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1.
J Adolesc Health ; 69(6): 1041-1043, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34666953

RESUMEN

Considering the urgent need to increase vaccine uptake in Alabama, a rural state with the lowest rates of COVID-19 vaccination in the country, we conducted an exploratory study to elucidate sentiments toward vaccination among African American or black adolescents. We conducted in-depth interviews with 15-17 year olds in rural Alabama (N = 28). About 54% of our sample were female. Nearly a third lived with an older family member; 18% knew someone who contracted COVID-19. Using Rapid Qualitative Analysis, 3 COVID-19 vaccine-related themes emerged: influence of community leaders and older family members, fear of side effects and misinformation, and institutional distrust. To address COVID-19 vaccine hesitancy among rural African American or black adolescents, we suggest adopting a socioecological approach to public health messaging that addresses misinformation and government distrust and is delivered by local influencers with the social capital necessary to promote behavior change, namely older family members and Church officials.


Asunto(s)
COVID-19 , Vacunas , Adolescente , Afroamericanos , Alabama , Vacunas contra la COVID-19 , Femenino , Humanos , SARS-CoV-2 , Vacunación
2.
Accid Anal Prev ; 163: 106428, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34649013

RESUMEN

With the rising number of cases and deaths from the COVID-19 pandemic, nations and local governments, including many across the U.S., imposed travel restrictions on their citizens. This travel restriction order led to a significant reduction in traffic volumes and a generally lower exposure to crashes. However, recent preliminary statistics in the US suggest an increase in fatal crashes over the period of lockdown in comparison to the same period in previous years. This study sought to investigate how the pandemic affected road crashes and crash outcomes in Alabama. Daily vehicle miles traveled and crashes were obtained and explored. To understand the factors associated with crash outcomes, four crash-severity models were developed: (1) Single-vehicle (SV) crashes prior to lockdown order (Normal times SV); (2) multi-vehicle (MV) crashes prior to lockdown order (Normal times MV); (3) Single-vehicle crashes after lockdown order (COVID times SV); and (4) Multi-vehicle crashes after lockdown order (COVID times MV). The models were developed using the first 28 weeks of crashes recorded in 2020. The findings of the study reveal that although traffic volumes and vehicle miles traveled had significantly dropped during the lockdown, there was an increase in the total number of crashes and major injury crashes compared to the period prior to the lockdown order, with speeding, DUI, and weekends accounting for a significant proportion of these crashes. These observations provide useful lessons for road safety improvements during extreme events that may require statewide lockdown, as has been done with the COVID-19 pandemic. Traffic management around shopping areas and other areas that may experience increased traffic volumes provide opportunities for road safety stakeholders to reduce the occurrence of crashes in the weeks leading to an announcement of any future statewide or local lockdowns. Additionally, increased law enforcement efforts can help to reduce risky driving activities as traffic volumes decrease.


Asunto(s)
COVID-19 , Pandemias , Accidentes de Tránsito , Alabama/epidemiología , Control de Enfermedades Transmisibles , Humanos , SARS-CoV-2
3.
Optom Vis Sci ; 98(9): 1085-1093, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34524213

RESUMEN

SIGNIFICANCE: Patients with glaucoma and providers recognized perceived treatment efficacy, patient-provider relationship, psychological stress, instillation skill, good quality of life, and forgetfulness as key determinants of glaucoma adherence. This shared insight could help shape the development of clinical and behavioral interventions for addressing treatment barriers and improving adherence. PURPOSE: Despite their impact on adherence in glaucoma, sociobehavioral factors may not be adequately explored during clinical consultations. We aimed to elicit consensus between patients and providers around key determinants of adherence and hypothesized that patients would place greater emphasis on sociobehavioral factors compared with providers. METHODS: A two-round Delphi survey was used to assess treatment beliefs, barriers, facilitators, motivators, and needs among 18 patients with glaucoma and providers. In round 1, agreement with 46 statements was scored on a 5-point Likert scale (strongly disagree to strongly agree). Statements with which 80% or more of panelists agreed reached consensus and advanced to round 2, where participants were asked to prioritize them based on their importance to treatment. RESULTS: There was consensus regarding the influence of perceived treatment efficacy, good provider relationship, good quality of life, psychological stress, glaucoma knowledge, instillation skill, and forgetfulness on glaucoma adherence. For statements that failed to reach consensus, the Bonferroni-corrected Mann-Whitney U test revealed that the greatest differences between patients and providers pertained to regimen complexity (provider median, 4 [interquartile range {IQR}, 1]; patient median, 1.5 [IQR, 1]; P = .002), instillation skill (providers, 4 [IQR, 0.5]; patients, 2 [IQR, 1]; P = .001), and low motivation (providers, 3 [IQR, 2.25]; patients, 1 [IQR, 0]; P = .003). CONCLUSIONS: Although patients and providers prioritized sociobehavioral factors as key determinants of adherence, disagreement between these groups was observed in other areas. Continued juxtaposition of patient and provider perspectives could spotlight underexplored areas and guide the development of successful interventions for improving adherence.


Asunto(s)
Glaucoma , Calidad de Vida , Alabama , Técnica Delfos , Glaucoma/terapia , Humanos , Cumplimiento y Adherencia al Tratamiento
4.
J Am Heart Assoc ; 10(16): e020491, 2021 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-34376060

RESUMEN

Background Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to assess safety, feasibility, and early clinical outcomes between suprasternal and transfemoral access for patients undergoing TAVR. Methods and Results We evaluated patients from 2 institutional prospective, observational registries containing 1348 patients. Patients were selected in a 2:1 ratio (transfemoral:suprasternal) on the basis of propensity score matching. The primary outcome was in-hospital mortality, and secondary outcomes included the incidence of ischemic stroke, major bleeding, vascular injury, left bundle-branch block, and permanent pacemaker implantation at 30-day follow-up. Propensity score matching identified 89 patients undergoing suprasternal TAVR and 159 patients undergoing transfemoral TAVR suitable for analysis. There was no significant difference between suprasternal TAVR and transfemoral TAVR with respect to in-hospital mortality (1.1% versus 0.6%; odds ratio [OR], 1.80; 95% CI, 0.11-29.06; P=0.680). No patients in either cohort suffered an ischemic stroke. The incidence of major bleeding (2.2% versus 2.5%; OR, 0.89; 95% CI, 0.16-4.96; P=0.895) and vascular injury (1.1% versus 1.9%; OR, 0.59; 95% CI, 0.06-5.77; P=0.651) did not differ significantly. The frequency of left bundle-branch block (9.4% versus 15.8%; OR, 0.56; 95% CI, 0.24-1.30; P=0.177) and permanent pacemaker implantation (11.2% versus 5.9%; OR, 2.01; 95% CI, 0.75-5.45; P=0.169) were not statistically significantly different. Conclusions Suprasternal TAVR was safe and achieved promising short-term clinical outcomes when compared with transfemoral TAVR. Future studies seeking to identify the optimal alternative access site should evaluate suprasternal TAVR access alongside other substitutes for transfemoral TAVR.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Tronco Braquiocefálico , Cateterismo Periférico , Arteria Femoral , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Alabama , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Tronco Braquiocefálico/diagnóstico por imagen , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Estudios de Factibilidad , Femenino , Arteria Femoral/diagnóstico por imagen , Mortalidad Hospitalaria , Humanos , Masculino , Ciudad de Nueva York , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Puntaje de Propensión , Estudios Prospectivos , Punciones , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del Tratamiento
5.
Nutr Metab Cardiovasc Dis ; 31(10): 2959-2968, 2021 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-34344546

RESUMEN

BACKGROUND AND AIMS: Watermelon juice is a rich food source of cardioprotective compounds such as arginine, citrulline, and lycopene. Preventative interventions are warranted as risk of cardiovascular disease increases among women after menopause, and age alone is an independent risk factor for vascular dysfunction. Thus, this study evaluated the effects of 100% watermelon juice on measures of vascular function. METHODS AND RESULTS: In this randomized, double-blind, placebo-controlled, crossover trial, 21 healthy postmenopausal women were randomized to consume two 360 mL servings of 100% watermelon juice per day or an isocaloric placebo for four weeks. Following a two-week washout period, they consumed the other beverage for an additional four weeks. Before and after each treatment arm, a fasting blood sample was taken for measurement of serum arginine, citrulline, lycopene, glucose, and insulin. Assessments of vascular function included pulse pressure, pulse wave velocity, 24-h ambulatory blood pressure, and flow-mediated dilation. General linear mixed models with intent-to-treat analyses were used to examine the effects of the intervention. Despite a significant treatment effect for circulating lycopene (p = 0.002), no changes in arginine, citrulline, or any vascular measures were observed. Although the juice intervention resulted in a slight but significant increase in fasting serum glucose (p = 0.001), changes in glucose homeostasis were not clinically significant. CONCLUSION: In contrast to findings from previous studies in younger adults and those with pre-existing hypertension, measures of vascular function in this cohort of healthy postmenopausal women were not impacted by supplemental watermelon juice. CLINICALTRIALS. GOV IDENTIFIER: NCT03626168.


Asunto(s)
Glucemia/metabolismo , Presión Sanguínea/efectos de los fármacos , Citrullus , Jugos de Frutas y Vegetales , Posmenopausia/sangre , Rigidez Vascular/efectos de los fármacos , Anciano , Alabama , Biomarcadores/sangre , Estudios Cruzados , Método Doble Ciego , Femenino , Homeostasis , Humanos , Licopeno/sangre , Persona de Mediana Edad , Factores de Tiempo
6.
J Safety Res ; 78: 155-169, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34399911

RESUMEN

INTRODUCTION: This study investigates the impact of several risk factors (i.e., roadway, driver, vehicle, environmental, and barrier-specific characteristics) on the injury severity resulting from barrier-related crashes and also on barrier-hit outcomes (i.e., vehicle containment, vehicle redirection, and barrier penetration). A total of 1,685 barrier-related crashes, which occurred on three major interstate highways (I-65, I-85, and I-20) in the state of Alabama, were collected for a seven-year period (2010-2016), and all relevant information from the police reports was reviewed. Features that were rarely explored before (e.g., median width, barrier length, barrier offset or lateral position, left shoulder width, blockout type, and number of cables) were also collected and examined. Two types of longitudinal barriers were analyzed: high-tension cable barriers installed on medians and strong-post guardrails installed on medians and/or roadsides. METHOD: Two separate mixed logit (MXL) models were used to analyze crash injury severity in median and roadside barrier-related crashes. Two additional MXL models were separately adopted for median and roadside barrier-related crashes to estimate the probability of three barrier-hit outcomes (vehicle containment, vehicle redirection, and barrier penetration). RESULTS: The results of crash injury severity MXL models showed that, for both median and roadside barrier crashes, barrier penetration, female drivers, and driver fatigue were associated with a higher probability of injury or fatal crashes. The results of barrier-hit MXL models showed that longer barrier length, Brifen cable barrier system, and barrier lateral position were significant predictors of median barrier-hit outcomes, whereas dark lighting condition, driving under the influence (DUI), presence of curved freeway sections, and right shoulder width significantly contributed to roadside barrier-hit outcomes. CONCLUSIONS: The MXL model succeeded in identifying several contributing factors of crash severity and barrier-hit outcomes along Alabama's interstate highways. Practical applications: One study application is to design longer barrier run length (greater than 1230 feet or 0.2 miles) to reduce the barrier penetration likelihood.


Asunto(s)
Accidentes de Tránsito , Heridas y Lesiones , Alabama , Femenino , Humanos , Modelos Logísticos , Policia , Factores de Riesgo , Heridas y Lesiones/epidemiología
7.
Am J Public Health ; 111(8): 1443-1447, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34464195

RESUMEN

To investigate how heat-health behaviors changed in summer 2020 compared with previous summers, our community-academic partnership conducted telephone surveys to collect data on cooling behaviors, safety concerns, and preferences for cooling alternatives for 101 participants living in Alabama. Participants indicating they would visit cooling centers declined from 23% in previous summers to 10% in summer 2020. The use of cooling centers and other public spaces may be less effective in reducing heat-related illness because of safety concerns amid the COVID-19 pandemic and police brutality.


Asunto(s)
Afroamericanos/estadística & datos numéricos , COVID-19/epidemiología , Conductas Relacionadas con la Salud , Trastornos de Estrés por Calor/prevención & control , Calor , Características de la Residencia/estadística & datos numéricos , Alabama , COVID-19/psicología , Vivienda , Humanos
8.
Ecology ; 102(10): e03467, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34236706

RESUMEN

Understanding the observed temperature dependence of decomposition (i.e., its "apparent" activation energy) requires separation of direct effects of temperature on consumer metabolism (i.e., the "inherent" activation energy) from those driven by indirect seasonal patterns in phenology and biomass, and by longer-term, climate-driven shifts in acclimation, adaptation, and community assembly. Such parsing is important because studies that relate temperature to decomposition usually involve multi-season data and/or spatial proxies for long-term shifts, and so incorporate these indirect factors. The various effects of such factors can obscure the inherent temperature dependence of detrital processing. Separating the inherent temperature dependence of decomposition from other drivers is important for accurate prediction of the contribution of detritus-sourced greenhouse gases to climate warming and requires novel approaches to data collection and analysis. Here, we present breakdown rates of red maple litter incubated in coarse- and fine-mesh litterbags (the latter excluding macroinvertebrates) for serial approximately one-month increments over one year in nine streams along a natural temperature gradient (mean annual: 12.8°-16.4°C) from north Georgia to central Alabama, USA. We analyzed these data using distance-based redundancy analysis and generalized additive mixed models to parse the dependence of decomposition rates on temperature, seasonality, and shredding macroinvertebrate biomass. Microbial decomposition in fine-mesh bags was significantly influenced by both temperature and seasonality. Accounting for seasonality corrected the temperature dependence of decomposition rate from 0.25 to 0.08 eV. Shredder assemblage structure in coarse-mesh bags was related to temperature across both sites and seasons, shifting from "cold" stonefly-dominated communities to "warm" communities dominated by snails or crayfish. Shredder biomass was not a significant predictor of either coarse-mesh or macroinvertebrate-mediated (i.e., coarse- minus fine-mesh) breakdown rates, which were also jointly influenced by temperature and seasonality. Unlike fine-mesh bags, however, temperature dependence of litter breakdown did not differ between models with and without seasonality for either coarse-mesh (0.36 eV) or macroinvertebrate-mediated (0.13 eV) rates. We conclude that indirect (non-thermal) seasonal and site-level effects play a variable and potentially strong role in shaping the apparent temperature dependence of detrital breakdown. Such effects should be incorporated into studies designed to estimate inherent temperature dependence of slow ecological processes.


Asunto(s)
Ecosistema , Insectos , Alabama , Animales , Biodegradación Ambiental , Georgia , Hojas de la Planta , Ríos , Temperatura
9.
PLoS Negl Trop Dis ; 15(7): e0009535, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34228748

RESUMEN

Mosquito-borne viruses cause diseases of great public health concern. Arboviral disease case distributions have complex relationships with socioeconomic and environmental factors. We combined information about socio-economic (population, and poverty rate) and environmental (precipitation, and land use) characteristics with reported human cases of arboviral disease in the counties of Alabama, USA, from 2007-2017. We used county level data on West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus, Eastern equine encephalitis virus, and Saint Louis encephalitis virus to provide a detailed description of their spatio-temporal pattern. We found a significant spatial convergence between incidence of WNV and poverty rate clustered in the southern part of Alabama. DENV, CHIKV and ZIKV cases showed a different spatial pattern, being mostly located in the northern part, in areas of high socioeconomic status. The results of our study establish that poverty-driven inequities in arboviral risk exist in the southern USA, and should be taken into account when planning prevention and intervention strategies.


Asunto(s)
Infecciones por Arbovirus/economía , Infecciones por Arbovirus/epidemiología , Alabama/epidemiología , Infecciones por Arbovirus/virología , Arbovirus/fisiología , Ambiente , Humanos , Pobreza , Salud Pública , Factores Socioeconómicos
10.
Accid Anal Prev ; 160: 106303, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34303495

RESUMEN

The effects of freeway incident clearance times on the flow of traffic have recently increased interests in understanding what factors influence incident durations. This has particularly become topical due to the financial and economic implications of traffic gridlocks caused by freeway incidents on industries and personal mobility. This paper presents two advanced econometric modeling methods, random parameters duration modeling and latent class duration modeling in understanding the factors that impact freeway incident clearance times in the State of Alabama. These two modeling approaches were further compared to identify which of them provides the best fit for the data with respect to accounting for unobserved heterogeneity. A total of 2206 freeway crash incident data from January 1 to December 31, 2018 were examined in developing the models. The study was based on a unique dataset that involved merging and matching Traffic Incident Management response data from the Alabama Department of Transportation (ALDOT) Traffic Management Center (TMC), freeway crash data from the Center for Advanced Public Safety (CAPS) at the University of Alabama, Alabama Service and Assistance Patrol (ASAP) data from ALDOT and traffic volume from ALDOT's Highway Performance Management System (HPMS). The model estimation results reveal that a total of nineteen variables were found statistically significant with five random variables (on-road, nighttime, rain, AADT, and ASAP existing coverage area) and fourteen fixed effects variables for the random parameters model. For latent class model, a total of eighteen variables were observed statistically significant within two distinct latent classes (Latent Class 1 with class membership probability of 0.23 and Latent Class 2 with class membership probability of 0.77) at a 0.05 significance level. A comparison of the two models reveals that the latent class model provides the better fit for the incident duration data. The findings of this study are expected to contribute to the body of knowledge on incident duration by employing two advanced econometric modeling methods and to inform statewide efforts in significantly reducing the duration of freeway incident clearance time. Moreover, this is to ensure that policy decisions that may arise from the findings of the study are sound and based on data-driven evidence.


Asunto(s)
Accidentes de Tránsito , Alabama , Humanos , Análisis de Clases Latentes , Probabilidad
11.
BMC Public Health ; 21(1): 1266, 2021 06 29.
Artículo en Inglés | MEDLINE | ID: mdl-34187438

RESUMEN

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education. METHODS: The current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention's feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data. RESULTS: Over the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10-18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year. CONCLUSIONS: Findings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.


Asunto(s)
Vacunas Meningococicas , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Farmacias , Farmacia , Adolescente , Alabama , Niño , Estudios de Factibilidad , Humanos , Infecciones por Papillomavirus/prevención & control , Proyectos Piloto , Población Rural , Vacunación
12.
Emerg Infect Dis ; 27(7): 1949-1952, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34152958

RESUMEN

A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine.


Asunto(s)
Infecciones Neumocócicas , Streptococcus pneumoniae , Alabama , Brotes de Enfermedades , Humanos , Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas , Prisiones , Serogrupo
13.
Emerg Infect Dis ; 27(7): 1886-1892, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34152960

RESUMEN

Eastern equine encephalitis virus (EEEV) is an arbovirus in the family Togaviridae, genus Alphavirus, found in North America and associated with freshwater/hardwood swamps in the Atlantic, Gulf Coast, and Great Lakes regions. EEEV disease in humans is rare but causes substantial illness and death. To investigate the molecular epidemiology and microevolution of EEEV from a fatal case in Alabama, USA, in 2019, we used next-generation sequencing of serum and cerebrospinal fluid (CSF). Phylogenetic inference indicated that the infecting strain may be closely related to isolates from Florida detected during 2010-2014, suggesting potential seeding from Florida. EEEV detected in serum displayed a higher degree of variability with more single-nucleotide variants than that detected in the CSF. These data refine our knowledge of EEEV molecular epidemiologic dynamics in the Gulf Coast region and demonstrate potential quasispecies bottlenecking within the central nervous system of a human host.


Asunto(s)
Virus de la Encefalitis Equina del Este , Alabama , Animales , Florida , Caballos , Humanos , América del Norte , Filogenia
15.
J Trauma Acute Care Surg ; 91(3): 514-520, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-33990533

RESUMEN

BACKGROUND: Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical US setting. METHODS: We conducted a prospective observational/simulation study at a level I trauma center and two associated emergency medical service (EMS) agencies over a 9-month period. The participating EMS agencies were asked to identify actual patients who might benefit from the activation of a hypothetical trauma center-based ARC team. This decision was then communicated in real time to the study team. RESULTS: Sixty-three patients were determined to require activation. The number of activations per month ranged from 2 to 15. The highest incidence of calls occurred between 4 pm to midnight. Of the 63 patients, 33 were transported to the trauma center. The most common presentation was with penetrating trauma. The median age was 27 years (interquartile range, 24-45 years), 75% were male, and the median Injury Severity Score was 11 (interquartile range, 7-20). Based on injury patterns, treatment received, and outcomes, it was determined that 6 (18%) of 33 patients might have benefited from ARC. Three of the patients died en-route to or soon after arrival at the trauma center. CONCLUSION: The prehospital identification of patients who might benefit from ARC is possible but faces challenges. Identifying strategies to adapt existing processes may allow better utilization of the existing infrastructure and should be a focus of future efforts. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level III.


Asunto(s)
Servicios Médicos de Urgencia/organización & administración , Hemorragia/mortalidad , Resucitación/métodos , Heridas y Lesiones/mortalidad , Adulto , Alabama/epidemiología , Servicios Médicos de Urgencia/métodos , Femenino , Hemorragia/etiología , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Evaluación de Necesidades/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Estudios Prospectivos , Centros Traumatológicos , Heridas y Lesiones/complicaciones , Heridas y Lesiones/terapia , Adulto Joven
16.
Sex Transm Dis ; 48(11): 813-818, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-33993163

RESUMEN

BACKGROUND: African Americans have the highest rates of Chlamydia trachomatis (CT) infection in the United States and also high reinfection rates. The primary objective of this study was to develop a Bayesian model to predict the probability of CT reinfection in African American women using immunogenetic data. METHODS: We analyzed data from a cohort of CT-infected African American women enrolled at the time they returned to a clinic in Birmingham, AL, for the treatment of a positive routine CT test result. We modeled the probability of CT reinfection within 6 months after treatment using logistic regression in a Bayesian framework. Predictors of interest were presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response, both of which we had previously reported were independently associated with CT reinfection risk. RESULTS: Among 99 participants evaluated, the probability of reinfection for those with a CT-specific CD4+ IFN-γ response and no HLA-DQB1*06 alleles was 14.1% (95% credible interval [CI], 3.0%-45.0%), whereas the probability of reinfection for those without a CT-specific CD4+ IFN-γ response and at least one HLA-DQB1*06 allele was 61.5% (95% CI, 23.1%-89.7%). CONCLUSIONS: Our model demonstrated that presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response can have an impact on the predictive probability of CT reinfection in African American women.


Asunto(s)
Afroamericanos , Infecciones por Chlamydia , Reinfección/genética , Afroamericanos/genética , Alabama , Teorema de Bayes , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/genética , Chlamydia trachomatis , Femenino , Cadenas beta de HLA-DQ/genética , Humanos , Interferón gamma
17.
Psychol Assess ; 33(10): 940-951, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33939455

RESUMEN

The Alabama Parenting Questionnaire-9 (APQ-9) is a widely used brief measure of parenting behaviors. However, the reliability coefficients of the three APQ-9 subscales vary substantially. A reliability generalization meta-analysis was conducted on the three APQ-9 subscales to (a) estimate mean internal consistency reliability values and (b) examine the sources of variance. A total of 113 coefficient alphas from 31,572 informants, across 32 studies were included in this meta-analysis. Results showed acceptable mean α values (.84 for positive parenting, .66 for inconsistent discipline, and .70 for poor supervision subscales). Moderator analyses results found that differences in coefficient αs of the three subscales were influenced by numerous variables including administration format, country, language version, population, the mean and standard deviation of scores, and sample size. Our findings support the utility of the parent-report APQ-9 as a useful measure of parenting behaviors. Future research direction is also discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Responsabilidad Parental , Encuestas y Cuestionarios , Alabama , Humanos , Responsabilidad Parental/psicología , Reproducibilidad de los Resultados
18.
Nurs Clin North Am ; 56(2): 189-202, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34023115

RESUMEN

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.


Asunto(s)
Infecciones por VIH/complicaciones , Terapia por Relajación/tendencias , Trastornos del Sueño-Vigilia/terapia , Alabama , Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Humanos , Malaui , Terapia por Relajación/métodos , Trastornos del Sueño-Vigilia/fisiopatología , Trastornos del Sueño-Vigilia/psicología
19.
Nutr Res ; 90: 1-12, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34049184

RESUMEN

Since the ongoing coronavirus disease 2019 (COVID-19) pandemic is linked to chronic inflammation, people with initial lower inflammatory status could have better outcomes from exposure to this disease. Because dietary habits are one of the most important modifiable risk factors for inflammation, identification of dietary components associated with inflammation could play a significant role in controlling or reducing the risk of COVID-19. We investigated the inflammatory potential of diets consumed by African American (AA) and Caucasian American (CA) women of childbearing age (n = 509) who are at high risk for exposure to COVID-19 by being residents of Birmingham, Alabama, a city severely affected by this pandemic. The overall pro- and anti- inflammatory scores were calculated using dietary intake data gathered using Block food frequency questionnaire. The proinflammatory potential of diets consumed by AAs was significantly higher compared to CAs. Several anti- and proinflammatory nutrients and food groups consumed differed by race. With consumption of a greater number of antioxidants and B-vitamins, CAs switched toward an anti-inflammatory score more effectively than AAs while AAs performed better than CAs in improving the anti-inflammatory score with the consumption of a greater number of minerals and vitamin D. Effective race-specific dietary modifications or supplementation with nutrients identified will be useful to improve proinflammatory diets toward anti-inflammatory. This approach could aid in controlling the current COVID-19 pandemic and future pandemics of a similar nature in women at risk for exposure.


Asunto(s)
Afroamericanos/estadística & datos numéricos , COVID-19/prevención & control , Dieta/métodos , Inflamación/fisiopatología , /estadística & datos numéricos , Adulto , Alabama , Dieta/efectos adversos , Dieta/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Encuestas y Cuestionarios , Adulto Joven
20.
J Community Health ; 46(6): 1115-1123, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33966116

RESUMEN

Racial/ethnic and socioeconomic disparities in COVID-19 burden have been widely reported. Using data from the state health departments of Alabama and Louisiana aggregated to residential Census tracts, we assessed the relationship between social vulnerability and COVID-19 testing rates, test positivity, and incidence. Data were cumulative for the period of February 27, 2020 to October 7, 2020. We estimated the association of the 2018 Social Vulnerability Index (SVI) overall score and theme scores with COVID-19 tests, test positivity, and cases using multivariable negative binomial regressions. We adjusted for rurality with 2010 Rural-Urban Commuting Area codes. Regional effects were modeled as fixed effects of counties/parishes and state health department regions. The analytical sample included 1160 Alabama and 1105 Louisiana Census tracts. In both states, overall social vulnerability and vulnerability themes were significantly associated with increased COVID-19 case rates (RR 1.57, 95% CI 1.45-1.70 for Alabama; RR 1.36, 95% CI 1.26-1.46 for Louisiana). There was increased COVID-19 testing with higher overall vulnerability in Louisiana (RR 1.26, 95% CI 1.14-1.38), but not in Alabama (RR 0.95, 95% CI 0.89-1.02). Consequently, test positivity in Alabama was significantly associated with social vulnerability (RR 1.66, 95% CI 1.57-1.75), whereas no such relationship was observed in Louisiana (RR 1.05, 95% CI 0.98-1.12). Social vulnerability is a risk factor for COVID-19 infection, particularly among racial/ethnic minorities and those in disadvantaged housing conditions without transportation. Increased testing targeted to vulnerable communities may contribute to reduction in test positivity and overall COVID-19 disparities.


Asunto(s)
COVID-19 , Alabama/epidemiología , Prueba de COVID-19 , Humanos , Incidencia , Louisiana , SARS-CoV-2 , Factores Socioeconómicos , Estados Unidos
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