length of stay (LOS). The research team controlled for characteristics of patients, hospitals, and physicians. RESULTS: For in-hospital mortality, the adjusted odds ratio was 0.94 (95% confidence interval [CI] = 0.90, 0.99; P < .02). Each standard deviation increase in the converted score was associated with a 5.51% reduction in the odds of in-hospital mortality. For log LOS, the adjusted estimate was 0.99 (95% CI = 0.98, 0.99; P < .001). Each standard deviation increase in the converted score was associated with a 1.34% reduction in log LOS. CONCLUSIONS: Better provider USMLE performance was associated with lower in-hospital mortality and shorter log LOS for patients, although the magnitude of the latter is unlikely to be of practical significance. These findings add to the body of evidence that examines the validity of the USMLE licensure program.


Assuntos
Avaliação Educacional , Internato e Residência , Humanos , Estados Unidos , Estudos Retrospectivos , Licenciamento em Medicina , Hospitalização , Pennsylvania , Médicos de Família
15.
J Sch Health ; 94(3): 228-234, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37553008

RESUMO

INTRODUCTION: Pennsylvania's Student Assistance Program (SAP) began in the mid-1980s to address student barriers to academic success. SAP teams, groups of trained school and community professionals, review referrals, and connect students to services. State leadership conducts an annual SAP team survey, but capacity to evaluate data and affect change is limited. In 2020, leadership partnered with [institution name] to collaboratively review the survey data. METHODS: Frequencies and percentages were calculated. Open responses were coded. Logistic regression models evaluated the association between SAP team size, team meeting frequency, and team maintenance. RESULTS: The 2019 to 2020 survey had 1003 respondents. Median number of SAP team members was 8 (range 1-21). The majority (54%) indicated their SAP team met once per week/cycle for 30 to 90+ minutes. Larger teams met more often. Annual team maintenance occurred for 38% of teams, and was more common for larger teams. SAP team members identified mental health (68%), trauma (44%), and parent engagement (36%) as top training needs. CONCLUSIONS: An academic partnership successfully provided the capacity to review SAP survey responses, and informed evidenced-based discussion of best practice guidelines and realignment of staff professional development opportunities.


Assuntos
Sucesso Acadêmico , Estudantes , Humanos , Pennsylvania , Serviços de Saúde Escolar , Inquéritos e Questionários
16.
Accid Anal Prev ; 196: 107447, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38157677

RESUMO

Bicycle-motor vehicle (BMV) accidents hold paramount importance due to their substantial impact on public safety. Specifically, road intersections, being critical conflict points, demand focused attention to reduce BMV crashes effectively and mitigate their severity. The existing research on the severity analysis of these crashes appears to have certain gaps that warrant further contribution. To address the mentioned limitations, this study first integrates multiple pre-collision features of the bicycles and vehicles to classify crash types based on the mechanism of the crashes. Then, the correlated random parameters ordered probit (CRPOP) model is employed to examine the factors influencing injury severity among bicyclists involved in intersection BMV crashes in Pennsylvania from 2013 to 2018. To gain deeper insights, this study conducts a separate analysis of crash data from 3-leg intersections, 4-leg intersections, and their combined scenarios, followed by a comparative examination of the results. The findings revealed that the presented crash typing approach yields new insights regarding injury severity outcomes. Moreover, in addition to exhibiting a comparable statistical performance contrasting to the more restricted models, the CRPOP model identified hidden correlations between three random parameters. Furthermore, the study demonstrated that analyzing combined crash data from the two intersection types obscured certain factors that were found significantly influential in the injury outcomes through analyzing sub-grouped data. Consequently, it is recommended to implement tailored countermeasures for each type of intersection.


Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/prevenção & controle , Ciclismo/lesões , Veículos Automotores , Pennsylvania/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle
17.
Syst Appl Microbiol ; 47(1): 126476, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38113702

RESUMO

Outbreaks of potato blackleg and soft rot caused by Pectobacterium species and more recently Dickeya species across the U.S. mid-Atlantic region have caused yield loss due to poor emergence as well as losses from stem and tuber rot. To develop management strategies for soft rot diseases, we must first identify which members of the soft rot Pectobacteriaceae are present in regional potato plantings. However, the rapidly expanding number of soft rot Pectobacteriaceae species and the lack of readily available comparative data for type strains of Pectobacterium and Dickeya hinder quick identification. This manuscript provides a comparative analysis of soft rot Pectobacteriaceae and a comprehensive comparison of type strains from this group using rep-PCR, MLSA and 16S sequence analysis, as well as phenotypic and physiological analyses using Biolog GEN III plates. These data were used to identify isolates cultured from symptomatic potato stems collected between 2016 and 2018. The isolates were characterized for phenotypic traits and by sequence analysis to identify the bacteria from potatoes with blackleg and soft rot symptoms in Pennsylvania potato fields. In this survey, P. actinidiae, P. brasiliense, P. polonicum, P. polaris, P. punjabense, P. parmentieri, and P. versatile were identified from Pennsylvania for the first time. Importantly, the presence of P. actinidiae in Pennsylvania represents the first report of this organism in the U.S. As expected, P. carotorvorum and D. dianthicola were also isolated. In addition to a resource for future work studying the Dickeya and Pectobacterium associated with potato blackleg and soft rot, we provide recommendations for future surveys to monitor for quarantine or emerging soft rot Pectobacteriace regionally.


Assuntos
Gammaproteobacteria , Pectobacterium , Solanum tuberosum , Dickeya , Solanum tuberosum/microbiologia , Pennsylvania , Doenças das Plantas/microbiologia , Filogenia , RNA Ribossômico 16S/genética , Pectobacterium/genética , Gammaproteobacteria/fisiologia
18.
Am J Transplant ; 23(11): 1811-1814, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37914432

RESUMO

In July 2022, the Pennsylvania Department of Health received two reports of laboratory-confirmed Legionnaires disease in patients who had recently received lung transplants from the same donor at a single Pennsylvania hospital. The donor's cause of death was freshwater drowning in a river, raising suspicion of potential donor-derived transmission, because Legionella bacteria naturally live in fresh water. Further investigation of patients receiving other organs from the same donor did not identify additional legionellosis cases. Health care-associated infection caused by water exposure at the hospital was also evaluated as a potential source of infection and was found to be unlikely. Hospital water quality parameter measurements collected during May-June 2022 were within expected ranges and no water disruptions were noted, although no testing for Legionella was performed during this period. Notifiable disease data did not identify any other Legionnaires disease cases with exposure to this hospital within the 6 months before or after the two cases. Although laboratory testing did not confirm the source of recipient infections, available data suggest that the most likely source was the donor lungs. This cluster highlights the need for increased clinical awareness of possible infection with Legionella in recipients of lungs from donors who drowned in fresh water before organ recovery.


Assuntos
Legionella , Doença dos Legionários , Humanos , Transplantados , Pennsylvania/epidemiologia , Pulmão
19.
J Prim Care Community Health ; 14: 21501319231212287, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37994782

RESUMO

INTRODUCTION: Influenza and COVID-19 vaccination rates remain suboptimal, demanding new community-centric approaches that improve targeted counseling and increase vaccine uptake. Notably, racially diverse communities show high vaccine hesitancy, yet most existing vaccine studies focus on white, college-educated cohorts. OBJECTIVE: Here, we identify factors influencing vaccination decisions of patients at Turtle Creek Primary Care clinic in Turtle Creek, PA, a racially-diverse borough. DESIGN: A retrospective mixed-methods study of the predominantly non-white patient population at Turtle Creek Primary Care clinic, a clinic caring for >70% minority patients. RESULTS: Fourteen factors emerged that patients reported were crucial to vaccine decision-making. Of these factors, top reasons for COVID-19 vaccine hesitancy were trust in vaccines, vaccine side effects, perceived vaccine knowledge, and faith/religion. Top reasons for influenza vaccine hesitancy were perceived need, vaccine side effects, trust in vaccines, and habitual behaviors. We also uncovered correlations between vaccine decision factors and sociodemographic factors. Participants > 65-years-old were more likely to cite personal safety in choosing to get the COVID-19 vaccine, while non-white participants were more likely to cite others' safety. Participants > 65-years-old were also more likely to cite personal safety in influenza vaccine decision-making, and non-female participants were more likely to cite perceived need for influenza vaccines. CONCLUSIONS: These data uncover targetable factors contributing to vaccine hesitancy and aid in developing community-centered, personalized vaccine education approaches in Turtle Creek and analogous minority communities.


Assuntos
COVID-19 , Vacinas contra Influenza , Influenza Humana , Humanos , Idoso , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Vacinas contra Influenza/uso terapêutico , Estudos Transversais , Influenza Humana/prevenção & controle , Pennsylvania , Estudos Retrospectivos , Vacinação , Análise Fatorial
20.
Prog Community Health Partnersh ; 17(3): 465-476, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37934444

RESUMO

BACKGROUND: Funded by the Centers for Disease Control and Prevention Racial and Ethnic Approaches to Community Health Initiative, Live Well Allegheny: Lifting Wellness for African Americans (LWA) in Allegheny County, Pennsylvania, aims to enhance health equity by addressing chronic disease in six African American communities via three key strategies: nutrition, physical activity, and community-clinical linkages. OBJECTIVES: This manuscript describes the coalition's partnership dynamics and evaluation methods with a focus on nutrition strategies. METHODS: We have a network of committed partners implementing the strategies and we are evaluating our efforts using community asset mapping, county population-based survey data, qualitative process interviews, focus groups, and program performance measures. RESULTS: The LWA coalition is the culmination of years of partnership building, which allows for more targeted activities related to health equity in the region. Thus far, the LWA coalition is thriving. The network of committed and talented partners in the nutrition strategy (healthy nutrition standards, food systems, and breastfeeding) reached 22 sites and more than 46,000 people during the first 2 years of the project. Process interviews conducted as part of the evaluation identified challenges and successes of implementation, and development of the coalition. CONCLUSIONS: This comprehensive evaluation approach supports formative processes, evaluation metrics, and prolonged sustainability plans of this community-based coalition.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Equidade em Saúde , Disparidades em Assistência à Saúde , Grupos Raciais , Humanos , Negro ou Afro-Americano , Doença Crônica , Pennsylvania , Estados Unidos , Disparidades em Assistência à Saúde/etnologia
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