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1.
J Psychiatr Res ; 173: 372-380, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38593696

RESUMO

Bullying, traditional or cyber, among adolescents, is a public health concern. In this study, we explored frequencies and correlates of different forms of bullying among Connecticut high-school students. Youth Risk Behavior Survey data from 2019 from Connecticut adolescents (N = 1814) were used. χ2 tests and survey-weighted logistic regressions examined relationships between bullying subgroups (in-school traditional bullying (ISTB) only, cyberbullying only, and both) and mental concerns, risk behaviors, academic performance, physical health, and receipt of social support, with the logistic regressions adjusted for demographics. The past-12-month frequency of having experienced only cyberbullying was 5.6%, only ISTB was 9.1%, and both forms was 8.7%. Between-group differences were observed by bullying status in terms of sex and race/ethnicity. In adjusted models, bullying status was associated with suicide attempts, suicidal ideation, self-harm, depression/dysphoria, mental health, use of alcohol, marijuana, injection drugs, tobacco, and e-vapor, gambling, driving under influence of alcohol, high-risk sexual behavior, physical fights, weapon-carrying, injuries/threats at school, feeling unsafe at school, dating violence, obesity, poor general health, insecure housing, less perceived family support, and poor academic performance. People experiencing both types of bullying were typically more likely to report adverse measures. High-school students commonly report bullying. The findings that both forms (traditional and cyber) were more robustly linked to negative experiences highlight the need for examining further relationships between types and patterns of bullying and mental health and functioning. Better understanding may help improve preventive anti-bullying interventions.


Assuntos
Bullying , Vítimas de Crime , Cyberbullying , Humanos , Adolescente , Connecticut/epidemiologia , Prevalência , Bullying/psicologia , Tentativa de Suicídio
2.
Matern Child Health J ; 28(6): 1121-1131, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38539033

RESUMO

Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Gravidez , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Prevalência , Adulto , Autorrelato , Connecticut/epidemiologia , Mães/estatística & dados numéricos , Mães/psicologia , Complicações na Gravidez/epidemiologia
3.
Mar Environ Res ; 196: 106371, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38309244

RESUMO

This study evaluated water quality, nitrogen (N), and phytoplankton assemblage linkages along the western Long Island Sound (USA) shoreline (Nov. 2020-Dec. 2021) following COVID-19 stay-in-place (SIP) orders through monthly surveys and N-addition bioassays. Ammonia-N (AmN; NH3+NH4+) negatively correlated with total chlorophyll-a (chl-a) at all sites; this was significant at Alley Creek, adjacent to urban wastewater inputs, and at Calf Pasture, by the Norwalk River (Spearman rank correlation, p < 0.01 and 0.02). Diatoms were abundant throughout the study, though dinoflagellates (Heterocapsa, Prorocentrum), euglenoids/cryptophytes, and both nano- and picoplankton biomass increased during summer. In field and experimental assessments, high nitrite + nitrate (N + N) and low AmN increased diatom abundances while AmN was positively linked to cryptophyte concentrations. Likely N + N decreases with presumably minimal changes in AmN and organic N during COVID-19 SIP resulted in phytoplankton assemblage shifts (decreased diatoms, increased euglenoids/cryptophytes), highlighting the ecological impacts of N-form delivered by wastewater to urban estuaries.


Assuntos
COVID-19 , Diatomáceas , Dinoflagellida , Humanos , Fitoplâncton/fisiologia , Nitrogênio/análise , Connecticut , New York , Águas Residuárias , Diatomáceas/fisiologia , Rios , Estuários
4.
Traffic Inj Prev ; 25(3): 322-329, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38363337

RESUMO

OBJECTIVES: To document the process of linking breathalyzer and motor vehicle crash (MVC) data for the State of Connecticut using a unique identifier in the place of personal and private information. METHODS: Deterministic linkage methodologies were utilized in Microsoft SQL Server to join 5,634 (of 6,650) breathalyzer records to corresponding MVC driver records for the period of January 1, 2017 to December 31, 2022. Differences between the linked and original datasets were documented by comparing the consistency of frequency and proportion distributions of key variables. RESULTS: Proportions of annual records, alcohol breath tests, and refusals were nearly unchanged when comparing linked and original breathalyzer data. When examining variables in the original MVC driver records, there were differences in the within-group proportions for sex and age, with an overrepresentation of males and drivers aged 26-to-40 years old. For crash and injury severity, the linked dataset had lower proportions of more severe injury records when compared to the original MVC data. Additionally, 1,007 breathalyzer records were not matched with an associated MVC record. CONCLUSIONS: Linkage methodology is sound and produced quality matches. The use of a unique identifier provided a strong match qualifier in the absence of personal and private data. Changes in proportions for age, sex, crash and injury severity align with previous research. Potential missed matches may be attributed to several factors outside of the linkage process, including data discrepancies and varied reporting practices. Future studies will further explore these differences and incorporate additional toxicology data as part of a continued effort to fuze crash, citation, toxicology, and public health data. The end result will be a holistic, comprehensive, and multifaceted database for transportation research and education.


Assuntos
Acidentes de Trânsito , Meios de Transporte , Masculino , Humanos , Adulto , Connecticut/epidemiologia
5.
J Acquir Immune Defic Syndr ; 96(1): 40-50, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38324241

RESUMO

BACKGROUND: Re-engaging people with HIV who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. METHODS: A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard of care where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N = 333) or standard of care (N = 322). HIV care continuum outcomes included re-engagement at 90 days, retention in care, and viral suppression by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. RESULTS: Participants randomized to DIS were more likely to be re-engaged at 90 days (adjusted odds ratios [aOR] = 1.42, P = 0.045). Independent predictors of re-engagement at 90 days were age older than 40 years (aOR = 1.84, P = 0.012) and perinatal HIV risk category (aOR = 3.19, P = 0.030). Predictors of retention at 12 months included re-engagement at 90 days (aOR = 10.31, P < 0.001), drug injection HIV risk category (aOR = 1.83, P = 0.032), detectable HIV-1 RNA before randomization (aOR = 0.40, P = 0.003), and county (Hartford aOR = 1.74, P = 0.049; New Haven aOR = 1.80, P = 0.030). Predictors of viral suppression included re-engagement at 90 days (aOR = 2.85, P < 0.001), retention in HIV care (aOR = 7.07, P < 0.001), and detectable HIV-1 RNA prerandomization (aOR = 0.23, P < 0.001). CONCLUSIONS: A D2C strategy significantly improved re-engagement at 90 days. Early re-engagement improved downstream benefits along the HIV care continuum like retention in care and viral suppression at 12 months. Moreover, other factors predictive of care continuum outcomes can be used to improve D2C strategies.


Assuntos
Infecções por HIV , Gravidez , Feminino , Humanos , Adulto , Infecções por HIV/tratamento farmacológico , Connecticut , Estudos Prospectivos , Continuidade da Assistência ao Paciente , RNA
6.
Artigo em Inglês | MEDLINE | ID: mdl-38397634

RESUMO

Health Improvement Through Employee Control (HITEC) is a 16-year program directed toward the health of corrections personnel and developed through the application of the principles of Participatory Action Research (PAR) and participatory ergonomics. Its impetus has always been the adverse health status of the corrections workforce: early mortality, depression, obesity, and hypertension. The HITEC program trained small "Design Teams" (DTs) of front-line personnel in participatory methods for intervention design for health improvement and organizational change in line with the Total Worker Health® principles. Periodic surveys and physical testing were introduced for longitudinal assessments. Comparative interventions at comparable sites included DTs without a priori assignation, problem-focused kaizen effectiveness teams (KETs), and bargaining unit-centered DTs. DT resilience and the replacement of members who transferred facilities or retired was aided by novel cooperative administrative structures. DT-generated interventions included stress lounges, changes in critical event report writing, a joint program with trained inmates to improve air quality, and training in staff mental health and sleep behavior. A specialized peer-to-peer Health Mentoring Program (HMP) paired new officers with trained peers. Many interventions and program features were institutionalized, thus improving prospects for self-supporting program longevity. Participatory interventions designed and supported by the corrections workforce were found to be both feasible and exceptionally effective.


Assuntos
Saúde Ocupacional , Humanos , Connecticut , Avaliação de Programas e Projetos de Saúde/métodos , Local de Trabalho , Promoção da Saúde/métodos
7.
Environ Entomol ; 53(2): 268-276, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38376061

RESUMO

Ticks and tick-borne diseases are of increasing concern across the United States, particularly in the Northeast. Ixodes scapularis Say (Ixodida: Ixodidae) remains the primary vector for the Lyme disease spirochete, Borrelia burgdorferi (Johnson, Schmid, Hyde, Steigerwalt, and Brenner). Prior studies established that I. scapularis can be found in greatest abundance in the 1-m forested ecotone surrounding the lawn edge in residential backyards. Our study was conducted on 42 properties in Guilford, CT, and sought to expand upon this premise by determining which key habitat features were associated with increased densities of host-seeking I. scapularis nymphs. We quantified nymphal abundances in 19 different habitat types that were posited to influence densities. We determined that nymphal I. scapularis densities were greatest in forested areas closest to lawn edges with leaf litter or understory vegetation present, as well as short lawns adjacent to woodland edges. Additionally, we determined that there were no significant declines in nymphal I. scapularis density where leaf litter was removed, lawns were left unmowed, or woodchip barriers were installed. Bird feeders and woodpiles were not associated with increased nymphal I. scapularis densities. However, areas adjacent to stone walls did have nearly 3 times the density of I. scapularis nymphs present compared with habitats without stone walls. The culmination of the results from this study can be utilized to create more targeted acaricide applications rather than broadcast spraying, as well as increase homeowner awareness for areas with heightened risk for exposure to nymphal I. scapularis, which are deemed the most epidemiologically important species and stage for pathogen transfer to humans.


Assuntos
Borrelia burgdorferi , Ixodes , Ixodidae , Doença de Lyme , Humanos , Estados Unidos , Animais , Connecticut , Ninfa
8.
JAMA Netw Open ; 7(1): e2350630, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38180756

RESUMO

Importance: Xylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses. Objective: To gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023. Exposure: State. Main Outcomes and Measures: Yearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories). Results: A total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine's representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states. Conclusions and Relevance: In this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine's reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine's geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.


Assuntos
Overdose de Drogas , Xilazina , Estados Unidos/epidemiologia , Humanos , Estudos Transversais , Aplicação da Lei , Connecticut
9.
Psychiatr Serv ; 75(5): 492-495, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38291887

RESUMO

Verbal mistreatment of staff by patients is common in health care settings. Experiencing or witnessing mistreatment can have harmful psychological impacts, affecting well-being and clinical practice. As part of an effort to become an antiracist organization, an academic community mental health center based in Connecticut developed an initiative to address verbal mistreatment. Training in the Expect, Recognize, Address, Support, Establish (ERASE) framework was provided to 140 staff members. This training and subsequent actions to enhance the culture of safety were perceived as helpful by staff. Further development of the initiative is proceeding as the center's primary performance improvement program.


Assuntos
Centros Comunitários de Saúde Mental , Humanos , Connecticut , Relações Profissional-Paciente , Pessoal de Saúde/psicologia , Cultura Organizacional
10.
Am J Forensic Med Pathol ; 45(2): 167-171, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38290004

RESUMO

ABSTRACT: We report 8 children younger than 2 years who died from acute illicit fentanyl intoxications in Connecticut between 2020 and 2022.The Connecticut Office of the Chief Medical Examiner (CT OCME) investigates all unexpected, violent, and suspicious deaths in Connecticut. The CT OCME's electronic database was searched for fentanyl deaths by age. All underwent autopsies and toxicology testing.The ages ranged from 28 days to 2 years (mean age, 12 months). The causes of death involved acute fentanyl intoxications with 1 having xylazine, 1 having para-fluorofentanyl, and 1 having cocaine and morphine. All the manners of death were certified as homicide. The postmortem fentanyl blood concentrations ranged from 0.40 to 46 ng/mL. Most of the children were found unresponsive after being put to sleep. Three were co-sleeping with adults (2 in bed; 1 on a recliner). There was a known history of parental/caregiver drug abuse in 7 of 8 of the fatalities.We summarize the key investigative, autopsy, and toxicological findings. As illicit fentanyl use increases, there is a potential for infant exposure and death. The investigation and certification of these deaths and the role of intentional administration versus inadvertent exposure due to caregiver neglect in the context of the certification of the manner of death are described.


Assuntos
Fentanila , Homicídio , Humanos , Fentanila/intoxicação , Fentanila/análogos & derivados , Fentanila/sangue , Lactente , Masculino , Feminino , Pré-Escolar , Homicídio/estatística & dados numéricos , Recém-Nascido , Connecticut/epidemiologia , Analgésicos Opioides/intoxicação , Analgésicos Opioides/sangue , Médicos Legistas , Entorpecentes/intoxicação , Entorpecentes/sangue , Drogas Ilícitas/intoxicação , Drogas Ilícitas/sangue
11.
JCO Oncol Pract ; 20(5): 708-716, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38295328

RESUMO

PURPOSE: Increasingly, states outsource administration of Medicaid insurance to privately administered Medicaid managed care organizations. However, on January 1, 2012, Connecticut transitioned from a privately to publicly administered Medicaid system. New Jersey retained a private model. METHODS: Our objective was to assess rates of early-stage cancer diagnosis and cancer survival in two states with similar sociodemographic characteristics but differing exposures to Medicaid privatization. Using data from the SEER Program between 2007 and 2016, Connecticut and New Jersey Medicaid patients with 10 common solid cancers including breast, lung, colorectal, prostate, kidney, bladder, cervix, uterus, head and neck cancer, and melanoma were included. A difference-in-differences analysis of stage of cancer presentation and cancer survival in Connecticut (intervention) was compared with New Jersey (control). RESULTS: Among 29,328 patients (14,424 patients from Connecticut and 14,904 patients from New Jersey) parallel trends were verified in early cancer diagnosis and survival for both states under privately administered Medicaid (pre-exposure). Connecticut's transition from privately to publicly administered Medicaid was associated with an adjusted 4.0% increase in overall early-stage cancer diagnosis (95% CI, +1.7% to +6.2%) and a 4.7% increase in early-stage cancer diagnosis for cancers with US Preventive Services Taskforce A/B recommendations for cancer screening (95% CI, 1.6% to 7.8%). Public administration of Medicaid was also associated with improved overall survival after cancer diagnosis (hazard ratio, 0.92 [95% CI, 0.85 to 0.99]). No changes were observed in New Jersey. CONCLUSION: Transition from private to public administration of Medicaid in Connecticut was associated with earlier-stage cancer diagnosis and improved cancer survival.


Assuntos
Medicaid , Neoplasias , Humanos , Estados Unidos , Neoplasias/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Privatização , Adulto , Connecticut/epidemiologia , New Jersey , Idoso
12.
J Womens Health (Larchmt) ; 33(1): 28-32, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37943625

RESUMO

Background: In 2019, the CDC expanded their recommendations for human papillomavirus (HPV) vaccination beyond age 26 years to include shared clinical decision-making (SCDM) among adults aged 27-45 years ("mid-adults"). The purpose of this study was to describe HPV vaccination status among mid-adult women before the implementation of SCDM for HPV vaccination. Methods: A cross-sectional survey was conducted during 2016-2019 in Connecticut, United States, and enrolled women born in 1981 or later (birth cohorts eligible for HPV vaccination). This analysis was restricted to participants aged 27 years and older at the time of the survey. Correlates of vaccination status, sources of vaccine information, and reasons for not receiving the vaccine were examined. Results: Among 298 participants, 64.4% had not received HPV vaccine. Other than age (younger age was associated with being vaccinated), no other demographic or behavioral correlates were associated with vaccination. Compared with unvaccinated women, vaccinated women were more likely to have heard about the HPV vaccine from a doctor (odds ratio [OR] = 3.45, 95% confidence interval [CI]: 2.00-5.88) and less likely to have heard about it from television (OR = 0.23, 95% CI: 0.13-0.41). The main reasons for not being vaccinated were "vaccine not offered" (48%) and "too old" (40%). Conclusions: A majority of mid-adult women in this study were not previously vaccinated against HPV, signaling the large opportunity for SCDM with this population. This may be facilitated by ensuring health care providers and mid-adult women know about the availability and potential benefits of HPV vaccination to inform decision making.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adulto , Estados Unidos , Humanos , Feminino , Connecticut , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/epidemiologia , Estudos Transversais , Vacinas contra Papillomavirus/uso terapêutico , Vacinação , Papillomavirus Humano
13.
J Interpers Violence ; 39(5-6): 1351-1367, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37804158

RESUMO

Sexual violence (SV) is a critical public health problem that is associated with numerous negative health consequences, including immediate- and long-term physical and mental health conditions and health-risk behaviors. Some of these health-risk behaviors (e.g., substance use, unsafe driving practices, poor mental health, lower impulse control, and abnormal brain circuitry) might increase the risk for sustaining a traumatic brain injury (TBI). A TBI causes neurological or neuropsychological changes and may also lead to various symptoms that affect a person's cognition, mobility, behavior, and mental health. Determining if those who have experienced SV are at increased risk of sustaining a TBI in their lifetime is critical given the high prevalence and health impacts of SV, the potential vulnerability to TBI after SV, and the known detrimental effects of TBI. This exploratory study examined data from the 2017 Connecticut behavioral risk factor surveillance system and found that lifetime SV victimization (controlling for age and sex) was associated with increased odds of reporting a recent TBI in the past 12 months (adjusted odds ratio [AOR] = 2.1; 95% confidence interval [CI] [1.03, 4.21]). Further research is needed to better understand how SV history is related to the risk of sustaining a TBI. Healthcare professionals can support patients who experience SV by providing resources to help reduce associated physical and mental health conditions and health-risk behaviors.


Assuntos
Lesões Encefálicas Traumáticas , Delitos Sexuais , Adulto , Humanos , Connecticut , Sistema de Vigilância de Fator de Risco Comportamental , Delitos Sexuais/psicologia , Saúde Mental , Lesões Encefálicas Traumáticas/epidemiologia
14.
Public Health Rep ; 139(2): 208-217, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37232422

RESUMO

OBJECTIVES: Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS: We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS: Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS: A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C Crônica , Hepatite C , Humanos , Antivirais/uso terapêutico , Connecticut/epidemiologia , Coinfecção/epidemiologia , Coinfecção/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Hepatite C/complicações , Hepatite C/epidemiologia , Hepatite C/tratamento farmacológico , Hepacivirus
15.
J Midwifery Womens Health ; 69(1): 127-135, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37387684

RESUMO

INTRODUCTION: Midwives in Connecticut lack resources for current, state-specific data regarding compensation, benefits, work hours, and scope of practice. The primary purpose of this study was to provide detailed information about the work and services provided by midwives in Connecticut and how they are compensated. METHODS: Certified nurse-midwives (CNMs) licensed in Connecticut were recruited for a 53-question online survey between October 2021 and February 2022. The survey included topics such as compensation, benefits, practice patterns, and precepting. RESULTS: For full-time salaried CNMs in Connecticut, compensation was higher than the national average for midwives. A majority of CNMs in the state work 40 hours per week or less in physician-owned private practices and are preceptors. DISCUSSION: For midwives planning to negotiate contracts in Connecticut, this report provides important information to ensure fair compensation and work hours. The survey also serves as a roadmap for midwives in other states who wish to collect and disseminate similar workforce data.


Assuntos
Tocologia , Enfermeiros Obstétricos , Gravidez , Humanos , Estados Unidos , Feminino , Connecticut , Certificação , Recursos Humanos
16.
Drug Alcohol Depend ; 254: 111040, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38043226

RESUMO

OBJECTIVE: To determine the relative risk of death following exposure to treatments for OUD compared to no treatment. METHODS: In this retrospective cohort study we compiled and merged state agency data on accidental and undetermined opioid overdose deaths in 2017 and exposures to OUD treatment in the prior six months to determine incidence rates following exposure to different treatment modalities. These rates were compared to the estimated incidence among those exposed to no treatment to determine relative risk of death for each treatment exposure. RESULTS: Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27-1.77). PRINCIPAL CONCLUSIONS: Exposure to non-MOUD treatments provided no protection against fatal opioid poisoning whereas the relative risk was reduced following exposures to MOUD treatment, even if treatment was not continued. Population level efforts to reduce opioid overdose deaths need to focus on expanding access to agonist-based MOUD treatments and are unlikely to succeed if access to non-MOUD treatments is made more available.


Assuntos
Buprenorfina , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Connecticut , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Overdose de Drogas/terapia , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/terapia , Tratamento de Substituição de Opiáceos
17.
J Natl Cancer Inst ; 116(3): 485-489, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-37991935

RESUMO

Although incarcerated adults are at elevated risk of dying from cancer, little is known about cancer screening in carceral settings. This study compared stage-specific incidence of screen-detectable cancers among incarcerated and recently released people with the general population, as a reflection of screening practices. We calculated the age- and sex-standardized incidence ratios (SIR) for early- and late-stage cancers for incarcerated and recently released adults compared to the general Connecticut population between 2005 and 2016. Our sample included 143 cancer cases among those incarcerated, 406 among those recently released, and 201 360 in the general population. The SIR for early-stage screen-detectable cancers was lower among incarcerated (SIR = 0.28, 95% CI = 0.17 to 0.43) and recently released (SIR = 0.69, 95% CI = 0.51 to 0.88) individuals than the general population. Incidence of late-stage screen-detectable cancer was lower during incarceration (SIR = 0.51, 95% CI = 0.27 to 0.88) but not after release (SIR = 1.32, 95% CI = 0.93 to 1.82). Findings suggest that underscreening and underdetection of cancer may occur in carceral settings.


Assuntos
Encarceramento , Neoplasias , Adulto , Humanos , Connecticut/epidemiologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Incidência , Fatores de Risco
18.
J Evid Based Soc Work (2019) ; 21(2): 162-176, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37796810

RESUMO

There has been widespread outrage within the social work profession regarding racial disparities in pass rates of licensing exams developed and administered by the Association of Social Work Boards (ASWB). The most supported remedy has been to eliminate testing for some categories of licensure with Connecticut, Illinois, and Rhode Island leading the way. Standardized testing has historically been a gatekeeping practice criticized for its exclusionary nature with no empirical evidence linking it to more competent mental health and other social work practice. Thus, the profession is correct in questioning an exam's relevance in social work regulation. However, the licensure test has become a lightning rod issue preventing more substantive analyses, debate, and antiracist reforms within the profession's policy, practice, and education arenas. This article uses the disparity in ASWB pass rates as the impetus for a more critical look at systemic issues in social work adversely impacting Black individuals entering the profession. The authors acknowledge that an anti-racist agenda in social work requires tackling long-standing problems that will not be as easily solved as eliminating multiple choice testing.


Assuntos
Licenciamento , Serviço Social , Humanos , Grupos Raciais , Connecticut , Illinois
19.
J Wildl Dis ; 60(1): 193-197, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37924242

RESUMO

A SARS-CoV-2 genomic and serologic survey was performed in a population of bobcats (Lynx rufus) inhabiting the state of Connecticut, USA. Wild animal populations are becoming established in densely populated cities with increased likelihood of direct or indirect contact with humans, as well as with household cats and dogs. Wild-caught bobcats (n=38) tested negative for SARS-CoV-2 genomic RNA by reverse-transcription quantitative PCR and for virus-neutralizing antibodies by ELISA, suggesting that either the species is not susceptible to SARS-CoV-2 or that the surveyed population has not yet been exposed to a source of infectious virus. However, this limited survey cannot rule out that human-to-bobcat or unknown reservoir-to-bobcat transmission of the virus occurs in nature.


Assuntos
COVID-19 , Doenças do Gato , Doenças do Cão , Lynx , Humanos , Animais , Gatos , Cães , SARS-CoV-2 , Connecticut/epidemiologia , População Suburbana , COVID-19/epidemiologia , COVID-19/veterinária , Doenças do Gato/epidemiologia
20.
Environ Sci Pollut Res Int ; 31(4): 5526-5539, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38123781

RESUMO

Foraging for edible and medicinal mushrooms is a cultural and social practice both globally and in the United States. Determining the toxic and nutrient element concentrations of edible and medicinal mushrooms is needed to ensure the safe consumption of this food source. Our research examined wild, foraged mushrooms in New England, USA to assess nutrient (Ca, K, Mg, P) and toxic (As, Hg, Pb, Cd) element relationships between mushrooms, substrates, and soils. We examined a gradient in nutrient and toxic elements from more rural Mountain and Hill Zones in Massachusetts, Vermont, and New Hampshire to more developed and urban Valley and Coastal Zones in Connecticut. Substrates and mineral soils were moderate to weak predictors of mushroom tissue concentrations. We found significant differences in nutrient and toxic element concentration among the five common genera: Ganoderma, Megacollybia, Pluteus, Pleurotus, and Russula. In particular, Pluteus had consistently higher toxic element concentrations while Pleurotus and Russula had the highest Bioaccumulation Factors (BAFs). We found that the urban areas of the Valley and Coastal zones of Connecticut had Cd Target Hazard Quotient (THQ) values and ΣTHQ values > 1.0, indicating potential non-carcinogenic health hazard. However, the trend was largely driven by the > 2.0 Cd THQ for Pluteus. Our results suggest that foraging in more urban areas can still yield mushrooms with safe concentrations of toxic elements and abundant nutrients. Further research of this kind needs to be conducted within this region and globally to ensure humans are consuming safe, foraged mushrooms.


Assuntos
Agaricales , Pleurotus , Humanos , Cádmio , Connecticut , Rios , Solo , New England , Nutrientes
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