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1.
JMIR Mhealth Uhealth ; 9(5): e25895, 2021 05 06.
Article in English | MEDLINE | ID: mdl-33955844

ABSTRACT

BACKGROUND: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. OBJECTIVE: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. METHODS: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. RESULTS: Patients' median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. CONCLUSIONS: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796.


Subject(s)
Sunburn , Adolescent , Adult , Health Behavior , Humans , Pandemics , Prospective Studies , Sunburn/drug therapy , Sunburn/epidemiology , Sunburn/prevention & control , Sunscreening Agents/therapeutic use , Ultraviolet Rays/adverse effects , United States , Young Adult
2.
MMWR Recomm Rep ; 70(2): 1-30, 2021 05 07.
Article in English | MEDLINE | ID: mdl-33956777

ABSTRACT

Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.


Subject(s)
Botulism/diagnosis , Botulism/therapy , Centers for Disease Control and Prevention, U.S. , Evidence-Based Medicine , Humans , United States
3.
Stud Health Technol Inform ; 279: 70-77, 2021 May 07.
Article in English | MEDLINE | ID: mdl-33965921

ABSTRACT

BACKGROUND: Considering the impacts of the COVID-19 pandemic on health service delivery, the US Office for Civil Rights (OCR) updated the policies on health data processing, and Health Insurance Portability and Accountability Act (HIPAA). OBJECTIVES: In this study, we investigated discourses on HIPAA in relation to COVID-19. METHODS: Through a search of media sources in the Factiva database, relevant texts were identified. We applied a text mining approach to identify concepts and themes in these texts. RESULTS: Our analysis revealed six central themes, namely, Health, HIPAA, Privacy, Security, Patients, and Need, as well as their associated concepts. Among these, Health was the most frequently discussed theme. It comprised concepts such as public, care, emergency, providers, telehealth, entity, use, discretion, OCR, Health and Human Services (HHS), enforcement, business, and services. CONCLUSION: Our discourse analysis of media outlets highlights the role of health data privacy law in the response to global public health emergencies and demonstrates how discourse analysis and computational methods can inform health data protection policymaking in the digital health era.


Subject(s)
Health Insurance Portability and Accountability Act , Confidentiality , Humans , Pandemics , Privacy , United States
4.
Curr Opin Anaesthesiol ; 34(3): 205-211, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935167

ABSTRACT

PURPOSE OF REVIEW: Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. RECENT FINDINGS: Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population.Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide useful tools to ascertain high-risk parturients for a referral to antenatal obstetric anesthesiology clinics and higher levels of maternal care. Major obstetric organizations have identified and laid out criteria for maternal level of care. Anesthesiology resources also play a role in these designations and can help triage patients to facilities with appropriate resources. SUMMARY: Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.


Subject(s)
Anesthesia, Obstetrical , Anesthesiology , Maternal Health Services , Anesthesia, Obstetrical/adverse effects , Anesthesiologists , Female , Humans , Maternal Mortality , Peripartum Period , Pregnancy , United States/epidemiology
5.
Curr Opin Anaesthesiol ; 34(3): 218-225, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935168

ABSTRACT

PURPOSE OF REVIEW: The aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature. RECENT FINDINGS: Cardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease. SUMMARY: The leading cause of morbidity and mortality in pregnant women is cardiac disease. Preconception counseling is useful for optimizing patients for pregnancy and setting appropriate expectations about care and outcomes. Ensuring that women are cared for in centers with appropriate multidisciplinary resources is key for improving outcomes for cardio-obstetric patients.


Subject(s)
Heart Diseases , Pregnancy Complications, Cardiovascular , Cesarean Section , Delivery, Obstetric , Female , Heart Diseases/complications , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Humans , Peripartum Period , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapy , United States
6.
Croat Med J ; 62(2): 154-164, 2021 Apr 30.
Article in English | MEDLINE | ID: mdl-33938655

ABSTRACT

AIM: To assess the correlations of B regulatory cells (Bregs) and monocyte subsets in peripheral blood with the National Institutes of Health (NIH)-consensus-defined clinical manifestations of chronic graft-vs-host disease (cGvHD), in an attempt to establish their role as cellular biomarkers. METHODS: This multidisciplinary prospective study enrolled adult cGVHD patients treated in the University Hospital Center Zagreb and University of Zagreb School of Medicine. Immunophenotypic subpopulations of CD24highCD38high Bregs (CD27-, CD27+, and total) and monocyte (classical, intermediate, and non-classical) counts were correlated with demographic, transplant, and cGVHD-related data. Bivariate correlation analysis was performed to evaluate the correlations between Bregs and monocytes subsets and cGVHD organ involvement, as well as cGVHD severity and immunosuppression intensity. RESULTS: Twenty-two adult patients (54.5% female) with cGVHD were enrolled. The median (range) age was 44.5 years (24-65). All patients were transplanted for hematologic malignancies and 40.9% had severe NIH cGVHD global score. The median time from cGVHD diagnosis to the analysis was 16.6 months (0-176). The organ most frequently affected with cGVHD were the eyes (68.2%), skin (45.5%), lungs (45.5%), and liver (40.9%). Lower total and CD27-Bregs counts were correlated with worse cGVHD severity, higher immunosuppression intensity, and lung cGVHD, in terms of cell count, but also with skin cGVHD, in terms of percentages. Patients with liver and joint/fascia cGVHD had a lower percentage of non-classical monocytes and patients with more severe global NIH score had a higher classical monocytes count. CONCLUSION: Different organs affected by cGVHD are differently associated with different subpopulations of Bregs and monocytes.


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Monocytes , Prospective Studies , United States , Young Adult
7.
BMC Psychiatry ; 21(1): 234, 2021 05 04.
Article in English | MEDLINE | ID: mdl-33947359

ABSTRACT

BACKGROUND: The Eating Disorders Genetics Initiative (EDGI) is an international investigation exploring the role of genes and environment in anorexia nervosa, bulimia nervosa, and binge-eating disorder. METHODS: A total of 14,500 individuals with eating disorders and 1500 controls will be included from the United States (US), Australia (AU), New Zealand (NZ), and Denmark (DK). In the US, AU, and NZ, participants will complete comprehensive online phenotyping and will submit a saliva sample for genotyping. In DK, individuals with eating disorders will be identified by the National Patient Register, and genotyping will occur using bloodspots archived from birth. A genome-wide association study will be conducted within EDGI and via meta-analysis with other data from the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED). DISCUSSION: EDGI represents the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of the three major eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). We will explicate the genetic architecture of eating disorders relative to each other and to other psychiatric and metabolic disorders and traits. Our goal is for EDGI to deliver "actionable" findings that can be transformed into clinically meaningful insights. TRIAL REGISTRATION: EDGI is a registered clinical trial: clinicaltrials.gov NCT04378101 .


Subject(s)
Bulimia Nervosa , Feeding and Eating Disorders , Australia , Bulimia Nervosa/genetics , Feeding and Eating Disorders/genetics , Genome-Wide Association Study , Humans , Meta-Analysis as Topic , New Zealand , United States
8.
MMWR Morb Mortal Wkly Rep ; 70(18): 685-688, 2021 May 07.
Article in English | MEDLINE | ID: mdl-33956781

ABSTRACT

On April 7, 2021, after 5 weeks' use of the Janssen COVID-19 vaccine under the Food and Drug Administration (FDA) Emergency Use Authorization (EUA), CDC received reports of clusters of anxiety-related events after administration of Janssen COVID-19 vaccine from five mass vaccination sites, all in different states. To further investigate these cases, CDC interviewed vaccination site staff members to gather additional information about the reported events and vaccination site practices. Four of the five sites temporarily closed while an investigation took place. Overall, 64 anxiety-related events, including 17 reports of syncope (fainting), an anxiety-related event, among 8,624 Janssen COVID-19 vaccine recipients, were reported from these sites for vaccines administered during April 7-9. As a follow-up to these interviews, CDC analyzed reports of syncope shortly after receipt of Janssen COVID-19 vaccine to the Vaccine Adverse Event Reporting System (VAERS), the vaccine safety monitoring program managed by CDC and FDA. To compare the occurrence of these events with those reported after receipt of other vaccines, reports of syncopal events after influenza vaccine administered in the 2019-20 influenza season were also reviewed. Syncope after Janssen COVID-19 vaccination was reported to VAERS (8.2 episodes per 100,000 doses). By comparison, after influenza vaccination, the reporting rate of syncope was 0.05 episodes per 100,000 doses. Anxiety-related events can occur after any vaccination. It is important that vaccination providers are aware that anxiety-related adverse events might be reported more frequently after receipt of the Janssen COVID-19 vaccine than after influenza vaccination and observe all COVID-19 vaccine recipients for any adverse reactions for at least 15 minutes after vaccine administration.


Subject(s)
Anxiety/complications , Mass Vaccination/psychology , Syncope/epidemiology , Adolescent , Adult , Adverse Drug Reaction Reporting Systems , Aged , Aged, 80 and over , Cluster Analysis , Female , Humans , Male , Middle Aged , United States/epidemiology , Young Adult
9.
MMWR Morb Mortal Wkly Rep ; 70(18): 661-666, 2021 May 07.
Article in English | MEDLINE | ID: mdl-33956783

ABSTRACT

Approximately 60,000 older adults (aged ≥65 years) die from unintentional injuries each year; in 2019 these included 34,000 fall deaths, 8,000 traffic-related motor vehicle crash deaths, and 3,000 drug poisoning deaths (1). In addition, >9,000 suicide deaths occur among older adults each year (1). Deaths among older adults account for 33% of these unintentional injury deaths and 19% of suicide deaths among all age groups (1). Nonfatal injuries from these causes are more common in this age group and can lead to long-term health consequences, such as brain injury and loss of independence. This study included 2018 data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) to determine the prevalence of selected nonfatal injuries among older adults treated in emergency departments (EDs) and hospitals. Injury mechanisms among the leading causes of injury death in older adults were studied, including unintentional falls, unintentional traffic-related motor vehicle crashes, unintentional opioid overdoses, and self-harm (suicidal and nonsuicidal by any mechanism). In 2018, an estimated 2.4 million ED visits and >700,000 hospitalizations from these injuries occurred among adults aged ≥65 years. Unintentional falls accounted for >90% of the selected ED visits and hospitalizations. Injuries among older adults can be prevented (2). Educational campaigns, such as CDC's Still Going Strong* awareness campaign, that use positive messages can encourage older adults to take steps to prevent injuries. Health care providers can help prevent injuries by recommending that older patients participate in effective interventions, including referrals to physical therapy and deprescribing certain medications.†.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Wounds and Injuries/therapy , Accidental Falls/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , Self-Injurious Behavior/epidemiology , United States/epidemiology , Wounds and Injuries/epidemiology
10.
MMWR Morb Mortal Wkly Rep ; 70(18): 674-679, 2021 May 07.
Article in English | MEDLINE | ID: mdl-33956782

ABSTRACT

Adults aged ≥65 years are at increased risk for severe outcomes from COVID-19 and were identified as a priority group to receive the first COVID-19 vaccines approved for use under an Emergency Use Authorization (EUA) in the United States (1-3). In an evaluation at 24 hospitals in 14 states,* the effectiveness of partial or full vaccination† with Pfizer-BioNTech or Moderna vaccines against COVID-19-associated hospitalization was assessed among adults aged ≥65 years. Among 417 hospitalized adults aged ≥65 years (including 187 case-patients and 230 controls), the median age was 73 years, 48% were female, 73% were non-Hispanic White, 17% were non-Hispanic Black, 6% were Hispanic, and 4% lived in a long-term care facility. Adjusted vaccine effectiveness (VE) against COVID-19-associated hospitalization among adults aged ≥65 years was estimated to be 94% (95% confidence interval [CI] = 49%-99%) for full vaccination and 64% (95% CI = 28%-82%) for partial vaccination. These findings are consistent with efficacy determined from clinical trials in the subgroup of adults aged ≥65 years (4,5). This multisite U.S. evaluation under real-world conditions suggests that vaccination provided protection against COVID-19-associated hospitalization among adults aged ≥65 years. Vaccination is a critical tool for reducing severe COVID-19 in groups at high risk.


Subject(s)
/administration & dosage , Hospitalization/statistics & numerical data , Aged , Female , Humans , Male , Risk Assessment , Treatment Outcome , United States/epidemiology , Vaccination Coverage/statistics & numerical data , Vaccines, Synthetic
11.
MMWR Morb Mortal Wkly Rep ; 70(18): 680-684, 2021 May 07.
Article in English | MEDLINE | ID: mdl-33956784

ABSTRACT

On February 27, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Janssen (Ad.26.COV2.S) COVID-19 vaccine (Janssen Biotech, Inc., a Janssen Pharmaceutical company, Johnson & Johnson) (1). The Janssen COVID-19 vaccine, the third COVID-19 vaccine authorized for use in the United States, uses a replication-incompetent human adenoviral type 26 vector platform* (2) and is administered as a single intramuscular dose, whereas the first two authorized vaccines use an mRNA platform and require 2 doses. On February 28, 2021, the Advisory Committee on Immunization Practices (ACIP) issued interim recommendations for use of Janssen COVID-19 vaccine among persons aged ≥18 years (3). During April 13-23, CDC and FDA recommended a pause in use of Janssen vaccine after reports of six cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia (platelet count <150,000/µL of blood) among Janssen vaccine recipients (4). Similar thrombotic events, primarily among women aged <60 years, have been described in Europe after receipt of the AstraZeneca COVID-19 vaccine, which uses a replication-incompetent chimpanzee adenoviral vector (5-7). The U.S. CVST cases that prompted the pause in Janssen vaccination, as well as subsequently detected CVST cases, are described elsewhere (8). This report summarizes adverse events among Janssen vaccine recipients, including non-CVST cases of thrombosis with thrombocytopenia syndrome (TTS), reported to the Vaccine Adverse Events Reporting System (VAERS), a passive surveillance system, and through v-safe, an active monitoring system. As of April 21, 2021, 7.98 million doses of the Janssen COVID-19 vaccine had been administered. Among 13,725 VAERS reports reviewed, 97% were classified as nonserious and 3% as serious,† including three reports among women of cases of thrombosis in large arteries or veins accompanied by thrombocytopenia during the second week after vaccination. These three cases and the previously detected CVST cases are consistent with 17 cases of TTS,§ a newly defined condition. Approximately 338,700 Janssen COVID-19 vaccine recipients completed at least one v-safe survey during the week after vaccination; 76% reported a systemic reaction, 61% reported a local reaction, and 34% reported a health impact.¶ Fatigue and pain were commonly reported symptoms in both VAERS and v-safe. The overall safety profile is consistent with preauthorization clinical trials data. Prompt review of U.S. vaccine safety data detected three additional cases of non-CVST TTS, in addition to the previously recognized CVST cases that initiated the pause in use of the Janssen COVID-19 vaccine. Ongoing monitoring of adverse events after COVID-19 vaccination, including vaccination with the Janssen single-dose vaccine, is essential for evaluating the risks and benefits of each vaccine.


Subject(s)
/adverse effects , Drug-Related Side Effects and Adverse Reactions/epidemiology , Product Surveillance, Postmarketing , Adolescent , Adult , Adverse Drug Reaction Reporting Systems , Aged , Aged, 80 and over , Centers for Disease Control and Prevention, U.S. , Child , Child, Preschool , Drug Approval , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Risk Assessment , Safety-Based Drug Withdrawals , Sinus Thrombosis, Intracranial/epidemiology , United States/epidemiology , United States Food and Drug Administration , Young Adult
12.
Sci Total Environ ; 773: 145650, 2021 Jun 15.
Article in English | MEDLINE | ID: mdl-33940747

ABSTRACT

COVID-19 is now one of the most leading causes of death in the United States (US). Systemic health, social and economic disparities have put the minorities and economically poor communities at a higher risk than others. There is an immediate requirement to develop a reliable measure of county-level vulnerabilities that can capture the heterogeneity of vulnerable communities. This study reports a COVID-19 Vulnerability Index (C19VI) for identifying and mapping vulnerable counties. We proposed a Random Forest machine learning-based vulnerability model using CDC's sociodemographic and COVID-19-specific themes. An innovative 'COVID-19 Impact Assessment' algorithm was also developed for evaluating severity of the pandemic and to train the vulnerability model. Developed C19VI was statistically validated and compared with the CDC COVID-19 Community Vulnerability Index (CCVI). Finally, using C19VI and the census data, we explored racial inequalities and economic disparities in COVID-19 health outcomes. Our index indicates that 575 counties (45 million people) fall into the 'very high' vulnerability class, 765 counties (66 million people) in the 'high' vulnerability class, and 1435 counties (204 million people) in the 'moderate' or 'low' vulnerability class. Only 367 counties (20 million people) were found as 'very low' vulnerable areas. Furthermore, C19VI reveals that 524 counties with a racial minority population higher than 13% and 420 counties with poverty higher than 20% are in the 'very high' or 'high' vulnerability classes. The C19VI aims at helping public health officials and disaster management agencies to develop effective mitigation strategies especially for the disproportionately impacted communities.


Subject(s)
Disasters , Censuses , Humans , Machine Learning , United States
13.
Value Health ; 24(5): 632-640, 2021 05.
Article in English | MEDLINE | ID: mdl-33933231

ABSTRACT

OBJECTIVE: To estimate the overall quality-adjusted life-years (QALYs) gained by averting 1 coronavirus disease 2019 (COVID-19) infection over the duration of the pandemic. METHODS: A cohort-based probabilistic simulation model, informed by the latest epidemiological estimates on COVID-19 in the United States provided by the Centers for Disease Control and Prevention and literature review. Heterogeneity of parameter values across age group was accounted for. The main outcome studied was QALYs for the infected patient, patient's family members, and the contagion effect of the infected patient over the duration of the pandemic. RESULTS: Averting a COVID-19 infection in a representative US resident will generate an additional 0.061 (0.016-0.129) QALYs (for the patient: 0.055, 95% confidence interval [CI] 0.014-0.115; for the patient's family members: 0.006, 95% CI 0.002-0.015). Accounting for the contagion effect of this infection, and assuming that an effective vaccine will be available in 3 months, the total QALYs gains from averting 1 single infection is 1.51 (95% CI 0.28-4.37) accrued to patients and their family members affected by the index infection and its sequelae. These results were robust to most parameter values and were most influenced by effective reproduction number, probability of death outside the hospital, the time-varying hazard rates of hospitalization, and death in critical care. CONCLUSION: Our findings suggest that the health benefits of averting 1 COVID-19 infection in the United States are substantial. Efforts to curb infections must weigh the costs against these benefits.


Subject(s)
/prevention & control , Health Care Costs/statistics & numerical data , Preventive Medicine/standards , Quality-Adjusted Life Years , /epidemiology , Cost-Benefit Analysis , Health Care Costs/trends , Humans , Pandemics/prevention & control , Pandemics/statistics & numerical data , Preventive Medicine/economics , Preventive Medicine/methods , United States
15.
Article in English | MEDLINE | ID: mdl-33946523

ABSTRACT

The aim of this study was to associate lifestyle characteristics with COVID-19 infection and mortality rates at the U.S. county level and sequentially map the impact of COVID-19 on different lifestyle segments. We used analysis of variance (ANOVA) statistical testing to determine whether there is any correlation between COVID-19 infection and mortality rates and lifestyles. We used ESRI Tapestry LifeModes data that are collected at the U.S. household level through geodemographic segmentation typically used for marketing purposes to identify consumers' lifestyles and preferences. According to the ANOVA analysis, a significant association between COVID-19 deaths and LifeModes emerged on 1 April 2020 and was sustained until 30 June 2020. Analysis of means (ANOM) was also performed to determine which LifeModes have incidence rates that are significantly above/below the overall mean incidence rate. We sequentially mapped and graphically illustrated when and where each LifeMode had above/below average risk for COVID-19 infection/death on specific dates. A strong northwest-to-south and northeast-to-south gradient of COVID-19 incidence was identified, facilitating an empirical classification of the United States into several epidemic subregions based on household lifestyle characteristics. Our approach correlating lifestyle characteristics to COVID-19 infection and mortality rate at the U.S. county level provided unique insights into where and when COVID-19 impacted different households. The results suggest that prevention and control policies can be implemented to those specific households exhibiting spatial and temporal pattern of high risk.


Subject(s)
Family Characteristics , Humans , Incidence , Life Style , United States/epidemiology
16.
Article in English | MEDLINE | ID: mdl-33946606

ABSTRACT

This study aimed to assess the overall level of sleep quality among female staff nurses in the United States during the early COVID-19 pandemic. It also aimed to examine factors associated with sleep quality and its seven subcomponents: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction. A descriptive, correlational, and cross-sectional study design was used. We performed descriptive, and regression analyses with a sample of 215 female staff nurses enrolled in post-licensure online nursing programs at a southeastern state university. Data collection was conducted using an online survey from April to May 2020. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Nurses working part time (p = 0.02), with lower perceived physical health (p = 0.01), a lower self-care self-regulation score (p < 0.001), and higher work stress (p < 0.05) showed poorer sleep quality. Factors associated with subcomponents of sleep quality varied. Poor sleep quality among nurses during the COVID-19 pandemic was reported. Various factors, including work environmental factors were associated with the sleep quality in this sample. Hospital administrators should consider developing intervention programs for improving the work environment, which would impact sleep quality, health status, and job performance.


Subject(s)
Nursing Staff, Hospital , Cross-Sectional Studies , Female , Humans , Pandemics , Sleep , Surveys and Questionnaires , United States/epidemiology
17.
J Emerg Manag ; 19(2): 131-141, 2021.
Article in English | MEDLINE | ID: mdl-33954963

ABSTRACT

The Food Safety Modernization Act mandates building a national Integrated Food Safety System, which represents a seamless partnership among federal, state, local, territorial, and tribal agencies. During multistate foodborne illness outbreak investigations, local and state partners, the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA), or the United States Department of Agriculture Food Safety Inspection Service, depending on the regulated food product, become engaged and assist in coordinating the efforts between partners involved and determine the allocation of resources. The FDA Center for Food Safety and Applied Nutrition (CFSAN) Office of the Coordinated Outbreak Response and Evaluation (CORE) Network coordinates foodborne illness outbreak surveillance, response, and post-response activities related to incidents involving multiple illnesses linked to FDA-regulated human food, dietary supplements, and cosmetic products. FDA has implemented the National Incident Management System (NIMS) Incident Command System (ICS) principles across the agency to coordinate federal response efforts, and CORE has adapted NIMS ICS principles for the emergency management of multistate foodborne illness outbreaks. CORE's implementation of ICS principles has provided several benefits to the operational cycle of foodborne illness outbreak investigations, including establishing a consistent, standardized, and transparent step-by-step approach to outbreak investigations. ICS principles have been instrumental in the development of a national platform for rapid and systematic laboratory, traceback, and epidemiologic information sharing, data analysis, and decision-making. This allows for partners across jurisdictions to reach a consensus regarding outbreak goals and objectives, deploy resources, and take regulatory and public health actions.


Subject(s)
Foodborne Diseases , Centers for Disease Control and Prevention, U.S. , Disease Outbreaks , Foodborne Diseases/epidemiology , Foodborne Diseases/prevention & control , Humans , Public Health , United States , United States Food and Drug Administration
20.
J Zoo Wildl Med ; 52(1): 332-336, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33827195

ABSTRACT

Giraffes (Giraffa camelopardalis) are commonly managed in zoos and conservation programs worldwide, but the current understanding of the occurrence and progression of neoplastic disease in this species is limited by the scarcity of published reports. This study collated documented cases of neoplasia on the basis of gross and histologic evaluation of ante- and postmortem samples. In total, 30 giraffes from 22 institutions across the United States were included. Subspecies was not reported in all cases, but those identified included Masai (Giraffa camelopardalis tippelskirchi), Rothschild (Giraffa camelopardalis rothschildi), and reticulated subspecies (Giraffe camelopardalis reticulata). Thirteen animals died natural deaths, 15 were euthanized, and 2 were alive at the time of this article. A total of 38 tumors were reported and classified as 18 different diagnoses, including leiomyoma (7), adenoma (4), luteoma (4), lymphoma (4), pheochromocytoma (3), squamous cell carcinoma (3), adenocarcinoma (2), ameloblastic fibroma (1), carcinomatosis of undetermined cell lineage (1), cavernous hemangioma (1), cystic granulosa cell tumor (1), dysgerminoma (1), fibrosarcoma (1), leukemia (1), lipoma (1), pituitary nerve sheath tumor (1), rhabdomyosarcoma (1), and teratoma (1). Multiple concurrent neoplastic lesions were documented in six cases. Mesenchymal tumors (18) were the majority of neoplasms. The most prevalent location, regardless of tumor type, was the female reproductive tract (14). Twenty-four neoplastic lesions were incidental findings at necropsy, whereas eight neoplasms were considered to be the primary cause of death. The findings reported here identify multiple neoplastic lesions in giraffes and could provide insight to the future management of this species.


Subject(s)
Giraffes , Neoplasms/veterinary , Animals , Animals, Zoo , Female , Male , Neoplasms/classification , Neoplasms/mortality , Neoplasms/pathology , Retrospective Studies , United States
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