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1.
Harmful Algae ; 138: 102704, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39244239

RESUMO

The production of allelochemicals by the toxigenic dinoflagellate Alexandrium catenella is one of the suggested mechanisms to facilitate its bloom formation and persistence by outcompeting other phototrophic protists and reducing grazing pressure. In Southern California, toxic events caused by A. catenella and paralytic shellfish toxins (PSTs) regularly impact coastal ecosystems; however, the trophic interactions and mechanisms promoting this species in a food web context are still not fully understood. In the present study, we combined a dynamical mathematical model with laboratory experiments to investigate potential toxic and allelochemical effects of an A. catenella strain isolated off the coast of Los Angeles, Southern California, on competitors and a common zooplankton consumer. Experiments were conducted using three toxigenic strains of A. catenella, comparing the new Californian isolate (Alex Cal) to two strains previously described from the North Sea, a lytic (Alex2) and non-lytic (Alex5) strain, testing for donor density-dependent effects on two phytoplankton species (Rhodomonas salina, Tetraselmis sp.) and on the rotifer Brachionus plicatilis. Bioassays revealed a steep decline in competitor and consumer populations with increasing Alex Cal concentrations, indicating an intermediate lytic activity compared to the North Sea strains (lytic Alex2 and non-lytic Alex5). The rotifer fed and grew well on the PST- toxic, but non-lytic Alex5 strain, while its survival significantly decreased with increasing concentrations of the two lytic strains Alex Cal and Alex 2, indicating that negative effects on the rotifer were mediated by allelochemicals rather than PST-toxins. Mixed culture experiments including both competitors and consumers demonstrated that the intensity of allelochemical effects not only depended on the A. catenella density but also on the target density. Negative effects on grazers were alleviated by co-occurring competitors with a lower sensitivity to allelochemicals, thus reducing harmful compounds and allowing grazing control on the dinoflagellate to come into effect again. Results from mixed culture experiments were supported by the mathematical approach used in this study which was calibrated with data from simple monoculture growth, pairwise competition and predator-prey experiments, demonstrating the applicability of this model approach to predict the outcome of more complex food web dynamics at the community level.


Assuntos
Dinoflagellida , Feromônios , Dinoflagellida/fisiologia , Dinoflagellida/metabolismo , Feromônios/metabolismo , Animais , Cadeia Alimentar , California , Toxinas Marinhas/metabolismo , Zooplâncton/fisiologia
2.
Food Microbiol ; 124: 104598, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39244357

RESUMO

This study aimed to identify different environmental microbiota in animal farms adjacent to produce fields and to understand their potential flow pattern. Soil and water samples were collected from 16 locations during the winter, spring, summer, and fall seasons. In addition, a high-resolution digital elevation model helped to create a stream network to understand the potential flow of the microbiome. Metagenomic analysis of the 16 S rRNA gene revealed that soil and water samples from the four seasons harbor diverse microbiome profiles. The phylogenetic relationship of operational taxonomic units (OTUs) is separated by a maximum of 0.6 Bray-Curtis distance. Similarly, the Principal Component Analysis (P = 0.001) demonstrated the soil and water microbiome clustering across different locations and seasons. The relative abundance of Proteobacteria, Bacteroidetes, and Firmicutes was higher in the water samples than in the soil samples. In contrast, the relative abundance of Actinobacteria and Chloroflexi was higher in the soil compared to the water samples. Soil samples in summer and water samples in spring had the highest abundance of Bacteroidetes and Firmicutes, respectively. A unique microbial community structure was found in water samples, with an increased abundance of Hydrogenophaga and Solirubrobacter. Genera that were significantly abundant at a 1% false discovery rate (FDR) among seasons and soil or water samples, include Nocardioides, Gemmatimonas, JG30-KF-CM45, Massilia, Gaiellales, Sphingomonas, KD4-96, Bacillus, Streptomyces, Gaiella, and Gemmatimonadaceae. The relative abundance of pathogenic genera, including Mycobacterium, Bacteroides, Nocardia, Clostridium, and Corynebacterium, were significantly (at 1% FDR) affected by seasons and environmental type. The elevation-based stream network model suggests the potential flow of microbiomes from the animal farm to the produce fields.


Assuntos
Bactérias , Fazendas , Microbiota , Estações do Ano , Microbiologia do Solo , Animais , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , California , RNA Ribossômico 16S/genética , Filogenia , Microbiologia da Água , Análise Espaço-Temporal , Metagenômica
3.
J Prim Care Community Health ; 15: 21501319241277397, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39238271

RESUMO

INTRODUCTION: Beyond our population growing older and living longer, there is an increased risk of developing a cognitive disorder. Standardized screening during a routine visit in primary care may be ideal for early detection of mild cognitive impairment (MCI) and follow-up for cognitive changes. AIM: This quality improvement (QI) project aimed to determine the impact of implementing the Mini-Cog© quick screening for early dementia detection to identify and follow up on the cognitive impairment of older adults in a primary care clinic setting. METHODS: Implementation started in February 2024 in a primary care clinic in Southern California. Data was collected for this project over a total of 16 weeks. This QI project implemented a routine cognitive screening using the Mini-Cog©. Cognitive impairment was identified, and if indicated by the Mini-Cog© scores, follow-up for a cognitive assessment and care plan services were initiated. Data were obtained from the project site's electronic medical record on a total sample size of 471 participants (n = 382 in the pre-implementation group and n = 89 in the post-implementation group). RESULTS: Pearson's chi-square test indicated a statistically significant improvement in the identification rate of cognitive impairment, increasing from 11.8% (n = 45 out of 382) at pre-implementation to 34.8% (n = 31 out of 89) at post-implementation, and specifically, mild cognitive impairment increased from zero identified in pre-implementation to 12.4% (n = 11 out of 89) post-implementation. Lastly, follow-up rates improved from 91.1% (n = 41 out of 45) to 100% (n = 31 out of 31) in post-implementation, and clinical significance was evident based on the phi-coefficient (φ = 0.196), indicating a small effect size and a 100% follow-up rate. CONCLUSIONS: The findings of this project suggest older adults should receive cognitive screenings to help identify early cognitive impairment and increase follow-up for further evaluation, treatment, and advanced care planning.


Assuntos
Disfunção Cognitiva , Atenção Primária à Saúde , Melhoria de Qualidade , Humanos , Disfunção Cognitiva/diagnóstico , Projetos Piloto , Feminino , Idoso , Masculino , California , Idoso de 80 Anos ou mais , Programas de Rastreamento/métodos , Demência/diagnóstico , Pessoa de Meia-Idade , Seguimentos
4.
JAMA Health Forum ; 5(9): e242802, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39240580

RESUMO

Importance: Housing deposits and tenancy supports have become new Medicaid benefits in multiple states; however, evidence on impacts from these specific housing interventions is limited. Objective: To evaluate the association of rental housing deposits and health care use among Medicaid beneficiaries receiving social needs case management as part of a Whole-Person Care (Medicaid 1115 waiver) pilot program in California. Design, Setting, and Participants: This cohort study compared changes in health care use among a group of adults who received a housing deposit between October 2018 and December 2021 along with case management vs a matched comparison group who received case management only in Contra Costa County, California, a large county in the San Francisco Bay Area. All participants were enrolled in health and social needs case management based on elevated risk of acute care use. Data analysis took place from March 2023 to June 2024. Exposure: Rental housing deposit funds that covered 1-time moving transition costs. Funds averaged $1750 per recipient. Main Outcomes and Measures: Changes in hospitalizations, emergency department visits, primary care visits, specialty care visits, behavioral health visits, psychiatric emergency services, or detention intakes during the 6 months before vs 6 months after deposit receipt. Changes 12 months before and after deposit receipt were examined as a sensitivity analysis. Results: Of 1690 case management participants, 845 received a housing deposit (362 [42.8%] <40 years old; 422 [49.9%] male) and 845 received case management only (367 [43.4%] <40 years old; 426 [50.4%] male). In adjusted analyses, deposit recipients had no statistically significant differential changes in health care use for any measure compared to participants who received case management alone. Twelve-month sensitivity analyses yielded consistent results. Conclusions and Relevance: In this cohort study, compared to case management only, housing deposits with case management were not associated with short-term changes in health care use. There may be other unmeasured health benefits or downstream benefits from greater case management engagement. States considering housing deposits as an expanded Medicaid benefit may need to temper expectations about short-term health care use impacts.


Assuntos
Habitação , Medicaid , Humanos , Masculino , Feminino , Estados Unidos , Adulto , Pessoa de Meia-Idade , Medicaid/estatística & dados numéricos , Habitação/estatística & dados numéricos , California , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Administração de Caso/estatística & dados numéricos , Estudos de Coortes
6.
J Matern Fetal Neonatal Med ; 37(1): 2397721, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39223033

RESUMO

OBJECTIVE: To evaluate the association between wildfire exposure in pregnancy and spina bifida risk. METHODS: This retrospective cohort study used the California Office of Statewide Health Planning and Development Linked Birth File with hospital discharge data between 2007 and 2010. The Birth File data were merged with the California Department of Forestry and Fire Protection data of the same year. Spina bifida was identified by its corresponding ICD-9 code listed on the hospital discharge of the newborn. Wildfire exposure was determined based on the zip code of the woman's home address. Pregnancy was considered exposed to wildfire if the mother lived within 15 miles of a wildfire during the pregnancy or within 30 days prior to pregnancy. RESULTS: There were 2,093,185 births and 659 cases of spina bifida between 2007 and 2010. The births were analyzed using multivariable logistic regression models and adjusted for potential confounders. Exposure to wildfire in the first trimester was associated with higher odds of spina bifida (aOR= 1.43 [1.11-1.84], p-value = 0.01). Wildfire exposure 30 days before the last menstrual period and during the second and third trimesters were not associated with higher spina bifida risk. CONCLUSION: Wildfire exposure has shown an increased risk of spina bifida during the early stages of pregnancy.


Assuntos
Disrafismo Espinal , Incêndios Florestais , Humanos , Feminino , Disrafismo Espinal/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto , California/epidemiologia , Incêndios Florestais/estatística & dados numéricos , Recém-Nascido , Adulto Jovem , Fatores de Risco , Exposição Materna/efeitos adversos , Exposição Materna/estatística & dados numéricos , Características de Residência/estatística & dados numéricos
7.
JAMA Netw Open ; 7(9): e2433730, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-39283635

RESUMO

Importance: Epidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes such as hypoxic-ischemic encephalopathy (HIE). Objective: To determine whether epidural analgesia is associated with increased risk of HIE after adjusting for the birthing person's maximal temperature before epidural placement and for the propensity to get an epidural. Design, Setting, and Participants: This retrospective, population-based cohort study was conducted at 15 Kaiser Permanente Northern California hospitals. Participants included singleton neonates born at 35 weeks' or later gestational age between 2012 and 2019. Elective cesarean deliveries and deliveries within 2 hours of hospital admission were excluded. Data analysis was performed from November 2022 to June 2024. Exposure: The primary exposure was epidural analgesia during labor. Main Outcomes and Measures: The primary outcome was HIE, defined as the presence of both neonatal acidosis (ie, pH <7 or base deficit ≥10) and encephalopathy. The presence and timing of epidural analgesia and demographic, pregnancy, and labor characteristics were extracted from electronic medical records. A propensity score for receiving epidural analgesia was created including demographic variables and comorbidities predating epidural placement. Logistic regression was used to evaluate the association between epidural analgesia and HIE, adjusting for maximal birthing parent's temperature before epidural placement and the propensity for receiving an epidural. Results: Among 233 056 infants born at 35 weeks' or later gestational age by vaginal or unplanned cesarean delivery after at least 2 hours of in-hospital labor, 177 603 (76%) were exposed to epidural analgesia and 439 (0.19%) had HIE. On unadjusted analysis, epidural analgesia was associated with an increased risk of maximal temperature greater than 38 °C during labor (risk ratio [RR], 8.58; 95% CI, 8.06-9.14). Each degree increase in maximal temperature during labor was associated with nearly triple the odds of HIE (odds ratio [OR], 2.82; 95% CI, 2.51-3.17). However, there was no significant association between epidural analgesia and the risk of HIE either on crude (RR, 1.21; 95% CI, 0.96-1.53) or adjusted (adjusted OR, 0.93; 95% CI, 0.73-1.17) analyses. Conclusions and Relevance: In this cohort study including more than 230 000 parent-infant dyads, epidural analgesia was associated with increased maximal temperature during labor, a known risk factor for HIE. However, epidural analgesia was not associated with increased odds of HIE.


Assuntos
Analgesia Epidural , Hipóxia-Isquemia Encefálica , Humanos , Analgesia Epidural/efeitos adversos , Analgesia Epidural/estatística & dados numéricos , Feminino , Hipóxia-Isquemia Encefálica/epidemiologia , Gravidez , Recém-Nascido , Estudos Retrospectivos , Adulto , California/epidemiologia , Masculino , Trabalho de Parto/fisiologia , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/estatística & dados numéricos , Analgesia Obstétrica/métodos , Estudos de Coortes
8.
Sci Adv ; 10(37): eadn8544, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39259801

RESUMO

As policymakers increasingly focus on environmental justice, a key question is whether emissions reductions aimed at addressing air quality or climate change can also ameliorate persistent air pollution exposure disparities. We examine evidence from California's aggressive vehicle emissions control policy from 2000 to 2019. We find a 65% reduction in modeled statewide average exposure to PM2.5 from on-road vehicles, yet for people of color and overburdened community residents, relative exposure disparities increased. Light-duty vehicle emissions are the main driver of the exposure and exposure disparity, although smaller contributions from heavy-duty vehicles especially affect some overburdened groups. Our findings suggest that a continued trend of emissions reductions will likely reduce concentrations and absolute disparity but may not reduce relative disparities without greater attention to the systemic factors leading to this disparity.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Exposição Ambiental , Material Particulado , Emissões de Veículos , California , Emissões de Veículos/análise , Material Particulado/análise , Humanos , Poluição do Ar/análise , Poluentes Atmosféricos/análise
9.
J Natl Compr Canc Netw ; 22(7): 447-453, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-39236758

RESUMO

BACKGROUND: Adolescent and young adult (AYA) patients with cancer have historically been understudied. Few studies have examined survival disparities associated with racial/ethnic and socioeconomic status (SES) and do not account for the influence of insurance status and access to care. We evaluated the association of SES and race/ethnicity with overall mortality for AYA patients who were members of an integrated health system with relatively equal access to care. METHODS: AYA patients diagnosed with the 15 most common cancer types during 2010 through 2018 at Kaiser Permanente Southern California were included. Neighborhood Deprivation Index (NDI) quartile (Q1: least deprived; Q4: most deprived) was used as a measure of SES. Mortality rate per 1,000 person-years was calculated for each racial/ethnic and NDI subgroup. Multivariable Cox model was used to estimate hazard ratios (HRs) for all-cause mortality adjusting for sex, age and stage at diagnosis, cancer type, race/ethnicity, and NDI. RESULTS: Data for 6,379 patients were tracked for a maximum of 10 years. Crude mortality rates were higher among non-White racial/ethnic patients compared with non-Hispanic (NH)-White patients. In the Cox model, Hispanic (HR, 1.31; P=.004) and NH-Black (HR, 1.34; P=.05) patients experienced significantly higher all-cause mortality risk compared with NH-White patients. Patients from more deprived neighborhoods had higher mortality risk. In the Cox model, there was no significant difference in all-cause mortality between Q1 and Q2 through Q4 (Q2: HR, 0.88; P=.26, Q3: HR, 0.94; P=.56, and Q4: HR, 0.95; P=.70). CONCLUSIONS: For AYAs with cancer with similar access to care, Hispanic and NH-Black patients have higher risk of all-cause mortality than NH-White patients, whereas no significant SES-associated survival disparities were observed. These findings warrant further investigation, awareness, and intervention to address inequities in cancer care among vulnerable populations.


Assuntos
Neoplasias , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Adolescente , Feminino , Masculino , Adulto Jovem , Adulto , Fatores Socioeconômicos , Disparidades em Assistência à Saúde/estatística & dados numéricos , California/epidemiologia , Etnicidade/estatística & dados numéricos , Classe Social
10.
Hum Vaccin Immunother ; 20(1): 2397872, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-39222955

RESUMO

HepB-CpG is a licensed adjuvanted two-dose hepatitis B vaccine for adults, with limited data on exposure during pregnancy. We assessed the risk of pregnancy outcomes among individuals who received HepB-CpG or the 3-dose HepB-alum vaccine ≤28 d prior to conception or during pregnancy at Kaiser Permanente Southern California (KPSC). The pregnancy cohort included KPSC members aged ≥18 y who received ≥1 dose of hepatitis B vaccine (HepB-CpG or HepB-alum) at KPSC outpatient family or internal medicine departments from August 2018 to November 2020. We followed these individuals through electronic health records from the vaccination date until the end of pregnancy, KPSC health plan disenrollment, or death, whichever came first. Among 81 and 125 eligible individuals who received HepB-CpG and HepB-alum, respectively, live births occurred in 84% and 74%, spontaneous abortion occurred in 7% and 17% (adjusted relative risk [aRR] 0.40, 95% CI: 0.16-1.00), and preterm birth occurred in 15% and 14% of liveborn infants (aRR 0.97, 95% CI 0.47-1.99). No major birth defects were identified through 6 months of age. The study found no evidence of adverse pregnancy outcomes for recipients of HepB-CpG in comparison to HepB-alum.


Assuntos
Vacinas contra Hepatite B , Hepatite B , Resultado da Gravidez , Vigilância de Produtos Comercializados , Humanos , Gravidez , Feminino , Adulto , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/efeitos adversos , Vigilância de Produtos Comercializados/estatística & dados numéricos , Adulto Jovem , Hepatite B/prevenção & controle , Adolescente , California/epidemiologia , Recém-Nascido , Vacinação/efeitos adversos , Vacinação/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Aborto Espontâneo/epidemiologia , Adjuvantes Imunológicos/efeitos adversos , Adjuvantes Imunológicos/administração & dosagem , Nascido Vivo/epidemiologia
11.
Health Aff (Millwood) ; 43(9): 1235-1243, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-39226504

RESUMO

In the Affordable Care Act (ACA) Marketplaces, enrollees must periodically demonstrate their eligibility to receive income-linked health insurance premium subsidies. Marketplaces can verify eligibility using existing records, but only with consumers' consent, which must be renewed at specified times. In a randomized experiment in September 2020, we tested the effect of email nudges reminding consumers to provide consent for verification of their continued eligibility for premium subsidies in California's ACA Marketplace. More than 20,000 households that had applied for subsidies but whose consent for eligibility verification would soon expire were sent one, two, or three emails reminding them to renew consent. Sending three emails increased consent updates by 1.9 percentage points (3.2 percent) and increased receipt of subsidies by 2.0 percentage points (4.0 percent). However, nearly 40 percent of households receiving three emails did not update their consent by the end of the open enrollment period, thus preventing their continued receipt of subsidies. To improve the affordability of Marketplace coverage, new policies and structural changes may be needed to reduce administrative barriers that can inhibit access to subsidies.


Assuntos
Correio Eletrônico , Definição da Elegibilidade , Trocas de Seguro de Saúde , Patient Protection and Affordable Care Act , Humanos , California , Estados Unidos , Cobertura do Seguro/estatística & dados numéricos , Feminino , Seguro Saúde/estatística & dados numéricos , Masculino , Adulto
12.
Microb Ecol ; 87(1): 113, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39259393

RESUMO

It is increasingly recognized that different genetic variants of hosts can uniquely shape their microbiomes. Invasive species often evolve in their introduced ranges, but little is known about the potential for their microbial associations to change during invasion as a result. We asked whether host genotype (G), microbial environment (E), or their interaction (G × E) affected the composition and diversity of host-associated microbiomes in Centaurea solstitialis (yellow starthistle), a Eurasian plant that is known to have evolved novel genotypes and phenotypes and to have altered microbial interactions, in its severe invasion of CA, USA. We conducted an experiment in which native and invading plant genotypes were inoculated with native and invaded range soil microbial communities. We used amplicon sequencing to characterize rhizosphere bacteria in both the experiment and the field soils from which they were derived. We found that native and invading plant genotypes accumulated different microbial associations at the family level in each soil community, often counter to differences in family abundance between soil communities. Root associations with potentially beneficial Streptomycetaceae were particularly interesting, as these were more abundant in the invaded range field soil and accumulated on invading genotypes. We also found that bacterial diversity is higher in invaded soils, but that invading genotypes accumulated a lower diversity of bacteria and unique microbial composition in experimental inoculations, relative to native genotypes. Thus variation in microbial associations of invaders was driven by the interaction of plant G and microbial E, and rhizosphere microbial communities appear to change in composition in response to host evolution during invasion.


Assuntos
Bactérias , Genótipo , Espécies Introduzidas , Microbiota , Rizosfera , Microbiologia do Solo , Bactérias/genética , Bactérias/classificação , Bactérias/isolamento & purificação , Centaurea/microbiologia , Centaurea/genética , Raízes de Plantas/microbiologia , California , Solo/química
13.
Mar Pollut Bull ; 207: 116902, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39244890

RESUMO

Agricultural nitrogen (N) contributes a dominant percentage to global N pollution in the coastal zone. Emerging research on N isotopes in bivalve shells has shown value for reconstructing historical increases in estuarine wastewater inputs. However, applications for fertilizer N are understudied. Here, we integrate the study of organic N isotopes, in concert with δ18O and δ13C, in estuarine bivalve shells to investigate spatial and long-term changes in nitrogen inputs and sources. Modern, museum-collected, and subfossil specimens of the genera Mytilus and Ostrea were profiled in a California estuary with an intensely agricultural watershed. Spatial patterns in bivalve isotopic composition reflected gradients in watershed nutrient inputs and productivity parameters. Furthermore, a comparison between modern and historical periods revealed changes in nutrient source or processing over the last 1,000 years. The N isotope values from shells offer perspective on agricultural pollution in estuaries.


Assuntos
Exoesqueleto , Monitoramento Ambiental , Estuários , Fertilizantes , Isótopos de Nitrogênio , Animais , Isótopos de Nitrogênio/análise , Fertilizantes/análise , Exoesqueleto/química , Poluentes Químicos da Água/análise , California , Nitrogênio/análise , Bivalves , Agricultura , Mytilus
14.
BMC Public Health ; 24(1): 2492, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39272039

RESUMO

BACKGROUND: Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes. METHODS: Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope. RESULTS: We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns. CONCLUSIONS: High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.


Assuntos
Negro ou Afro-Americano , Habitação , Pobreza , População Urbana , Humanos , Masculino , Feminino , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Habitação/estatística & dados numéricos , Adulto Jovem , Adolescente , População Urbana/estatística & dados numéricos , California/epidemiologia , Pessoas Mal Alojadas/estatística & dados numéricos , Pessoas Mal Alojadas/psicologia , Saúde Mental/estatística & dados numéricos
15.
J Acquir Immune Defic Syndr ; 97(2): 142-149, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39250648

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP. METHODS: In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP. RESULTS: Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services. CONCLUSION: Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.


Assuntos
Infecções por HIV , Farmacêuticos , Profilaxia Pré-Exposição , Humanos , California , Profilaxia Pré-Exposição/métodos , Masculino , Feminino , Infecções por HIV/prevenção & controle , Estudos Transversais , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Injeções , Adulto Jovem
16.
Harm Reduct J ; 21(1): 166, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39252036

RESUMO

BACKGROUND: Cannabis is the most common illicit substance used in pregnancy. As use continues to increase, understanding peoples' behaviors surrounding cannabis use during pregnancy is needed to improve maternal and child health outcomes. The aim of this study was to better understand pregnant individuals' perceptions and knowledge of cannabis use and use patterns as well as the social and environmental factors that may influence their use. METHODS: We conducted interviews with 19 participants between December 2022 and March 2023. Individuals self-identified as BIPOC (Black, Indigenous, People of Color), were over 21 years of age, spoke English or Spanish, resided in California, and had used cannabis during pregnancy in the last 0-2 years. Using qualitative, constructivist grounded theory methods, we analyzed the contexts that contributed to participants' lived experiences surrounding cannabis use behaviors during pregnancy. RESULTS: Participants reported making conscious decisions to responsibly manage their cannabis use during pregnancy to minimize potential harm to the fetus. Participants prioritized making what they perceived to be safer adjustments to their use of cannabis: (1) changing the amount of cannabis used, (2) changing the types of cannabis products used, and (3) changing sources of cannabis procurement. DISCUSSION: Our findings show that pregnant individuals are seeking information about safe cannabis use beyond medical supervision and are open to altering their cannabis consumption patterns. However, they are unable to find trustworthy and evidence-based harm reduction practices which can be implemented to mitigate harm to their unborn children. A harm reduction approach is needed in the field of maternal cannabis use to promote positive maternal and fetal health outcomes. CONCLUSIONS: More data is needed on comprehensive harm reduction approaches to cannabis use during pregnancy. This requires implementation of education on these topics in healthcare settings presented by prenatal care clinicians.


Assuntos
Redução do Dano , Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde , California , Complicações na Gravidez/prevenção & controle , Cannabis/efeitos adversos , Fumar Maconha/psicologia , Uso da Maconha/psicologia
17.
BMJ Open Diabetes Res Care ; 12(4)2024 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-39242122

RESUMO

INTRODUCTION: Diabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity. RESEARCH DESIGN AND METHODS: Two cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means. RESULTS: Participant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386). CONCLUSIONS: Characteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida's lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Disparidades em Assistência à Saúde , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Disparidades em Assistência à Saúde/estatística & dados numéricos , California/epidemiologia , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Florida/epidemiologia , Estudos de Coortes , Área Carente de Assistência Médica , Diabetes Mellitus Tipo 1/epidemiologia , Hemoglobinas Glicadas/análise , Fatores Socioeconômicos , Diabetes Mellitus/epidemiologia , Seguimentos
18.
J Prim Care Community Health ; 15: 21501319241277408, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39245900

RESUMO

OBJECTIVES: Financial strain has important consequences for patients, providers, and health care systems. However, there is currently no gold standard measure to screen for financial strain. This study compared the performance of 3 single-item screeners using a composite measure of financial strain as a "gold standard." METHODS: We conducted a secondary analysis of unweighted data from a 2021 survey of Kaiser Permanente Northern California health plan members comparing the percentages of adults who experienced financial strain based on 3 general single-item screeners, a screener specific to medical and dental health care use, and a composite financial strain measure. The study sample was comprised of 2734 non-Medicaid insured adults who answered all financial strain questions. Kappa statistics evaluating agreement of the 3 general screeners with the composite measure were calculated for the sample overall, by age group, and within age group, by 4 levels of income and 4 racial/ethnic subgroups. RESULTS: Among 947 adults aged 35 to 65, 30.7% had just enough money or not enough money to make ends meet, 23.3% had a somewhat hard or hard time paying for basics, 18.8% had trouble paying for ≥1 type of expense, 20.5% had delayed/used less medical/dental care, and 41.5% had experienced financial strain based on the composite measure. Among 1787 adults aged 66 to 85, the percentages who screened positive on these measures were 22.7%, 19.4%, 12.9%, 19.8%, and 34.4%, respectively. Across the sample, by income categories and racial/ethnic groups, the making ends meet screener identified higher percentages of adults experiencing financial strain and performed better when compared with the composite measure than the hard to pay for the very basics and trouble paying for expenses screeners. Overall, substantial decreases in the percentages of adults who screened positive on the financial strain measures were seen as level of income increased. Within income categories, middle-aged adults were more likely than older adults to have experienced financial strain based on the composite and general single-item screeners. CONCLUSIONS: As social risk screening becomes part of the standard of care, it will be important to assess how well different brief screeners for financial strain perform with diverse patient populations.


Assuntos
Prestação Integrada de Cuidados de Saúde , Estresse Financeiro , Humanos , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Feminino , Masculino , California , Idoso , Prestação Integrada de Cuidados de Saúde/economia , Inquéritos e Questionários , Renda/estatística & dados numéricos
19.
Proc Natl Acad Sci U S A ; 121(37): e2318296121, 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39236239

RESUMO

Anthropogenic habitat destruction and climate change are reshaping the geographic distribution of plants worldwide. However, we are still unable to map species shifts at high spatial, temporal, and taxonomic resolution. Here, we develop a deep learning model trained using remote sensing images from California paired with half a million citizen science observations that can map the distribution of over 2,000 plant species. Our model-Deepbiosphere-not only outperforms many common species distribution modeling approaches (AUC 0.95 vs. 0.88) but can map species at up to a few meters resolution and finely delineate plant communities with high accuracy, including the pristine and clear-cut forests of Redwood National Park. These fine-scale predictions can further be used to map the intensity of habitat fragmentation and sharp ecosystem transitions across human-altered landscapes. In addition, from frequent collections of remote sensing data, Deepbiosphere can detect the rapid effects of severe wildfire on plant community composition across a 2-y time period. These findings demonstrate that integrating public earth observations and citizen science with deep learning can pave the way toward automated systems for monitoring biodiversity change in real-time worldwide.


Assuntos
Ciência do Cidadão , Aprendizado Profundo , Ecossistema , Plantas , Tecnologia de Sensoriamento Remoto , Tecnologia de Sensoriamento Remoto/métodos , Ciência do Cidadão/métodos , Plantas/classificação , Mudança Climática , Florestas , Biodiversidade , California , Incêndios Florestais , Humanos , Conservação dos Recursos Naturais/métodos
20.
Elife ; 122024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39207443

RESUMO

Filamentous multicellular cable bacteria perform centimeter-scale electron transport in a process that couples oxidation of an electron donor (sulfide) in deeper sediment to the reduction of an electron acceptor (oxygen or nitrate) near the surface. While this electric metabolism is prevalent in both marine and freshwater sediments, detailed electronic measurements of the conductivity previously focused on the marine cable bacteria (Candidatus Electrothrix), rather than freshwater cable bacteria, which form a separate genus (Candidatus Electronema) and contribute essential geochemical roles in freshwater sediments. Here, we characterize the electron transport characteristics of Ca. Electronema cable bacteria from Southern California freshwater sediments. Current-voltage measurements of intact cable filaments bridging interdigitated electrodes confirmed their persistent conductivity under a controlled atmosphere and the variable sensitivity of this conduction to air exposure. Electrostatic and conductive atomic force microscopies mapped out the characteristics of the cell envelope's nanofiber network, implicating it as the conductive pathway in a manner consistent with previous findings in marine cable bacteria. Four-probe measurements of microelectrodes addressing intact cables demonstrated nanoampere currents up to 200 µm lengths at modest driving voltages, allowing us to quantify the nanofiber conductivity at 0.1 S/cm for freshwater cable bacteria filaments under our measurement conditions. Such a high conductivity can support the remarkable sulfide-to-oxygen electrical currents mediated by cable bacteria in sediments. These measurements expand the knowledgebase of long-distance electron transport to the freshwater niche while shedding light on the underlying conductive network of cable bacteria.


Assuntos
Água Doce , Transporte de Elétrons , Água Doce/microbiologia , Sedimentos Geológicos/microbiologia , Sulfetos/metabolismo , California , Condutividade Elétrica , Oxirredução
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