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3.
J Asthma ; : 1-12, 2019 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-31187658

RESUMEN

Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers. Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression. Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged ≤9 years (77% among children), and adults aged ≥45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims. Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings.

4.
Am J Epidemiol ; 188(1): 206-213, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-30165474

RESUMEN

Since the 2007 Zika epidemic in the Micronesian state of Yap, it has been apparent that not all people infected with Zika virus (ZIKV) experience symptoms. However, the proportion of infections that result in symptoms remains unclear. Existing estimates have varied in their interpretation of symptoms due to other causes and the case definition used, and they have assumed perfect test sensitivity and specificity. Using a Bayesian model and data from ZIKV serosurveys in Yap (2007), French Polynesia (2013-2014), and Puerto Rico (2016), we found that assuming perfect sensitivity and specificity generally led to lower estimates of the symptomatic proportion. Incorporating reasonable assumptions for assay sensitivity and specificity, we estimated that 27% (95% credible interval (CrI): 15, 37) (Yap), 44% (95% CrI: 26, 66) (French Polynesia), and 50% (95% CrI: 34, 92) (Puerto Rico) of infections were symptomatic, with variation due to differences in study populations, study designs, and case definitions. The proportion of ZIKV infections causing symptoms is critical for surveillance system design and impact assessment. Here, we accounted for key uncertainties in existing seroprevalence data and found that estimates for the symptomatic proportion ranged from 27% to 50%, suggesting that while the majority of infections are asymptomatic or mildly symptomatic, symptomatic infections might be more common than previously estimated.


Asunto(s)
Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/fisiopatología , Teorema de Bayes , Humanos , Micronesia/epidemiología , Polinesia/epidemiología , Puerto Rico/epidemiología , Sensibilidad y Especificidad , Estudios Seroepidemiológicos
5.
J Asthma ; 56(1): 42-49, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29425057

RESUMEN

OBJECTIVE: Asthma affects six million children in the United States. Most people can control their asthma symptoms with effective care, management, and appropriate medical treatment. Information on the relationship between asthma control and quality of life indicators and health care use among school-age children is limited. METHODS: Using the 2006-2010 combined Behavior Risk Factor Surveillance System Asthma Call-back Survey child data, we examined asthma control and asthma attack status among school-age (aged 5-17 years) children with asthma from 35 states and the District of Columbia. Multivariable logistic regression models were used to assess if having uncontrolled asthma and having ≥1 asthma attacks affect quality of life (activity limitation and missed school days) and healthcare use (emergency department [ED] visits and hospitalizations). RESULTS: About one-third (36.5%) of the 8,484 respondents with current asthma had uncontrolled asthma and 56.8% reported ≥1 asthma attack in the past year. Having uncontrolled asthma and having ≥1 asthma attack were significantly associated with activity limitation (aPR = 1.43 and 1.74, respectively), missed school (1.45 and 1.68), ED visits (2.05 and 4.78), and hospitalizations (2.38 and 3.64). Long-term control (LTC) medication use was higher among respondents with uncontrolled asthma (61.3%) than respondents with well-controlled asthma (33.5%). CONCLUSIONS: Having uncontrolled asthma is associated with reduced quality of life and increased health care use. However, only 61.3% of respondents with uncontrolled asthma use LTC medications. Increasing use of LTC medications among children with uncontrolled asthma could help improve quality of life and reduce health care use.


Asunto(s)
Asma/epidemiología , Asma/psicología , Calidad de Vida , Absentismo , Adolescente , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/fisiopatología , Sistema de Vigilancia de Factor de Riesgo Conductual , Broncodilatadores/uso terapéutico , Niño , Preescolar , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Recursos en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Estados Unidos/epidemiología
6.
Clin Infect Dis ; 67(4): 624-627, 2018 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-29534160

RESUMEN

A prospective cohort of women with reverse transcription polymerase chain reaction (RT-PCR) confirmed Zika virus infection aged 18-39 years in Puerto Rico found that pregnant women have about a 3-fold longer estimated median detection of Zika virus RNA in serum, which can increase definitive diagnosis of infection and facilitate timely and appropriate clinical management.


Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , ARN Viral/sangre , Infección por el Virus Zika/diagnóstico , Virus Zika/aislamiento & purificación , Adolescente , Adulto , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Estudios Prospectivos , Puerto Rico/epidemiología , Adulto Joven , Infección por el Virus Zika/epidemiología
7.
J Infect Dis ; 217(11): 1678-1689, 2018 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-29216376

RESUMEN

Background: During the outbreak of Zika virus (ZIKV) disease in Puerto Rico in 2016, nonpregnant women aged 20-39 years were disproportionately identified with ZIKV disease. We used household-based cluster investigations to determine whether this disparity was associated with age- or sex-dependent differences in the rate of ZIKV infection or reported symptoms. Methods: Participation was offered to residents of households within a 100-m radius of the residences of a convenience sample of 19 laboratory-confirmed ZIKV disease cases. Participants answered a questionnaire and provided specimens for diagnostic testing by reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Results: Among 367 study participants, 114 (31.1%) were laboratory positive for ZIKV infection, of whom 30% reported a recent illness (defined as self-reported rash or arthralgia) attributable to ZIKV infection. Age and sex were not associated with ZIKV infection. Female sex (adjusted prevalence ratio [aPR], 2.28; 95% confidence interval [CI], 1.40, 3.67), age <40 years (aPR, 2.39; 95% CI, 1.55, 3.70), and asthma (aPR, 1.63; 95% CI, 1.12, 2.37) were independently associated with symptomatic infection. Conclusions: Although neither female sex nor age were associated with an increased prevalence of ZIKV infection, both were associated with symptomatic infection. Further investigation to identify a potential mechanism of age- and sex-dependent differences in reporting symptomatic ZIKV infection is warranted.


Asunto(s)
Infección por el Virus Zika/epidemiología , Virus Zika/patogenicidad , Adulto , Anciano , Brotes de Enfermedades , Composición Familiar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Prevalencia , Puerto Rico/epidemiología
8.
Environ Sci Technol ; 50(8): 4564-71, 2016 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-26953674

RESUMEN

Household air pollution (HAP) contributes to 3.5-4 million annual deaths globally. Recent interventions using improved cookstoves (ICS) to reduce HAP have incorporated temperature sensors as stove use monitors (SUMs) to assess stove use. We deployed SUMs in an effectiveness study of 6 ICSs in 45 Kenyan rural homes. Stove were installed sequentially for 2 weeks and kitchen air monitoring was conducted for 48 h during each 2-week period. We placed SUMs on the ICSs and traditional cookstoves (TCS), and the continuous temperature data were analyzed using an algorithm to examine the number of cooking events, days of exclusive use of ICS, and how stove use patterns affect HAP. Stacking, defined as using both a TCS and an ICS in the same day, occurred on 40% of the study days, and exclusive use of the ICS occurred on 25% of study days. When researchers were not present, ICS use declined, which can have implications for long-term stove adoption in these communities. Continued use of TCSs was also associated with higher HAP levels. SUMs are a valuable tool for characterizing stove use and provide additional information to interpret HAP levels measured during ICS intervention studies.


Asunto(s)
Contaminación del Aire Interior/análisis , Contaminación del Aire Interior/prevención & control , Culinaria , Composición Familiar , Artículos Domésticos , Monóxido de Carbono/análisis , Culinaria/instrumentación , Culinaria/normas , Estudios Cruzados , Calor , Artículos Domésticos/instrumentación , Artículos Domésticos/normas , Humanos , Kenia , Tamaño de la Partícula , Material Particulado/análisis , Población Rural
10.
J Environ Health ; 78(5): 14-21, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26738314

RESUMEN

Lake County, California, is in a high geothermal-activity area. Over the past 30 years, the city of Clearlake has reported health effects and building evacuations related to geothermal venting. Previous investigations in Clearlake revealed hydrogen sulfide at levels known to cause health effects and methane at levels that can cause explosion risks. The authors conducted an investigation in multiple cities and towns in Lake County to understand better the risk of geothermal venting to the community. They conducted household surveys and outdoor air sampling of hydrogen sulfide and methane and found community members were aware of geothermal venting and some expressed concerns. The authors did not, however, find hydrogen sulfide above the California Environmental Protection Agency air quality standard of 30 parts per billion over one hour or methane above explosive thresholds. The authors recommend improving risk communication, continuing to monitor geothermal gas effects on the community, and using community reports and complaints to monitor and document geothermal venting incidents.


Asunto(s)
Contaminantes Atmosféricos/análisis , Exposición a Riesgos Ambientales , Gases/análisis , Conocimientos, Actitudes y Práctica en Salud , Sulfuro de Hidrógeno/análisis , Metano/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California , Niño , Preescolar , Ciudades , Estudios Transversales , Monitoreo del Ambiente , Energía Geotérmica , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Medición de Riesgo , Adulto Joven
11.
Int Arch Occup Environ Health ; 86(4): 479-88, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-22729564

RESUMEN

PURPOSE: To assess occupational inhalation exposure to the herbicide atrazine during pesticide application in a developing country. METHODS: Personal air samples were collected during atrazine application using a personal sampling pump equipped with an OSHA Versatile Sampler (OVS-2) sorbent tube. Samples were collected from 24 pesticide applicators in Honduras. Application was observed during sampling, and a survey was completed in the home. RESULTS: Fourteen of the 24 participants used pump backpack sprayers to apply atrazine and 10 used tractor/boom systems. Despite applying about 15 times as much atrazine, the tractor/boom participants (11.5 µg/m(3)) had only slightly higher (not statistically significant) time-weighted averages (TWA) than participants using backpack sprayers (9.6 µg/m(3)). Within the backpack sprayer group, those that used a cone spray nozzle (11.54 µg/m(3)) had nearly double the TWA than applicators using a flat spray nozzle (5.98 µg/m(3); P = 0.04). In the tractor/boom group, the participants that rode on the boom or the back of the tractor monitoring nozzles (15.0 µg/m(3)) had almost double the average TWA than tractor drivers (8.0 µg/m(3); P = 0.097). CONCLUSIONS: Since tractor/boom pesticide application decreases the number of man-hours required to apply pesticides, and does not increase inhalation exposure significantly, it decreases the overall population occupational exposure. Monitoring nozzles on booms from a distance rather than on the back of a tractor or boom may decrease or eliminate inhalation exposure. Use of flat spray nozzles for herbicide application among pump backpack sprayers may reduce their inhalation exposure.


Asunto(s)
Contaminantes Ocupacionales del Aire/análisis , Atrazina/análisis , Herbicidas/análisis , Exposición por Inhalación/análisis , Control de Malezas/métodos , Adulto , Honduras , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Control de Malezas/instrumentación
12.
J Occup Environ Hyg ; 9(5): 289-97, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22506545

RESUMEN

Twenty-nine commercial pesticide applicator households in eastern Iowa were enrolled to investigate in-home contamination of atrazine, the most commonly used corn herbicide in the Unites States. From each home, four vacuum dust samples were collected during atrazine application season (Visit 1) and again 6 months later during winter months (Visit 2). Samples were taken from the following locations: primary entryway for pesticide applicator, living room, master bedroom, and kitchen. The applicator completed an atrazine handling log and household questionnaire with spouse. Of the 230 dust samples, only 2 were below the level of detection, 2 ng of atrazine per gram (ng/g) of fine dust (dust particle size 5-150 µm). Dust levels were standardized to chemical loading. During application season the entryway (2.68 ng/cm(2)) and kitchen (0.47 ng/cm(2)) had the highest geometric mean atrazine chemical loading. The entryway chemical loading during Visit 2 was the second highest aggregate (0.55 ng/cm(2)). Aggregate concentrations were significantly higher at Visit 1 compared with Visit 2 when paired by location (p≤0.02). Analysis showed that job (application, mixing/loading, or both) was not associated with in-home atrazine contamination. Linear regression showed a strong positive association between atrazine handling (number of acres applied with atrazine, number of days atrazine handled, and pounds of atrazine handled) and aggregate dust chemical loading from both visits (p = 0.06, 0.03, and 0.10, respectively). Frequency of vacuuming was inversely associated with Visit 2 concentrations (p = 0.10) and showed a weaker association with Visit 1 (p = 0.30). Removing shoes outside the home was associated with lower atrazine chemical loading (p = 0.03), and applicators changing work clothes in the master bedroom had significantly increased atrazine chemical loading in master bedrooms (p = 0.01). Changes in hygiene practices for commercial pesticide applicators could significantly reduce atrazine and, likely, other pesticide contaminations in the home.


Asunto(s)
Contaminación del Aire Interior/análisis , Atrazina/análisis , Polvo/análisis , Exposición a Riesgos Ambientales/análisis , Herbicidas/análisis , Control de Malezas , Adulto , Servicio de Limpieza , Vivienda , Humanos , Iowa , Modelos Lineales , Masculino , Persona de Mediana Edad , Ropa de Protección , Estaciones del Año , Encuestas y Cuestionarios , Factores de Tiempo , Carga de Trabajo , Adulto Joven
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