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1.
Prev Med ; 177: 107770, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37951544

RESUMO

Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015-2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.


Assuntos
Consumo Excessivo de Bebidas Alcoólicas , Uso da Maconha , Transtornos Relacionados ao Uso de Substâncias , Uso de Tabaco , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Gestantes/psicologia , Estresse Psicológico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Uso de Tabaco/epidemiologia , Uso da Maconha/epidemiologia , Consumo de Bebidas Alcoólicas
2.
Subst Use Misuse ; 58(2): 163-170, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36546533

RESUMO

Background: Opioid-related overdose deaths recently accelerated. In response, overdose education and naloxone distribution (OEND) has been implemented widely, though access remains sparse in rural Appalachia. Despite increasing OEND, risk factors for non-evidence-based overdose responses among the training-naïve remain unknown. Methods: We enrolled 169 adults who use prescription opioids non-medically and reside in rural West Virginia (August 2014-March 2015). Participants were interviewed about witnessing overdose (lifetime and prior-year), characteristics of the most recent overdose, responses to the overdose, and OEND acceptability. Logistic regression was used to assess factors associated with non-evidence-based responses to overdose. Results: Among the 73 participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any non-evidence-based responses. Participants were significantly more likely to report a non-evidence-based response when victims were unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). Common evidence-based responses included staying with the victim until help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common non-evidence-based responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of OEND, the majority (n = 69, 95%) were willing to train, particularly those reporting non-evidence-based responses (n = 52, 98%). Conclusions: These findings underscore the need to expand access to OEND in rural communities and indicate OEND is acceptable to training-naïve individuals who use opioids in rural Appalachia. Given the "harm reduction deserts" in the region, approaches to expand OEND should be pursued.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Analgésicos Opioides/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , População Rural , Naloxona/uso terapêutico , Região dos Apalaches , Prescrições , Overdose de Opiáceos/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
3.
Inj Prev ; 27(4): 369-374, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32873604

RESUMO

BACKGROUND: Overdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016-2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US. METHODS: Structured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation. RESULTS: The primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt. CONCLUSIONS: Based on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.


Assuntos
Overdose de Drogas , Naloxona , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/prevenção & controle , Humanos , Aplicação da Lei , Naloxona/uso terapêutico , West Virginia/epidemiologia
4.
Am J Public Health ; 109(12): 1702-1706, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31622141

RESUMO

Current injury surveillance systems in the United States, including the National Electronic Injury Surveillance System (NEISS), are unable to draw reliable subnational and subannual incidence estimates.Compared with the International Classification of Diseases (ICD), the clinical ontology system currently used widely in health care, NEISS's coding structure lacks specificity and consistency. In parallel, the quality of ICD codes depends on accurate and complete documentation by health care providers and skillful translation into ICD codes in electronic health care data. Additionally, there is no national mandate to collect external cause of injury data.Electronic health care data, such as health records and claims, with updated codes and uniform adherence to recommendations for coding external cause of injury, have the potential to be used for a more robust and timely surveillance of injury to accurately and reliably reflect the injury burden in the United States.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Vigilância em Saúde Pública/métodos , Ferimentos e Lesões/epidemiologia , Causalidade , Codificação Clínica , Confiabilidade dos Dados , Registros Eletrônicos de Saúde/normas , Humanos , Classificação Internacional de Doenças , Fatores de Tempo , Estados Unidos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/prevenção & controle
5.
J Community Health ; 44(1): 172-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30145703

RESUMO

Concurrent use of prescription medications and alcohol is prevalent among older adults and impacts women more than men, however little is known about characteristics of older women who use both. The current analysis aims to evaluate those characteristics. Participants were recruited through HealthStreet, an outreach program. Community health workers (CHWs) assess health needs and concerns among community members. CHWs collect demographic, substance use, and other health data from participants. Female participants (≥ 50 years) interviewed November 2011-November 2017 were included and stratified into four groups: neither prescription opioid nor hazardous alcohol use (three or more drinks in a single day), hazardous alcohol use only, prescription opioid use only, and both prescription opioid and hazardous alcohol use. Chi square and ANOVA tests were used to compare these groups. Among the 2370 women (53% black; mean age 61 years), 70% reported neither prescription opioid nor hazardous alcohol use, 12% reported hazardous alcohol use only, 15% reported prescription opioid use only, and 3% reported use of both in the past 30 days. Concurrent prescription opioid and hazardous alcohol use were significantly associated with comorbid depression and anxiety (p < 0.0001); women who endorsed prescription opioid use only were significantly more likely to report a history of back pain, cancer, or diabetes compared to their counterparts (p < 0.0001). Nearly a third of women reported prescription opioid and/or hazardous alcohol use in the past 30 days. Because the risk and consequences of concomitant alcohol and opioid use increase with age, interventions tailored to women are needed.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Saúde da Mulher/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/efeitos adversos , Prevalência , Características de Residência , Fatores de Risco
6.
J Subst Use ; 24(4): 455-460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814798

RESUMO

BACKGROUND: Understanding motivations behind non-medical use of prescription stimulants (NMUPS) is important to prevent such use. METHODS: Adult participants from St. Louis, MO, who endorsed NMUPS on 5 or more days in the past 12 months (n=60) were asked about their motivations for use. Associations between motives for use and patterns of non-medical use in the past 12 months were assessed using multivariable logistic regression, controlling for demographic factors and non-medical use of other prescription drugs. RESULTS: On average, 5.5 different motives for stimulant use were endorsed. Compared to those who only used someone else's stimulants, adults who only used stimulants other than prescribed were less likely to endorse use "to get high" (aOR=0.48, 95%CI 0.26-0.90) and more likely to endorse use "to function" (aOR=1.97, 95%CI 1.04-3.75); adults who were engaged in both patterns of NMUPS were more likely to endorse use "to function" (aOR=4.12, 95%CI 1.56-10.88) and "to modify the effects of other drugs" (aOR=2.29, 95%CI 1.13-4.61). CONCLUSION: Although using stimulants for performance enhancement is common, most people who used diverted stimulants reported using stimulants to get high. Prevention and harm reduction strategies should consider these differences.

7.
J Sport Rehabil ; 27(5): 451-459, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28952868

RESUMO

CONTEXT: Thigh muscle strains are among the most common injuries in high school soccer for both males and females. Similar results have been reported among college soccer players, specifically for hamstring strains. In college soccer, males have a higher injury rate than women, although they share common injury characteristics. Currently, no studies exist comparing the injury rate or injury characteristics of thigh muscle strains between sexes playing high school soccer. OBJECTIVE: To compare thigh muscle strain injury rates and injury event characteristics among sexes participating in high school soccer. DESIGN: Descriptive epidemiology study. SETTING: A total of 100 nationally representative high schools that participated in the High School Sports-Related Injury Surveillance System, Reporting Information Online. PARTICIPANTS: High school soccer athletes who had a thigh muscle strain. MAIN OUTCOME MEASURES: Injury rates of thigh muscle strains were calculated between sexes. The occurrence of the following variables during a thigh muscle injury was compared between sexes: grade level, age, level of play, event type, time of practice, time of competition, basic injury mechanism, soccer activity, player position, field location, practice type, and time of season. RESULTS: Males had a lower injury rate of thigh muscle strains during competition than females (rate ratio = 0.66; 95% confidence interval, 0.47-0.93). No differences between sexes existed in the distribution of first-time or recurrent event characteristics. When combining sexes, recurrent strains (93%) occurred more frequently on the offensive side of the field than first-time strains (59%), P < .001. The majority of strains occurred among the varsity players (71%), during running activities (60%) and practices (58%). CONCLUSIONS: Males were less likely to sustain a thigh muscle strain during competitions, but no other differences existed between sexes. The events surrounding all thigh muscle strains may be described with some common properties. Consideration of these characteristics may assist in the development of preventive and rehabilitative programs as well as direct future research on thigh muscle strains among high school soccer players.


Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos da Perna/epidemiologia , Fatores Sexuais , Futebol/lesões , Entorses e Distensões/epidemiologia , Coxa da Perna/lesões , Adolescente , Atletas , Feminino , Humanos , Masculino , Músculo Esquelético/lesões , Estados Unidos
8.
Matern Child Health J ; 19(12): 2646-53, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26156823

RESUMO

INTRODUCTION: Prescription drug abuse is a public health epidemic, resulting in 15,000 deaths annually. Disruption of childhood residence has been shown to increase drug-seeking behavior among adolescents; however, little research has explored its association specifically with non-medical use of prescription drugs (NMUPD). The objective of the study was to measure the association between residential mobility and NMUPD. METHODS: The 2010 National Survey on Drug Use and Health data were analyzed for 15,745 participants aged 12-17 years. NMUPD was defined as self-report of any non-medical use (i.e., taking a prescription drug that was not prescribed to them or consumption for recreational purposes) of tranquilizers, pain relievers, sedatives, or stimulants. Logistic regression for survey data was used to estimate the association between residential mobility and NMUPD, adjusting for potential confounders. RESULTS: After controlling for demographic, intrapersonal, interpersonal, and community factors, adolescents with low mobility (1-2 moves in the past 5 years) and residential instability (≥3 moves) were 16% (OR 1.16, 95% CI 1.01, 1.33) and 25% (OR 1.25, 95% CI 1.00, 1.56) more likely to report NMUPD compared to non-mobile adolescents (0 moves). Low-mobile adolescents were 18% (OR 1.18, 95% CI 1.01, 1.38) more likely to abuse pain relievers, specifically. No relationship was found between moving and tranquilizer, stimulant, or sedative use. DISCUSSION: Increasing childhood residential mobility is associated with NMUPD; therefore, efforts to prevent NMUPD should target mobile adolescents. Further examination of the psychological effects of moving and its association with pain reliever abuse is indicated.


Assuntos
Dinâmica Populacional/tendências , Uso Indevido de Medicamentos sob Prescrição/tendências , Adolescente , Criança , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
9.
Am J Ind Med ; 57(2): 245-53, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24248892

RESUMO

BACKGROUND: The purpose of this study was to examine non-robbery-related occupational homicides in the retail industry from 2003 to 2008. METHODS: Data were abstracted from the Census of Fatal Occupational Injuries. Motive (robbery- or non-robbery-related) and workplace violence (WPV) typology (Type I-IV) were assigned using narrative text fields. Non-robbery-related homicide rates were calculated and compared among WPV types, demographic characteristics, and occupation. RESULTS: Twenty-eight percent of homicides that occurred in the retail industry were non-robbery-related. The leading event associated with non-robbery-related homicides was Type II (perpetrated by customers) (34%), followed by Type IV (perpetrated by personal relationship) (31%). The majority of homicides were due to arguments (50%). Security guards and workers in drinking establishments had the highest homicide rates per 100,000 workers (14.3 and 6.0, respectively). CONCLUSIONS: Non-robbery-related homicides comprised a meaningful proportion of workplace homicides in the retail industry. Research is needed to develop strategies to prevent non-robbery-related homicides specifically.


Assuntos
Comércio/estatística & dados numéricos , Dissidências e Disputas , Homicídio/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Bases de Dados Factuais , Feminino , Serviços de Alimentação/estatística & dados numéricos , Homicídio/classificação , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Motivação , Ocupações/estatística & dados numéricos , Roubo , Estados Unidos/epidemiologia , Adulto Jovem
10.
Matern Child Health J ; 18(5): 1104-13, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23912315

RESUMO

The effectiveness of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment during pregnancy for malaria is well established. However, adherence to recommended guidelines remains poor. This study examines factors related to receipt of SP among pregnant women in Kenya. Descriptive and inferential statistics for complex survey data were utilized using the 2008-2009 Kenya Demographic and Health Survey. With the exception of women residing in Nyanza, women who reside in other provinces were more likely to receive one dose of SP versus none compared to women living in Nairobi. Women receiving antenatal care from a nurse or midwife and women who owned a bed net were almost twice as likely to receive one dose of SP versus none (aOR 1.92, 95% CI 1.28, 2.86 and aOR 1.79; 95% CI 1.12, 2.78; respectively); whereas, women who received other anti-malarial drugs were over 90% less likely to receive one dose of SP versus none (aOR 0.08; 95% CI 0.02, 0.26). Among women who receive any SP, increased numbers of antenatal care visits were associated with receipt of two or more doses of SP (aOR 1.16; 95% CI 1.02, 1.32-per additional visit), while women living in the western province were nearly 75% less likely to receive two or more doses compared to women in Nairobi (aOR 0.27; 95% CI 0.08, 0.94). Receipt of the recommended ≥2 doses of SP is associated with predisposing and enabling characteristics. Further research is needed to identify barriers to receiving SP during pregnancy.


Assuntos
Antimaláricos/uso terapêutico , Malária/prevenção & controle , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Adolescente , Adulto , Combinação de Medicamentos , Feminino , Número de Gestações , Fidelidade a Diretrizes , Humanos , Quênia , Gravidez , Cuidado Pré-Natal
11.
Drug Alcohol Depend ; 254: 111038, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38041982

RESUMO

BACKGROUND: Studies of prenatal substance exposure often rely on self-report, urine drug screens, and/or analyses of blood or meconium biomarkers. Accuracy of these measures is limited when assessing exposure over many weeks or months of gestation. Nails are increasingly being considered as a matrix from which to assess substance exposure. This systematic review synthesizes data on the validity of detecting alcohol, nicotine, cannabis, and opioid from nail clippings, with an emphasis on prenatal exposure assessment. METHODS: The systematic review was conducted using PRISMA 2020 guidelines. Seven databases were searched with keywords relevant to the four substances of interest. Results were summarized grouping manuscripts by the exposure of interest with focus on accuracy and feasibility. RESULTS: Of 2384 papers initially identified, 35 manuscripts were included in our qualitative synthesis. Only a few studies specifically looked at pregnant individuals or mother-child dyads. Across the four substances, many studies demonstrated a dose-response relationship between exposure and concentration of analytes in nails. Nail assays appear to detect lower level of exposure compared to hair; however, sample insufficiency, especially for multi-substance assays, remains a limitation. CONCLUSIONS: Based on the reviewed studies, nail clippings are an acceptable and potentially preferable matrix for the evaluation of these four prenatal substances when sampling frequency and/or study design necessitates assessment of past exposures over an extended period. Nails have the advantage of infrequent sampling and minimal invasiveness to assess a broad exposure period. Future studies should examine validity of analytes in toenail versus fingernail clippings.


Assuntos
Cannabis , Unhas , Gravidez , Feminino , Humanos
12.
W V Med J ; 109(4): 22-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23930558

RESUMO

Substance abuse among pregnant women is a significant public health problem affecting both maternal and fetal health. Access to both obstetrical care and substance abuse treatment is a challenge for women in rural West Virginia. A multi-disciplinary collaborative treatment approach for this population is necessary to reach and retain women in treatment. Through such collaboration, a positive impact on access to treatment for women from rural communities and reduced barriers to both prenatal care and substance abuse treatment can be achieved in order to improve outcomes for both mother and infant.


Assuntos
Disparidades em Assistência à Saúde , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Serviços de Saúde Rural , Feminino , Redução do Dano , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , West Virginia
13.
Artigo em Inglês | MEDLINE | ID: mdl-36901564

RESUMO

This paper describes the prevalence of and factors associated with intimate partner violence (IPV) in the urgent care setting and an academic emergency department in Appalachia. A questionnaire assessing social support, mental and physical health status, substance use, and intimate partner violence was administered to 236 women seeking care in an academic emergency department or two affiliated urgent care clinics. Data collected were compared to IPV screening data from medical records. Separate logistic regression models were fit to estimate the association between sociodemographic and health-related factors and lifetime physical and sexual intimate partner violence, adjusted for the clinical setting. Of the 236 participating women, 63 were seen in the emergency department and 173 were seen in an urgent care clinic. Emergency department patients were significantly more likely to report lifetime threatened physical, physical, or sexual abuse. Based on medical records, over 20% of participants had not been screened for IPV by clinical staff during their healthcare visit. Of those that were screened, none disclosed IPV, despite a substantial proportion reporting IPV on the survey. Although survey reports of IPV were lower in the urgent care clinics, this remains an important location to introduce screenings and resources.


Assuntos
Violência por Parceiro Íntimo , População Rural , Humanos , Feminino , Inquéritos e Questionários , Instituições de Assistência Ambulatorial , Serviço Hospitalar de Emergência , Prevalência
14.
Sci Total Environ ; 870: 161842, 2023 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-36716893

RESUMO

The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled in recent years and widely varies geographically in the US. However, few studies have examined which environmental factors are associated with OUD during pregnancy. We conducted an external exposome-wide association study (ExWAS) to investigate the associations between external environmental factors and OUD diagnosed during pregnancy. Data were obtained from a unique, statewide database in Florida comprising linked individual-level birth and electronic health records. A total of 255,228 pregnancies with conception dates between 2012 and 2016 were included. We examined 82 exposome measures characterizing seven aspects of the built and social environment and spatiotemporally linked them to each individual record. A two-phase procedure was utilized for the external ExWAS. In Phase 1, we randomly divided the data into a discovery set (50 %) and a replication set (50 %). Associations between exposome measures (normalized and standardized) and OUD initially diagnosed during pregnancy were examined using logistic regression. A total of 15 variables were significant in both the discovery and replication sets. In Phase 2, multivariable logistic regression was used to fit all variables selected from Phase 1. Measures of walkability (the national walkability index, OR: 1.23, 95 % CI: 1.17, 1.29), vacant land (the percent vacant land for 36 months or longer, OR: 1.06, 95 % CI: 1.00, 1.12) and food access (the percentage of low food access population that are seniors at 1/2 mile, OR: 1.47, 95 % CI: 1.38, 1.57) were each associated with diagnosis of OUD during pregnancy. This is the first external ExWAS of OUD during pregnancy, and the results suggest that low food access, high walkability, and high vacant land in under-resourced neighborhoods are associated with diagnosis of OUD during pregnancy. These findings could help develop complementary tools for universal screening for substance use and provide direction for future studies.


Assuntos
Expossoma , Transtornos Relacionados ao Uso de Opioides , Feminino , Gravidez , Humanos , Florida/epidemiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Características de Residência
15.
JMIR Form Res ; 7: e44500, 2023 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-37285185

RESUMO

BACKGROUND: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. OBJECTIVE: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. METHODS: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. RESULTS: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. CONCLUSIONS: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population.

16.
Am J Prev Med ; 62(5): e297-e301, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35151524

RESUMO

INTRODUCTION: Increases in opioid prescribing contributed to the opioid epidemic in the U.S. Subsequent efforts to promote safer use of opioids for treating pain included augmenting prescription drug monitoring programs and prescribing guidelines. The purpose of this study is to characterize the distribution of opioids dispensed in the U.S. by specialty. METHODS: Data from the IQVIA National Prescription Audit were analyzed (in 2019). Prescriptions were standardized to morphine milligram equivalents using the 2018 Centers for Disease Control and Prevention conversion file. The annual number of prescriptions and total dose (morphine milligram equivalents) of opioids dispensed, overall and by specialty (provider type or physician specialty), were calculated for 2012-2017. RESULTS: The number of prescriptions for opioids dispensed declined by 26.6% overall from 2012 to 2017. However, the number of prescriptions dispensed increased for pain medicine (8.8%) and advanced practice providers (nurse practitioners: 34.8%, physician assistants: 5.4%). Similarly, total morphine milligram equivalents for opioids dispensed declined by 28.6% from 2012 to 2017. Despite an increase in the number of prescriptions, total morphine milligram equivalents of opioids dispensed declined by nearly 20% in pain medicine. Higher total morphine milligram equivalents of dispensed opioids were observed in 2017 than in 2012 for advanced practice providers (nurse practitioners: 19.1%, physician assistants: 1.8%), although a decline in morphine milligram equivalents was observed from 2016 to 2017. CONCLUSIONS: During a period in which prescribing interventions were expanded, opioid prescribing declined overall, although not uniformly by specialty.


Assuntos
Analgésicos Opioides , Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Humanos , Morfina , Dor/tratamento farmacológico , Padrões de Prática Médica
17.
J Am Coll Health ; : 1-4, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35727228

RESUMO

Background: We evaluate the public health surveillance program, Screen, Test, and Protect (STP) designed to control and prevent COVID-19 at a large academic university in the United States. Methods: STP was established at the University of Florida in May 2020. This report details STP's full-time workforce, centralized database, and testing and vaccination programs. We evaluate the program's success in controlling COVID-19 during the 2020-2021 academic school year. Results: COVID-19 cases rose among the campus community in the first few weeks of campus reopening in Fall 2020. Test positivity levels returned to prefall semester levels within one month, however. A few additional, yet smaller, waves occurred during the 2020-2021 school year and were successfully controlled without any campus-wide closures. Conclusions: This program may serve as a framework for other institutions managing the ongoing COVID-19 crisis, in addition to setting the standard for programmatic management of future emerging infectious diseases at universities.

18.
J Paediatr Child Health ; 47(10): 742-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21449905

RESUMO

AIM: This study estimated and compared rates of emotional, developmental and behavioural (EDB) problems among children with chronic health conditions. METHODS: Rates of EDB problems were estimated using data from the 2005-2007 National Survey of Children with Special Health Care Needs. The National Survey of Children's Health (NSCH) 2003 was used to provide national estimates as referent values. RESULTS: The overall rate of EDB problems for children with chronic health conditions was 15%, about three times the rate for children in the general US population. The rate of attention deficit disorder/attention-deficit/hyperactivity disorder was 18%, over twice that for children in the general population. Children with migraine or other types of recurrent headaches had the highest rate of EDB problems (47%), about nine times the rate for the NSCH sample; those with arthritis or other joint problems had nearly 30%, about five times the rate for the NSCH. CONCLUSIONS: Chronic health conditions are associated with high rates of EDB problems. Children with recurrent headaches and arthritis have particularly high rates, possibly related to pain associated with these conditions. Chronic health condition management programmes should address both medical treatment as well as EDB co-morbid problems through a multidimensional approach to care.


Assuntos
Sintomas Afetivos/epidemiologia , Transtornos do Comportamento Infantil/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Adolescente , Comportamento do Adolescente , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Comorbidade , Intervalos de Confiança , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Estresse Psicológico
19.
Breastfeed Med ; 16(7): 547-552, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33781096

RESUMO

Background: Although rates of complementary food and beverage (CFB) consumption among infants under 4 to 6 months of age have been declining, they remain well above the American Academy of Pediatrics (AAPs) recommendations. It is unclear if women with low income in the United States are more likely than other women to introduce CFBs early. We examined timing of introduction of CFBs to infants of mothers with low income to further illuminate infant feeding practices in this potentially vulnerable population. Materials and Methods: We analyzed infant feeding data collected prospectively from 443 mother-infant dyads. Data were obtained by interview at 1, 3, and 6 months postpartum. We used Kaplan-Meier curves to show time to introduction of CFBs overall and by type of CFB, and log-rank tests to compare timing by demographic and clinical characteristics. Results: Participants were mostly non-Hispanic black or white, with a high school education or less. By month 3, 48% of infants were fed at least one CFB, increasing to over 83% by month 5. Women who did not work outside the home introduced CFBs significantly earlier than those who worked, as did women who smoked compared with those who did not. Timing did not differ by other participant characteristics. Conclusions: Introduction of CFBs before 4-6 months was common. Clinical guidance and intervention programs should support mothers toward the goal of improving infant diets in this at-risk population.


Assuntos
Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Bebidas , Aleitamento Materno , Criança , Comportamento Alimentar , Feminino , Humanos , Lactente , Estados Unidos
20.
Biom J ; 52(5): 590-603, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20857422

RESUMO

Study planning often involves selecting an appropriate sample size. Power calculations require specifying an effect size and estimating "nuisance" parameters, e.g. the overall incidence of the outcome. For observational studies, an additional source of randomness must be estimated: the rate of the exposure. A poor estimate of any of these parameters will produce an erroneous sample size. Internal pilot (IP) designs reduce the risk of this error - leading to better resource utilization - by using revised estimates of the nuisance parameters at an interim stage to adjust the final sample size. In the clinical trials setting, where allocation to treatment groups is pre-determined, IP designs have been shown to achieve the targeted power without introducing substantial inflation of the type I error rate. It has not been demonstrated whether the same general conclusions hold in observational studies, where exposure-group membership cannot be controlled by the investigator. We extend the IP to observational settings. We demonstrate through simulations that implementing an IP, in which prevalence of the exposure can be re-estimated at an interim stage, helps ensure optimal power for observational research with little inflation of the type I error associated with the final data analysis.


Assuntos
Biometria/métodos , Projetos de Pesquisa , Alelos , Lesões Encefálicas/terapia , Criança , Ensaios Clínicos como Assunto , Simulação por Computador , Interpretação Estatística de Dados , Humanos , Modelos Estatísticos , Projetos Piloto , Tamanho da Amostra
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