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1.
J Assist Reprod Genet ; 39(7): 1611-1618, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35583571

RESUMO

PURPOSE: Supraphysiologic serum estradiol levels may negatively impact the likelihood of conception and live birth following IVF. The purpose of this study is to determine if there is an association between serum estradiol level on the day of progesterone start and clinical outcomes following programmed frozen blastocyst transfer cycles utilizing oral estradiol. METHODS: This is a retrospective cohort study at an academic fertility center analyzing 363 patients who underwent their first autologous single (SET) or double frozen embryo transfer (DET) utilizing oral estradiol and resulting in blastocyst transfer from June 1, 2012, to June 30, 2018. Main outcome measures included implantation, clinical pregnancy, live birth, and miscarriage rates. Cycles were stratified by quartile of serum estradiol on the day of progesterone start and separately analyzed for SET cycles only. Poisson and Log binomial regression were used to calculate relative risks (RR) with 95% confidence intervals (CI) for implantation, clinical pregnancy, live birth, and miscarriage with adjustments made for age and BMI. RESULTS: Cycles with the highest quartile of estradiol (mean 528 pg/mL) were associated with lower risks of implantation (RR 0.66, CI 0.50-0.86), ongoing pregnancy (RR 0.66, CI 0.49-0.88), and live birth (RR 0.70, CI 0.52-0.94) compared with those with the lowest estradiol quartile (mean 212 pg/mL). Similar findings were seen for analyses limited to SETs. There was no significant difference in miscarriage rate or endometrial thickness between groups. CONCLUSION: High levels of serum estradiol on the day of progesterone start may be detrimental to implantation, pregnancy, and live birth following frozen blastocyst transfer.


Assuntos
Aborto Espontâneo , Progesterona , Aborto Espontâneo/epidemiologia , Blastocisto , Transferência Embrionária/métodos , Estradiol , Feminino , Humanos , Nascido Vivo , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
2.
Cancer ; 127(20): 3872-3880, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34161610

RESUMO

BACKGROUND: Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes. METHODS: The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]). RESULTS: The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3- and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS: FP+, 85.4%; FP-, 79.4%; P = .411; 5-year IDFS: FP+, 73.7%; FP-, 67.1%; P = .288). Similarly, no difference in overall survival (OS) was observed between the 2 groups (3-year OS: FP+, 95.5%; FP-, 93.5%; P = .854; 5-year OS: FP+, 84.2%; FP-, 81.4%; P = .700). CONCLUSIONS: FP after a breast cancer diagnosis delays the time to treatment by a small amount, but this delay does not lead to inferior IDFS or OS.


Assuntos
Neoplasias da Mama , Preservação da Fertilidade , Adulto , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estudos Retrospectivos , Adulto Jovem
3.
Int J Gynecol Cancer ; 31(10): 1341-1347, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34429355

RESUMO

OBJECTIVE: To evaluate the impact of size and distribution of residual disease after interval debulking surgery on the timing and patterns of recurrence for patients with advanced-stage epithelial ovarian cancer. METHODS: Patient demographics and data on disease treatment/recurrence were collected from medical records of patients with stage IIIC/IV epithelial ovarian cancer who were managed with neoadjuvant chemotherapy/interval debulking surgery between January 2010 and December 2014. Among patients without complete surgical resection but with ≤1 cm of residual disease, the number of anatomic sites (<1 cm single anatomic location vs <1 cm multiple anatomic locations) was used to describe the size and distribution of residual disease. RESULTS: A total of 224 patients were included. Of these, 70.5% (n=158) had a complete surgical resection, 12.5% (n=28) had <1 cm single anatomic location, and 17.0% (n=38) had <1 cm multiple anatomic locations. Two-year progression-free survival for complete surgical resection, <1 cm single anatomic location, and <1 cm multiple anatomic locations was 22.2%, 17.9% and 7%, respectively (p=0.007). Size and distribution of residual disease after interval debulking surgery did not affect location of recurrence and most patients had recurrence at multiple sites (complete surgical resection: 64.7%, <1 cm single anatomic location: 55.6%, and <1 cm multiple anatomic locations: 71.4%). Controlling for additional factors that may influence platinum resistance and surgical complexity, the rate of platinum-resistant recurrence was similar for patients with complete surgical resection and <1 cm single anatomic location (OR=1.07, 95% CI 0.40 to 2.86; p=0.888), but women with <1 cm multiple anatomic locations had an increased risk of platinum resistance (OR=3.09, 95% CI 1.41 to 6.78 p=0.005). CONCLUSIONS: Despite current classification as 'optimal,' <1 cm multiple anatomic location at the time of interval debulking surgery is associated with a shorter progression-free survival and increased risk of platinum resistance.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Neoplasia Residual/patologia , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/métodos , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Estudos Retrospectivos
4.
Subst Use Misuse ; 56(5): 674-682, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33648428

RESUMO

Introduction: Simultaneous polydrug use of electronic nicotine delivery systems (ENDS) and alcohol among college students is not well understood despite high rates of vaping and alcohol use among this population. The current study examined rates of simultaneous use and compared demographic characteristics, vaping history, motivations for initiating use, and outcome expectancies based on polydrug use status. Methods: An online and paper-and pencil questionnaire was administered to undergraduate students at a university in the northeast of the U.S. Purposive sampling strategies were used and a raffle was offered to incentivize participation. Results: Simultaneous polydrug use was prevalent in the sample of 670 college students, with 55.6% reporting simultaneous and non-simultaneous use, 34.0% reporting simultaneous use only, and 10.4% reporting non-simultaneous use only. An examination of differences based on polydrug use status indicated that students who reported simultaneous and non-simultaneous use were more likely to be males, report vaping daily, and endorse a wide range of motivations for use. Students who engaged in simultaneous use only were more likely to be females, indicate a social contextual-related motivation for initiating use, and had higher scores on appetite control, emotion regulation, and taste sensation outcome expectancies. Students who engaged in non-simultaneous use only were more likely to be nonwhite students and report the lowest expectation of health risks. Conclusions: The findings reveal differences based on simultaneous polydrug use status that can be informative in the development of contextually relevant prevention programming. Future research is needed to further explore simultaneous use of ENDS and alcohol.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Feminino , Humanos , Masculino , Motivação , Estudantes , Universidades
5.
Public Health Nurs ; 38(5): 920-925, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34048076

RESUMO

OBJECTIVES AND DESIGN: This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons. SAMPLE AND MEASUREMENT: Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries. RESULTS: Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services. CONCLUSION: Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population.


Assuntos
Assistência Alimentar , Adulto , Doença Crônica , Estudos Transversais , Alimentos , Abastecimento de Alimentos , Humanos
6.
Health Promot Pract ; 22(2): 248-256, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-31847597

RESUMO

Inclusive place-making is an important strategy to ensure that built-environment improvements contribute rather than detract from community health. We conducted participatory research to support 15 youth leaders as they advocated for improvements to their walk-to-school environment. The project included four phases. During Phase 1 (Route and Experience Identification), we visited 21 classrooms in three Bridgeport high schools and used an interactive mapping process with students to identify the most often used walk-to-school routes. Youth leaders also collected questionnaires from 187 peers about their school travel experiences. During Phase 2 (Route Assessment), the youth leaders examined the quality of these routes using the Microscale Audit of Pedestrian Streetscapes assessment tool. During Phase 3 (Data Analysis), the University partners analyzed the data collected in the prior phases. Percentage scores were calculated for each segment and crossing along the routes assessed. We used chi-square tests to examine associations between students' travel model and negative travel-related experiences. Almost all segments (82%) and crossings (91%) examined received a failing grade (<64%). In addition, a greater proportion of students who walk/cycle/skate to school rather than ride in a motor vehicle reported feeling unsafe (p = .001), missing first period (p = .006), and lower grades (p = .001) due to travel-related challenges. The findings from these assessments were used during Phase 4 (Youth Campaign) to advocate for safer routes to schools. We describe both the lessons learned and successes from the project. Other municipalities might benefit from replicating the youth-led, participatory approach used in this study.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Caminhada , Adolescente , Ciclismo , Cidades , Humanos , Instituições Acadêmicas , Meios de Transporte , Viagem , Doença Relacionada a Viagens
7.
Nurs Outlook ; 69(2): 212-220, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33070980

RESUMO

BACKGROUND: Low-income, working-age Veterans with children have risk for food insecurity. Less known is extent to which their risk compares to nonveterans. PURPOSE: To evaluate odds of food insecurity for working-age Veterans with children compared to socioeconomically-matched nonveterans with children. METHOD: We constructed a propensity score-matched cohort using 2011-2014 National Health and Nutrition Examination Survey data. Covariate-adjusted logistic regressions estimated Veterans' odds for overall food insecurity and for each level of severity compared to nonveterans. FINDINGS: We matched 155 Veterans to 310 nonveterans on gender, race/ethnicity, education, income. Models were adjusted for age, marital-status, depression, and listed matched variables. Although Veteran-status had no effect on overall food insecurity (odds ratio = 1.09, 95% confidence interval [0.62,1.93]), Veteran-status increased odds for very low food security (odds ratio = 2.71, 95% confidence interval [1.21, 6.07]). DISCUSSION: Veterans do not have higher odds of food insecurity than non-veterans, but they are more likely to have the more severe very low food security (often associated with hunger) than non-veterans. Investigation of food insecurity's impact on Veteran health/well-being is needed.


Assuntos
Fatores Etários , Insegurança Alimentar , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estados Unidos
8.
AIDS Care ; 31(7): 848-856, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616376

RESUMO

A substantial body of literature has characterized how psychosocial factors, including HIV-related stigma and coping, are associated with HIV testing and HIV care utilization post-diagnosis. Less is known about if certain psychosocial characteristics pre-diagnosis may also predict linkage to care among individuals who receive an HIV-positive diagnosis. We examined if pre-diagnosis awareness/perception about HIV-related stigma and dispositional coping styles predicted linkage to HIV care within three months post-diagnosis with a secondary analysis of 604 patients from a randomized controlled trial (Sabes Study). Awareness/perception about HIV-related stigma, dispositional maladaptive and adaptive coping were measured before patients underwent an HIV test. Linkage to care was measured as receipt of care within three months of receiving the diagnosis. After adjusting for covariates, individuals who reported greater dispositional maladaptive coping pre-diagnosis had lower odds of linking to care, OR = 0.82, 95%CI [0.67, 1.00], p = .05. There was also a non-significant inverse association between dispositional adaptive coping pre-diagnosis and linkage to care. These preliminary data suggest the need for further longitudinal research and highlight the potential utility of pre-diagnosis psychosocial assessment and tailored counseling when providing positive HIV diagnosis results.


Assuntos
Adaptação Psicológica , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Estigma Social , Adulto , Conscientização , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Percepção , Peru , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Gynecol Oncol ; 150(3): 406-411, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30017539

RESUMO

OBJECTIVES: To investigate the utility of para-aortic lymph node dissection among women undergoing radical hysterectomy and pelvic lymph adenectomy for FIGO Stage IA2-IB2 cervical cancer using the National Cancer Database (NCDB). METHODS: We identified patients with stage IA2-IB2 squamous cell, adenosquamous, or adenocarcinoma of the cervix diagnosed 2011-2014 in the NCDB. The primary outcome was the negative predictive value of histologically assessed pelvic lymph node status for para-aortic lymph node status among women undergoing pelvic and para-aortic lymph node dissection. We calculated probability of para-aortic lymph node metastasis conditional on pelvic lymph node status. Finally, we compared overall survival between patients undergoing para-aortic lymph node dissection and those in whom this procedure was omitted. RESULTS: A total of 3212 patients met study inclusion criteria, of whom 994 (30.9%) underwent para-aortic lymph node dissection. In this group, the risk of isolated para-aortic metastasis was 0.11%. The negative predictive value of surgically assessed pelvic lymph nodes to predict para-aortic lymph node status was 99.9% (95% CI 99.9-99.9). Among 93 patients with pelvic lymph node metastasis, 18 (19.4%) had concurrent para-aortic lymph node metastasis. There was no difference in overall survival between women undergoing pelvic and para-aortic lymph node dissection compared with those undergoing pelvic lymphadenectomy only (p = 0.69). CONCLUSIONS: In patients undergoing radical hysterectomy and pelvic lymphadenectomy for stage IA2-IB2 cervical cancer, para-aortic lymph node dissection is not warranted based on the low risk of isolated metastatic disease, and lack of survival benefit associated with the procedure.


Assuntos
Carcinoma/secundário , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Neoplasias do Colo do Útero/patologia , Aorta , Carcinoma/cirurgia , Feminino , Humanos , Histerectomia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pelve , Valor Preditivo dos Testes , Probabilidade , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/cirurgia
10.
J Community Health ; 43(3): 524-533, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29243012

RESUMO

We examined use of a farmers' market that leverages community partnerships to provide free produce to lower-income persons. Participants (n = 422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees' reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P < 0.001) and in 2015 was low-income (P < 0.001). Most attendees heard about the market through flyers (P < 0.001) and word of mouth (P ≤ 0.001) in 2014 and through local, non-profit services (P < 0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P < 0.001). Impoverished households (P = 0.020) and households receiving more financial support services (P < 0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.


Assuntos
Abastecimento de Alimentos/economia , Abastecimento de Alimentos/métodos , Promoção da Saúde/métodos , Dieta , Fazendeiros , Frutas , Humanos , Pobreza , Inquéritos e Questionários , Verduras
11.
Prev Chronic Dis ; 15: E28, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29494331

RESUMO

We examined the relative importance of 23 community issues among elected officials and health directors in Connecticut in 2016. For this cross-sectional study, 74 elected officials (40.7% response rate) and 47 health directors (62.7% response rate), who were purposively sampled, completed a questionnaire to rate their perceived importance of 23 community issues. Eight of these issues were related to active living, healthy eating, or obesity. We used χ2 tests to evaluate differences in responses. Compared with elected officials, health directors significantly more often perceived obesity, access to healthy groceries, poor nutrition, lack of pedestrian walkways, and pedestrian safety as important. Elected officials significantly more often than health directors perceived lack of good jobs, quality of public education, and cost of living as important. Health advocates should work with both groups to develop and frame policies to address both upstream (eg, jobs, education) and downstream (eg, healthy eating policies) determinants of obesity.


Assuntos
Dieta Saudável , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Obesidade/prevenção & controle , Connecticut/epidemiologia , Estudos Transversais , Exercício Físico , Empregados do Governo/psicologia , Empregados do Governo/estatística & dados numéricos , Humanos , Obesidade/epidemiologia , Inquéritos e Questionários
12.
J Strength Cond Res ; 31(9): 2432-2437, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27806012

RESUMO

Marcello, RT, Greer, BK, and Greer, AE. Acute effects of plyometric and resistance training on running economy in trained runners. J Strength Cond Res 31(9): 2432-2437, 2017-Results regarding the acute effects of plyometrics and resistance training (PRT) on running economy (RE) are conflicting. Eight male collegiate distance runners (21 ± 1 years, 62.5 ± 7.8 ml·kg·min V[Combining Dot Above]O2 peak) completed V[Combining Dot Above]O2 peak and 1 repetition maximum (1RM) testing. Seven days later, subjects completed a 12 minutes RE test at 60 and 80% V[Combining Dot Above]O2 peak, followed by a PRT protocol or a rested condition of equal duration (CON). The PRT protocol consisted of 3 sets of 5 repetitions at 85% 1RM for barbell squats, Romanian deadlifts, and barbell lunges; the same volume was used for resisted lateral lunges, box jumps, and depth jumps. Subjects completed another RE test immediately after the treatments and 24 hours later. Subjects followed an identical protocol 6 days later with condition assignment reversed. Running economy was determined by both relative V[Combining Dot Above]O2 (ml·kg·min) and energy expenditure (EE) (kcal·min). There was a significant (p ≤ 0.05) between-trial increase in V[Combining Dot Above]O2 (37.1 ± 4.2 ml·kg·min PRT vs. 35.5 ± 3.9 ml·kg·min CON) and EE (11.4 ± 1.3 kcal·min PRT vs. 11.0 ± 1.4 kcal·min CON) immediately after PRT at 60% V[Combining Dot Above]O2 peak, but no significant changes were observed at 80% V[Combining Dot Above]O2 peak. Respiratory exchange ratio was significantly (p ≤ 0.05) reduced 24 hours after PRT (0.93 ± 0.0) as compared to the CON trial (0.96 ± 0.0) at 80% V[Combining Dot Above]O2 peak. Results indicate that high-intensity PRT may acutely impair RE in aerobically trained individuals at a moderate running intensity, but that the attenuation lasts less than 24 hours in duration.


Assuntos
Exercício Pliométrico/métodos , Treinamento Resistido/métodos , Corrida/fisiologia , Adolescente , Atletas , Metabolismo Energético , Humanos , Masculino , Consumo de Oxigênio , Adulto Jovem
13.
Fam Community Health ; 39(3): 199-206, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27214675

RESUMO

This study provides economically disadvantaged, minority food pantry patrons (hereafter, patrons) a meaning-ful voice by examining their experiences trying to obtain sufficient, nutritious food. Five focus groups were conducted using a semistructured discussion guide. Atlast.ti software was used to manage and analyze the data. Patrons reported that pantry staff who preserved their dignity by showing compassion were highly valued. Stigma and shame associated with pantry use were major concerns. Patrons suggested environmental and policy changes to improve their food acquisition experiences. These findings suggest that multilevel interventions addressing food access, food distribution policies, and patron-staff interactions are warranted.


Assuntos
Abastecimento de Alimentos/economia , Grupos Minoritários/legislação & jurisprudência , Política Nutricional/economia , Populações Vulneráveis/legislação & jurisprudência , Grupos Focais , Humanos , Pesquisa Qualitativa
14.
Int J Sport Nutr Exerc Metab ; 26(2): 145-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26402571

RESUMO

The purpose of the current study was to determine whether expected changes in body weight via a 3-day low-carbohydrate (LC) diet will disrupt the reliability of air displacement plethysmography measurements via BOD POD. Twenty-four subjects recorded their typical diets for 3 days before BOD POD and 7-site skinfold analyses. Subjects were matched for lean body mass and divided into low-CHO (LC) and control (CON) groups. The LC group was given instruction intended to prevent more than 50 grams/day of carbohydrate consumption for 3 consecutive days, and the CON group replicated their previously recorded diet. Body composition measurements were repeated after dietary intervention. Test-retest reliability measures were significant (p < .01) and high for body fat percentage in both the LC and the CON groups (rs = .993 and .965, respectively). Likewise, skinfold analysis for body fat percentage reliability was high in both groups (rs = .996 and .997, respectively). There were significant differences between 1st and 2nd BOD POD measurements for body mass (72.9 ± 13.3 vs. 72.1 ± 13.0 kg [M ± SD]) and body volume (69.0 ± 12.7-68.1 ± 12.2 L) in the LC group (p < .05). However, there were no differences (p > .05) in BOD POD-determined body fat percentage, lean body mass, or fat mass between the 1st and 2nd trial in either group. Body composition measures via BOD POD and 7-site skinfolds remain reliable after 3 days of an LC diet despite significant decreases in body mass.


Assuntos
Composição Corporal , Dieta com Restrição de Carboidratos , Pletismografia/instrumentação , Adulto , Peso Corporal , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores de Tempo
15.
Nurs Econ ; 34(4): 172-81, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29975022

RESUMO

Hospitals are penalized financially for high 30-day readmission rates for specific diagnoses, including heart failure. The economic imperative exists to better manage the heart-failure population and acute care providers are in need of appropriate tools to aid in their efforts. This study was conducted to determine if the Rothman Index score may be useful to prospectively identify patients with heart failure at risk for extended hospitalization, high inpatient cost of care, and 30-day readmission. Results from this study suggest the Rothman Index score can be a useful adjunct to current clinical assessment methods in helping multidisciplinary teams better manage patient care and limited resources.


Assuntos
Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Medição de Risco , Idoso , Gerenciamento Clínico , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Health Promot Pract ; 16(2): 202-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25258432

RESUMO

OBJECTIVE: This study engaged community members to describe physical activity (PA) environments in parks and to examine if the PA environment in parks was related to the economic characteristics of households near parks. METHOD: Twenty-four Bridgeport, adult residents examined the PA environments in 21 Bridgeport, Connecticut, parks using the Community Stakeholder Park Audit Tool (CPAT) during the summer, 2013. ESRI's Geographical Information System was used to identify the economic characteristics (i.e., median household income, percentage of households below the poverty line; from 2010 Census data) of households within 0.5 miles of a park. Descriptive and inferential statistics were used to analyze CPAT data. RESULTS: A negative association was identified between the parks' PA area and safety scores (p = .012). Positive associations were identified between the parks' PA area and amenities scores (p < .001), access and amenities scores (p = .006), and park safety concern and surrounding safety concern scores (p < .001). There were no significant associations between park environment indices and the economic characteristics of households less than 0.5 miles from parks. Community members recommended several strategies to enhance PA environments in parks. CONCLUSIONS: The findings highlight the utility of CPAT for enabling community members identify opportunities to enhance PA environments in parks.


Assuntos
Meio Ambiente , Logradouros Públicos/estatística & dados numéricos , Recreação , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Feminino , Sistemas de Informação Geográfica , Humanos , Masculino , Pessoa de Meia-Idade , Segurança , Fatores Socioeconômicos
17.
Int J Prosthodont ; 35(2): 233­239, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33625398

RESUMO

PURPOSE: To evaluate whether intraoral devices reduce the adverse oral and dental effects of radiotherapy in head and neck cancer patients. MATERIALS AND METHODS: A systematic search of the Medline and Embase databases for articles published before March 2019 was performed by two independent reviewers. Studies published in English that evaluated whether intraoral devices reduced the risk of radiotherapy-related complications in patients receiving radiotherapy to the head and neck region were included. The kappa statistic was used to calculate the level of inter-reviewer agreement. RESULTS: Five studies met the inclusion criteria, although only one was considered to be a low risk of bias. One study reported that intraoral devices did not reduce the severity of mucositis after 7 weeks. The remaining four studies reported that intraoral devices reduced the risk of xerostomia, mucositis, trismus, dysphagia, and dental caries over 2 to 6 months. CONCLUSION: There are limited data to support the use of intraoral devices in head and neck cancer patients undergoing radiotherapy. Well-designed clinical studies that consider long-term outcomes are necessary to draw definitive conclusions.


Assuntos
Cárie Dentária , Neoplasias de Cabeça e Pescoço , Mucosite , Lesões por Radiação , Xerostomia , Cárie Dentária/etiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Doença Iatrogênica , Mucosite/complicações , Xerostomia/etiologia , Xerostomia/prevenção & controle
18.
J Am Coll Health ; 70(6): 1839-1847, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33253007

RESUMO

Objective: Using social cognitive theory as a framework, this study examined electronic nicotine delivery systems (ENDS) use, related cognitions, and context among college students. Participants: Respondents were 1229 students attending a mid-sized, northeastern university. Methods: A cross-sectional survey was administered and SPSS was used for analysis. Results: Almost 41% of respondents reported ENDS use in the prior month (past-month user), 26.8% reported trying ENDS but no use in the prior month (occasional user), and 32.3% reported never trying ENDS. The results highlight significant associations in past-month versus occasional use and reasons for initation, location for ENDS use, perceived norms for ENDS use, and outcome expectations for ENDS use. Conclusions: This study highlights a need for theory-based, multi-level strategies to reduce ENDS use. Interventions should increase awareness about the risks of ENDS, include peer-based interventions to foster health-promoting campus social environments, and explore the use of policies restricting campus ENDS use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Estudos Transversais , Humanos , Teoria Psicológica , Estudantes/psicologia , Universidades
19.
Br Dent J ; 227(10): 893-899, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31758131

RESUMO

Introduction There are many conflicting demands for dentists and dental care professionals (DCPs) when using social media, for example between using social media for marketing and as professional provider of information. To gain a fuller understanding of how dentists/DCPs should optimally use social media, these conflicting demands need to be explored. The aim of this scoping review was to map out the current state of the literature describing the conflicting demands encountered by dentists and DCPs when using social media and the approaches used to manage these conflicting demands.Methods A scoping review was carried out. PubMed and Web of Science Core Collection were searched using inclusion and exclusion criteria. Data was extracted from the identified articles and analysed.Results The review identified 39 articles for inclusion. Conflicting demands were related to marketing and education with little information about how these conflicting demands can be managed.Conclusions The published literature on dentists'/DCPs' use of social media highlights that there are conflicting demands and little advice on management strategies. To gain an understanding of these conflicting demands, further research is required, including looking at the patient perspective, to inform future practice.


Assuntos
Mídias Sociais , Assistência Odontológica , Odontólogos , Humanos
20.
Stigma Health ; 4(2): 204-212, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31157298

RESUMO

This pilot study examines associations of perceived stigma pre-diagnosis with experienced stigma and social support post-diagnosis with qualitative data; and quantifies the interplay between pre- and post-diagnosis social factors on depressive symptoms among a sample of newly diagnosed Peruvian men who have sex with men (n = 67 total). Qualitative findings highlight the differences between perceptions of stigma pre-disclosure and actual social experiences post-disclosure for most participants. Perceived stigma pre-diagnosis was significantly related to post-diagnosis social support, B = -0.35, p = 0.03, and marginally associated with experienced stigma, B = 0.29, p = 0.07. Pre-diagnosis perceived stigma was associated with greater depressive symptoms, but only among individuals who reported higher amounts of social support, B = 0.55, p = 0.01. Findings suggest the importance of addressing social perceptions in order to optimize the beneficial effects of social support resources among newly diagnosed individuals.

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