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1.
Am J Public Health ; : e1-e4, 2020 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-32191526

RESUMEN

From April 2016 to June 2017, the Health + Housing Project employed four community health workers who engaged residents of two subsidized housing buildings in New York City to address individuals' broadly defined health needs, including social and economic risk factors. Following the intervention, we observed significant improvements in residents' food security, ability to pay rent, and connection to primary care. No immediate change was seen in acute health care use or more narrowly defined health outcomes. (Am J Public Health. Published online ahead of print March 19, 2020: e1-e4. doi:10.2105/AJPH.2019.305544).

4.
J Urban Health ; 95(6): 826-831, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29987771

RESUMEN

National examination surveys provide trend information on diabetes prevalence, diagnoses, and control. Few localities have access to such information. Using a similar design as the National Health and Nutrition Examination Survey (NHANES), two NYC Health and Nutrition Examination Surveys (NYC HANES) were conducted over a decade, recruiting adults ≥ 20 years using household probability samples (n = 1808 in 2004; n = 1246 in 2013-2014) and physical exam survey methods benchmarked against NHANES. Participants had diagnosed diabetes if told by a health provider they had diabetes, and undiagnosed diabetes if they had no diagnosis but a fasting plasma glucose ≥ 126 mg/dl or A1C ≥ 6.5%. We found that between 2004 and 2014, total diabetes prevalence (diagnosed and undiagnosed) in NYC increased from 13.4 to 16.0% (P = 0.089). In 2013-2014, racial/ethnic disparities in diabetes burden had widened; diabetes was highest among Asians (24.6%), and prevalence was significantly lower among non-Hispanic white adults (7.7%) compared to that among other racial/ethnic groups (P < 0.001). Among adults with diabetes, the proportion of cases diagnosed increased from 68.3 to 77.3% (P = 0.234), and diagnosed cases with very poor control (A1C > 9%), decreased from 26.9 to 18.0% (P = 0.269), though both were non-significant. While local racial/ethnic disparities in diabetes prevalence persist, findings suggest modest improvements in diabetes diagnosis and management.


Asunto(s)
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Monitoreo del Ambiente/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Encuestas Epidemiológicas/tendencias , Población Urbana/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Ciudades/epidemiología , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Prevalencia , Población Urbana/estadística & datos numéricos , Adulto Joven
5.
Nicotine Tob Res ; 18(11): 2065-2074, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27190401

RESUMEN

INTRODUCTION: Exposure to secondhand smoke is hazardous and can cause cancer, coronary heart disease, and birth defects. New York City (NYC) and other jurisdictions have established smoke-free air laws in the past 10-15 years. METHODS: NYC Health and Nutrition Examination Survey (HANES) 2013-2014 was a population-based survey of NYC residents, aged 20 years and older, in which biospecimens were collected and cotinine levels were measured. Secondhand smoke exposure was assessed by demographics and risk factors and compared with that from NYC HANES 2004 and national HANES. RESULTS: More than a third (37.1%, 95% confidence interval [CI] = 33.3%-41.2%) of nonsmoking adult New Yorkers were exposed to secondhand smoke, defined as a cotinine level of 0.05-10ng/mL. This was significantly lower than in 2004 NYC HANES, when 56.7% (95% CI = 53.6%-59.7%) of nonsmokers were exposed to secondhand smoke, but was greater than the proportion of adults exposed nationwide, as measured by national HANES (24.4%, 95% CI = 22.0%-26.9% in 2011-2012). Men, non-Hispanic blacks, adults aged 20-39, those with less education, and those living in high-poverty neighborhoods were more likely to be exposed. CONCLUSIONS: There has been a large decrease in secondhand smoke exposure in NYC, although disparities persist. The decrease may be the result of successful policies to limit exposure to secondhand smoke in public places and of smokers smoking fewer cigarettes per day. Yet NYC residents still experience more secondhand smoke exposure than US residents overall. Possible explanations include multiunit housing, greater population density, and pedestrian exposure. IMPLICATIONS: Measuring exposure to secondhand smoke can be difficult, and few studies have monitored changes over time. This study uses serum cotinine, a nicotine metabolite, from a local population-based examination survey, the NYC HANES 2013-2014, to examine exposure to secondhand smoke in an urban area that has implemented stringent antismoking laws. Comparison with NYC HANES conducted 10 years ago allows for an assessment of changes in the last decade in the context of municipal tobacco control policies. Results may be helpful to jurisdictions considering implementing similar tobacco control policies.


Asunto(s)
Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversos , Adulto , Biomarcadores/sangre , Cotinina/sangre , Estudios Transversales , Exposición a Riesgos Ambientales , Femenino , Vivienda/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Encuestas Nutricionales , Factores de Riesgo , Fumar/tendencias , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Estados Unidos/epidemiología , Adulto Joven
6.
BMJ Case Rep ; 20152015 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-25691577

RESUMEN

We report a case of a 64-year-old man presented to A&E with a 2-week to 4-month history of right hip pain, right leg weakness and fasciculations, extensive bruising and a vesicular skin rash. He had a CT of the chest/abdomen/pelvis, which revealed multiple extensive haematomas including an iliopsoas haematoma causing a lumbar plexopathy and resulting in the right hip and leg symptoms. He had clotting studies showing a prolonged activated partial thromboplastin time. Haematology review together with mixing studies suggested a diagnosis of acquired haemophilia A. He was treated at the local tertiary centre with activated prothrombin complex concentrate and steroids and made a full recovery.


Asunto(s)
Hemofilia A/diagnóstico , Hospitales Generales , Corticoesteroides/uso terapéutico , Antifibrinolíticos/uso terapéutico , Factores de Coagulación Sanguínea/uso terapéutico , Proteína C-Reactiva , Diagnóstico Diferencial , Hemoglobinas , Hemofilia A/sangre , Hemofilia A/tratamiento farmacológico , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Ácido Tranexámico/uso terapéutico
7.
Prev Med Rep ; 2: 580-5, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26844121

RESUMEN

PURPOSE: Capacity to monitor non-communicable diseases (NCDs) at state or local levels is limited. Emerging approaches include using biomeasures and electronic health record (EHR) data. In 2004, New York City (NYC) performed a population-based health study on adult residents using biomeasures (NYC Health and Nutrition Examination Study, or NYC HANES), modeled after NHANES. A second NYC HANES was launched in 2013 to examine change over time, evaluate municipal policies, and validate a proposed EHR-based surveillance system. We describe the rationale and methods of NYC HANES 2013-2014. METHODS: NYC HANES was a population-based, cross-sectional survey of NYC adults using three-stage cluster sampling. Between August 2013 and June 2014, selected participants completed a health interview and physical exam (blood pressure, body mass index, and waist circumference). Fasting biomeasures included diabetes, lipid profiles, kidney function, environmental biomarkers, and select infectious diseases. RESULTS: Of the 3065 households approached, 2742 were eligible and 1827 were successfully screened (67%). A total of 1524 of eligible participants completed the survey (54%), for an overall response rate of 36%. CONCLUSION: Completing a second NYC HANES a decade after the first study affords an opportunity to understand changes in prevalence, awareness and control of NCDs and evaluate municipal efforts to manage them.

8.
Int Wound J ; 12(3): 344-50, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24750780

RESUMEN

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.


Asunto(s)
Vendajes/economía , Análisis Costo-Beneficio/métodos , Enfermedad Crítica/economía , Unidades de Cuidados Intensivos/economía , Úlcera por Presión/prevención & control , Siliconas/economía , Enfermedad Crítica/terapia , Femenino , Talón , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/economía , Sacro
9.
Int Wound J ; 12(3): 302-8, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23711244

RESUMEN

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex(®) Border Sacrum and Mepilex(®) Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.


Asunto(s)
Vendajes , Enfermedad Crítica , Úlcera por Presión/prevención & control , Siliconas , Técnicas de Cierre de Heridas/instrumentación , Heridas y Traumatismos/complicaciones , Adulto , Anciano , Diseño de Equipo , Femenino , Estudios de Seguimiento , Talón , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Úlcera por Presión/epidemiología , Úlcera por Presión/etiología , Estudios Prospectivos , Sacro , Resultado del Tratamiento
11.
Diabetes Care ; 32(10): 1907-9, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19587371

RESUMEN

OBJECTIVE: To determine the microbiological profile of diabetes-related foot infections (DRFIs) and the impact of wound duration, inpatient treatment, and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS: Postdebridement microbiological samples were collected from individuals presenting with DRFIs from 1 January 2005 to 31 December 2007. RESULTS: A total of 653 specimens were collected from 379 individuals with 36% identifying only one isolate. Of the total isolates, 77% were gram-positive bacteria (staphylococci 43%, streptococci 13%). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 23%; risk factors for MRSA included prolonged wound duration (odds ratio 2.31), inpatient management (2.19), and CKD (OR 1.49). Gram-negative infections were more prevalent with inpatient management (P = 0.002) and prolonged wound duration (P < 0.001). Pseudomonal isolates were more common in chronic wounds (P < 0.001). CONCLUSIONS: DRFIs are predominantly due to gram-positive aerobes but are usually polymicrobial and increase in complexity with inpatient care and ulcer duration. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered.


Asunto(s)
Pie Diabético/microbiología , Pie Diabético/patología , Hospitalización , Enfermedades Renales/fisiopatología , Staphylococcus aureus Resistente a Meticilina/fisiología , Infecciones Estafilocócicas/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/patogenicidad , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Infecciones Estafilocócicas/microbiología , Adulto Joven
15.
J Occup Health Psychol ; 10(2): 83-96, 2005 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15826220

RESUMEN

In this cross-sectional study, main and moderated relationships between 5 job stressors and alcohol consumption, drug use, and depression were examined using data from a community sample of 583 young adults (mean age = 23.68 years). Analyses revealed a few direct associations between high job boredom, low skill variety, and low autonomy and depression measures and heavy alcohol use. There were no direct relationships between job stress and binge drinking, alcohol consumption, drug use, or heavy drug use. In a few cases, job stress-outcome relationships were moderated by intrinsic job motivation or gender. The findings supported a specificity-of-effects hypothesis and underscored the need for examining the processes linking occupational stress to substance use and depression.


Asunto(s)
Depresión/psicología , Empleo/psicología , Enfermedades Profesionales/psicología , Estrés Fisiológico/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Depresión/epidemiología , Modificador del Efecto Epidemiológico , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Modelos Psicológicos , Motivación , Factores Sexuales , Estrés Fisiológico/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Factores de Tiempo
16.
J Am Acad Dermatol ; 51(5): 723-30, 2004 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-15523350

RESUMEN

BACKGROUND: Intertriginous and facial involvement are manifestations of psoriasis that require a different approach than is used for typical plaque psoriasis on other skin areas. Topical corticosteroids are the primary treatment for psoriasis; however, the side effects of corticosteroids are magnified on intertriginous and facial skin. Topical tacrolimus offers the potential for anti-inflammatory effect without the atrophy or other local side effects associated with the use of topical corticosteroids. OBJECTIVE: To determine the efficacy and tolerability of 0.1% tacrolimus ointment for the treatment of facial or intertriginous psoriasis. METHODS: One hundred sixty-seven patients 16 years or older were evaluated in an 8-week, randomized, double-blind, vehicle-controlled, multi-center study. Upon entry into the study, patients were randomized 2:1 to apply the tacrolimus ointment 0.1% or vehicle twice daily to all psoriatic lesions of the face or intertriginous areas for 8 weeks. The physician's global assessment was used to assess improvement from baseline. The inverse psoriasis severity for patients was measured using a 6-point scale from clear to very severe. RESULTS: As early as day 8, more patients ( P = .004) had cleared or achieved excellent improvement in the 0.1% tacrolimus ointment group compared to the vehicle group (24.8% vs 5.8%). At the end of the 8-week treatment period 65.2% of the tacrolimus ointment group and 31.5% of the vehicle were clear or almost clear ( P < .0001) based on a Static Severity Score. Adverse events were similar in the 0.1% tacrolimus ointment and vehicle groups. Conclusion Tacrolimus ointment is an effective treatment for psoriasis of the face or intertriginous areas.


Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Dermatosis Facial/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Psoriasis/tratamiento farmacológico , Tacrolimus/uso terapéutico , Adolescente , Adulto , Fármacos Dermatológicos/efectos adversos , Método Doble Ciego , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Pomadas , Tacrolimus/efectos adversos
17.
Cutis ; 73(4): 267-71, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15134327

RESUMEN

The safety and efficacy of tacrolimus ointment 0.1% (Protopic) in the treatment of atopic dermatitis of the eyelids were assessed in an open-label clinical trial of 21 patients with moderate to severe eyelid dermatitis. Of those 21 patients, 20 received study drug and were followed. Patients applied tacrolimus ointment 0.1% twice daily for 8 weeks and were followed for 2 additional weeks after the last day of treatment. Complete eye examinations were conducted throughout the study. Efficacy was assessed through the investigator's evaluation of the patients' individual signs and symptoms of eyelid dermatitis and the physician global assessment (PGA) of eyelid clinical response. Improvement in the investigator's evaluation of the signs and symptoms of eyelid dermatitis was observed during the study. A total of 80% of patients (16/20) experienced marked improvement or better in PGA at 8 weeks. Adverse events were limited to local burning and itching after the first few applications of study medication. Of the 20 patients, 12 reported burning (60%), and 5 reported itching (25%). There was no statistically significant increase in intraocular pressure (IOP) during the study compared with baseline. In addition, none of the patients developed cataracts or glaucoma during the study. In summary, tacrolimus ointment 0.1% may be a safe and effective treatment option for patients with moderate to severe eyelid dermatitis.


Asunto(s)
Dermatitis Atópica/tratamiento farmacológico , Párpados/patología , Inmunosupresores/uso terapéutico , Tacrolimus/uso terapéutico , Administración Tópica , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/administración & dosificación , Masculino , Persona de Mediana Edad , Pomadas , Índice de Severidad de la Enfermedad , Tacrolimus/administración & dosificación , Resultado del Tratamiento
19.
J Am Acad Dermatol ; 48(4): 564-8, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12664020

RESUMEN

The safety and efficacy of 0.1% tacrolimus ointment for the treatment of psoriasis on the face, intertriginous areas, or both were evaluated in an open-label, clinical trial of 21 patients with psoriasis. Patients applied 0.1% tacrolimus ointment twice daily for 8 weeks. Efficacy was assessed through the investigator's evaluation of the individual signs and symptoms of psoriasis, and the physician's global evaluation of change in disease status. Assessments of cutaneous atrophy and other adverse events were made throughout the study to evaluate the safety of tacrolimus ointment. A total of 21 patients were enrolled in the study; 21 patients at least 18 years of age received study medication. Statistically significant improvement in the physician's assessment of the individual signs and symptoms was observed during the study. A total of 81% of patients (17 of 21) experienced complete clearance at day 57 (end of treatment). Only 2 patients reported adverse events, which were limited to itching and the feeling of warmth at the application site. None of the patients had atrophy, telangiectasia, or striae develop during the study. In summary, tacrolimus 0.1% ointment may be a safe and effective treatment option for patients with psoriasis on the face, intertriginous areas, or both.


Asunto(s)
Inmunosupresores/administración & dosificación , Psoriasis/tratamiento farmacológico , Tacrolimus/administración & dosificación , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Pomadas , Psoriasis/patología , Tacrolimus/efectos adversos
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