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2.
J Stroke Cerebrovasc Dis ; 29(2): 104553, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31837920

RESUMEN

BACKGROUND: To assess prevalence and to determine the impact of chronic obstructive pulmonary disease (COPD) on health care utilization in patients with cerebrovascular accident (CVA). METHODS: We performed retrospective analysis of data from 12,102 patients who had diagnosis of CVA from 2014 to 2019 at tertiary medical center. We calculated the prevalence of COPD among patients with diagnosis of CVA. We performed unadjusted, covariate adjusted, and propensity-matched analysis to evaluate differences in health care utilization in patients with CVA and COPD compared to patients with CVA without COPD. RESULTS: 12,102 patients were diagnosed with CVA episodes. The prevalence of COPD among CVA patients was 7.65 % (95%CI: 7.18-8.13). The unadjusted and covariate adjusted analysis demonstrated that the average number of hospitalizations among CVA patients with a diagnosis of COPD was significantly higher than CVA patients without COPD. After adjusting for modifiable and nonmodifiable confounders, CVA patients diagnosed with COPD have on average 1 more hospitalization (1.21; 95%CI: 1.12-1.30) than those who are not diagnosed with COPD. Subsequent analysis based on propensity-matched data suggests that CVA patients diagnosed with COPD have on average approximately 1 more hospitalization (1.44; 95% CI: 1.31-1.58) than CVA patients without COPD. CONCLUSIONS: Our study suggests significant prevalence of COPD among CVA patients. The presence of COPD as a comorbidity resulted in patients with COPD and CVA having increased number of hospitalizations compared to CVA patients without COPD.


Asunto(s)
Hospitalización , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Arkansas/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Centros de Atención Terciaria
3.
Am J Public Health ; 110(2): 166-173, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31855474

RESUMEN

Health disparities adversely affect millions of people living in disadvantaged communities, resisting public health interventions that do not address the specific conditions, driving forces, or health problems in these communities. Drawing from the underutilized science of deliberative methods, we introduce the innovative citizens' panels for health equity approach-a novel methodology that engages public expertise and knowledge of community health needs, risks, and priorities to tailor public health research and interventions for greater relevance and impact on disadvantaged communities.By engaging affected residents and stakeholders in informed deliberation and decision-making about community health disparities, citizens' panels provide important guidance for (1) designing research studies to target the major health disparities affecting disadvantaged communities and (2) tailoring evidence-based interventions to the perspectives, practices, and preferences of disadvantaged residents.Employed as the primary methodology in 2 federally funded projects conducted in California and Arkansas between 2017 and 2019, citizens' panels offer a systematic method for obtaining rich community insight into health disparities, shaping community-informed solutions, and affording disadvantaged communities influence over public health decision-making to stimulate grassroots change and health equity.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Toma de Decisiones , Procesos de Grupo , Disparidades en Atención de Salud , Arkansas , California , Prioridades en Salud , Humanos , Grupos Minoritarios , Salud Pública
4.
Artículo en Inglés | MEDLINE | ID: mdl-31877981

RESUMEN

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression-the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2.90 (CI: 1.21-7.00) and 7.81 (CI: 3.71-16.45) times more likely to be at risk for low FVC and FI, respectively, compared to children of mothers with no MD. Similar findings but at lower magnitude were found for mothers with low symptoms of MD in comparison with mothers with no MD-both for Low FVC (1.57 times more likely; CI: 1.01-2.45) and FI (2.14 times more likely; CI: 1.28-3.58). The results presented are Odds Ratios from the multivariable adjusted models. Conclusions: Implications for the etiology of obesity, prevention/intervention efforts, and future research are offered, including recommended addition of maternal depression and household FI screening in early childhood programs.


Asunto(s)
Depresión/epidemiología , Conducta Alimentaria/psicología , Abastecimiento de Alimentos , Frutas , Madres/psicología , Verduras , Adulto , Arkansas/epidemiología , Preescolar , Dieta Saludable , Femenino , Humanos , Masculino , Oportunidad Relativa , Factores de Riesgo , Estados Unidos
5.
Plant Dis ; 103(12): 3108-3116, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31657998

RESUMEN

Wheat powdery mildew, caused by Blumeria graminis f. sp. tritici, is managed in the United States with cultivar resistance and foliar fungicides. Despite high levels of fungicide sensitivity in other cereal mildew populations, fungicide sensitivity of U.S. B. graminis f. sp. tritici has never been evaluated. Almost 400 B. graminis f. sp. tritici isolates were collected from 15 U.S. states over 2 years and phenotyped for sensitivity to two widely used demethylation inhibitor (DMI) fungicides, tebuconazole and prothioconazole. A large range of sensitivity to both DMIs was observed, with more insensitive isolates originating from the eastern United States (Great Lakes, Mid-Atlantic, and Southeast regions) and more sensitive isolates from central states (Plains region, Arkansas, and Missouri). Cross-resistance was indicated by a positive although weak association between tebuconazole and prothioconazole sensitivities at all levels of analysis (EC50 values, P < 0.0001). A possible fitness cost was also associated with prothioconazole insensitivity (P = 0.0307) when analyzed at the state population level. This is the first assessment of fungicide sensitivity in the U.S. B. graminis f. sp. tritici population, and it produced evidence of regional selection for reduced DMI efficacy. The observation of reduced sensitivity to DMI fungicides in the eastern United States underlines the importance of rotating between chemistry classes to maintain the effectiveness of DMIs in U.S. wheat production. Although cross-resistance was demonstrated, variability in the relationship of EC50 values for tebuconazole and prothioconazole also suggests that multiple mechanisms influence B. graminis f. sp. tritici isolate responses to these two DMI fungicides.


Asunto(s)
Ascomicetos , Farmacorresistencia Fúngica , Fungicidas Industriales , Arkansas , Ascomicetos/efectos de los fármacos , Fungicidas Industriales/farmacología , Concentración 50 Inhibidora , Missouri , Estados Unidos
6.
J Econ Entomol ; 112(6): 2731-2736, 2019 12 09.
Artículo en Inglés | MEDLINE | ID: mdl-31504628

RESUMEN

The sugarcane aphid, Melanaphis sacchari (Zehntner) (Hemiptera: Aphididae), has become a major pest of grain sorghum, Sorghum bicolor (L.) Moench, in the United States in recent years. Feeding by large densities of sugarcane aphids causes severe damage, which can lead to a total loss of yield in extreme cases. Our objective was to determine the effect of grain sorghum planting date on sugarcane aphid population dynamics and their potential to reduce yields. We conducted field experiments from 2015 to 2017 in which an aphid-susceptible grain sorghum hybrid was planted at four different dates, which encompassed the typical range of planting dates used in Arkansas production systems. Plots were either protected from sugarcane aphid feeding using foliar insecticide sprays, or left untreated to allow natural populations of sugarcane aphids to colonize and reproduce freely. Planting date impacted both the magnitude and severity of sugarcane aphid infestations, with the highest population densities (and subsequent reductions in sorghum yield) generally occurring on plots that were planted in May or June. Sugarcane aphid feeding reduced yields in the untreated plots in two of the four planting date categories we tested. Earlier planting generally resulted in less sugarcane aphid damage and improved yields compared with later planting dates. While the effect of planting date on sugarcane aphid populations is likely to vary by region, sorghum producers should consider grain sorghum planting date as a potential cultural tactic to reduce the impact of sugarcane aphid.


Asunto(s)
Áfidos , Saccharum , Sorghum , Animales , Arkansas , Dinámica Poblacional
7.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31501233

RESUMEN

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Asunto(s)
Desarrollo Infantil , Abastecimiento de Alimentos/estadística & datos numéricos , Trastornos del Crecimiento/epidemiología , Estado de Salud , Obesidad Pediátrica/epidemiología , Delgadez/epidemiología , Afroamericanos/estadística & datos numéricos , Factores de Edad , Arkansas/epidemiología , Baltimore/epidemiología , Boston/epidemiología , Cuidadores/estadística & datos numéricos , Preescolar , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Minnesota/epidemiología , Encuestas Nutricionales , Philadelphia/epidemiología , Pobreza , Análisis de Regresión
8.
Environ Monit Assess ; 191(10): 632, 2019 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-31522277

RESUMEN

Continuous monitoring data can be extremely useful for assessing water-quality conditions particularly for variables, such as dissolved oxygen, that exhibit dynamic diel swings. As a means of evaluating stream dissolved oxygen criteria used by the Arkansas Department of Environmental Quality (ADEQ), we compared continuous dissolved oxygen (DO) data collected at five small- to moderate-sized (watersheds 10-100 mi2), high-gradient streams in the Boston Mountains distributed across a land-use and nutrient condition gradient. The sampled streams exhibit a general pattern established for other aquatic systems (e.g., larger streams, low-gradient streams, and lakes) where increasing land-use intensity results in increased nutrient concentrations, stream eutrophication, and increased DO variability. DO concentrations were < 6 mg/L for fewer than 4% of measurements at the two sites identified "a priori" as least disturbed by nutrient and land-use indices, while concentrations at the three sites identified as moderately and most disturbed were < 6 mg/L for 20 to 33% of measurements. These findings demonstrate that the current criterion (10% of the DO measurements are < 6 mg/L) employed by ADEQ was effective at identifying various degrees of DO impairment in Boston Mountain streams. Our analysis also demonstrated that continuous pH and specific conductance data and estimates of stream metabolism were helpful for attributing DO variability to anthropogenic or natural origins. Considerations that were useful for examining these relationships and evaluating ADEQ's DO criterion should be applicable to DO studies in other locations where stream and geologic characteristics are similar to those of the Boston Mountains.


Asunto(s)
Monitoreo del Ambiente/métodos , Lagos/química , Oxígeno/análisis , Ríos/química , Calidad del Agua , Arkansas , Nutrientes
9.
Syst Parasitol ; 96(8): 695-702, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31482383

RESUMEN

Although nine nominal species of Eimeria Schneider, 1875 have been reported from owls (Strigiformes Wagler), molecular data are available for only one, Eimeria megabubonis Upton, Campbell, Weigel & McKown, 1990. This species has been reported from the great horned owl, Bubo virginianus (Gmelin) at the type-locality of Kansas, USA, and the additional localities of Oklahoma and Mississippi, USA. Eimeria bubonis Cawthorn & Stockdale, 1981, also from B. virginianus, is represented in the literature only by its original description from Saskatchewan, Canada. The present work reports a novel host locality of E. bubonis from B. virginianus in Arkansas, USA. Additionally, novel molecular data from the 18S ribosomal RNA gene and the cytochrome c oxidase subunit 1 mitochondrial gene is provided for E. bubonis. Phylogenetic analysis using the newly generated and previously published sequence data for Eimeria spp. is also presented.


Asunto(s)
Eimeria/clasificación , Eimeria/genética , Estrigiformes/parasitología , Animales , Arkansas , Complejo IV de Transporte de Electrones/genética , Oklahoma , Filogenia , ARN Ribosómico 18S/genética , Especificidad de la Especie
11.
J Therm Biol ; 82: 10-17, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31128637

RESUMEN

Ectothermic animals contend with variable environmental temperature through behavioral thermoregulation, including selection of activity-times and microhabitat spaces with suitable operative temperatures. Thus, an important component to understanding the influence of temperature on animals is through the assessment of thermal constraints on time and space usage. Thermal ecologists have recognized that postural adjustments are an important part of behavioral thermoregulation. However, the impact of postural adjustments on available space and time has received little attention. We hypothesized that postural adjustments would significantly affect the thermal availability of space and time for surface activity. To test our hypothesis, we used data collected over a four-year study of the thermal ecology of Eastern Collared Lizards (Crotaphytus collaris) in Arkansas. We used a novel approach to model three distinct postures used by C. collaris, and to assess the impact of posture on available space and time. For our study species and habitat, posture had a significant impact on several indices of available space and time including: a) a 13% increase in length of the reproductive activity season, b) a 35% increase in the frequency distribution of habitat within active body temperature range and c) a 42% increase in average thermal quality index. We conclude that posture can significantly impact space and time available for surface activity in species that employ it for thermoregulation. Thus, a clearer understanding of the thermal constraints on time-space usage in ectotherms requires consideration of the impact of posture on the spatiotemporal distribution of thermally suitable microhabitats.


Asunto(s)
Regulación de la Temperatura Corporal , Lagartos/fisiología , Animales , Arkansas , Conducta Animal , Temperatura Corporal , Ecosistema , Lagartos/anatomía & histología , Postura , Reproducción , Estaciones del Año
12.
Prev Chronic Dis ; 16: E61, 2019 05 16.
Artículo en Inglés | MEDLINE | ID: mdl-31095920

RESUMEN

INTRODUCTION: Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined. METHODS: We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m2) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers' perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 "ride-alongs" and an environmental scan. RESULTS: Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage. CONCLUSION: Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers' body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers' health.


Asunto(s)
Conducción de Automóvil/estadística & datos numéricos , Vehículos a Motor/estadística & datos numéricos , Obesidad/epidemiología , Sobrepeso/epidemiología , Población Rural/estadística & datos numéricos , Instituciones Académicas , Adulto , Arkansas/epidemiología , Índice de Masa Corporal , Peso Corporal , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores Socioeconómicos
13.
Public Health Nurs ; 36(4): 541-544, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30945355

RESUMEN

Newborn screening (NBS) is a public health program that detects genetic conditions in neonates enabling treatment before clinical symptoms manifest. Severe combined immune deficiency (SCID) is a primary immune deficiency found in the absence of functioning T and B lymphocytes. Hematopoietic cell transplantation is a potentially curative treatment if received within the first 42 months of life; without treatment, this condition is fatal in the first 2 years of life due to severe opportunistic infections. SCID was added to the recommended uniform panel of conditions for inclusion in state NBS programs in 2010. This manuscript examines the societal costs and benefits of NBS for SCID in Arkansas and implications to health services and social welfare. Total cost per year of all NBS for SCID and resulting early treatment for one patient with SCID in Arkansas is estimated at $1,078,714. Cost of late treatment of one patient with SCID is estimated at $1.43 million. Based on an expected diagnosis of one patient per year in Arkansas, this results in an estimated net cost savings for NBS for SCID in Arkansas of $351,286 per year. Based on cost-effectiveness analysis, NBS for SCID in Arkansas is cost-effective, with higher societal benefit than cost.


Asunto(s)
Análisis Costo-Beneficio , Pruebas Genéticas/métodos , Tamizaje Neonatal/economía , Tamizaje Neonatal/métodos , Inmunodeficiencia Combinada Grave/diagnóstico , Arkansas , Linfocitos B/inmunología , Linfocitos B/trasplante , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Recién Nacido , Inmunodeficiencia Combinada Grave/terapia , Linfocitos T/inmunología , Linfocitos T/trasplante
14.
Narrat Inq Bioeth ; 9(1): 53-62, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31031291

RESUMEN

Marshallese migrating to the United States face numerous challenges in accessing health care and managing illness and chronic disease. This study explores health care providers' perceptions of and experiences with ethical dilemmas as they care for Marshallese patients. Utilizing a qualitative research design, we interviewed 21 providers to explore the ethical dilemmas they encountered while treating Marshallese patients. We used the framework of bioethical principlism to categorize and describe the ethical dilemmas reported by those providers. When explicitly asked whether they experienced such situations, approximately half (10/21) affirmed that they had, and analysis of the qualitative data indicated that all interviewees described an ethical dilemma at least once during their interviews. We characterized providers' ethical dilemmas in terms of conflicts that arise when prioritizing different ethical principles in the care of this complex patient population, including the principles of respect for autonomy, nonmaleficence, beneficence, and justice.


Asunto(s)
Personal de Salud/ética , Migrantes , Adulto , Anciano , Arkansas/epidemiología , Actitud del Personal de Salud , Actitud Frente a la Salud , Beneficencia , Ética Médica , Femenino , Accesibilidad a los Servicios de Salud/ética , Disparidades en Atención de Salud/ética , Disparidades en Atención de Salud/etnología , Humanos , Masculino , Micronesia/etnología , Persona de Mediana Edad , Autonomía Personal , Justicia Social , Adulto Joven
15.
Poult Sci ; 98(9): 3400-3404, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-30895310

RESUMEN

Poultry well-being and economic burden due to heat stress (HS) are of great importance to the poultry industry. Efficient design and effective evaluation of any strategies to alleviate the adverse effects of HS on poultry production require an accurate measurement of stress. However, current methods for monitoring stress in poultry are less than ideal, as they are invasive or subjective, and therefore variable. Here, we demonstrated that HSP70, the well-established intracellular stress chaperone, is expressed in chicken feather and is responsive to HS, and could therefore be used as a stress marker. Growing feathers were collected from the same bird (Cobb500, n = 9) in the morning (barn temperature 24°C) and afternoon (barn temperature 29.5°C) in the summer (2016 June 21) in Arkansas, USA. In the afternoon, the birds were panting and their core body temperatures were significantly higher compared to the morning time, as illustrated by iButton data thermo-loggers. Concomitantly, blood HSP70 mRNA and feather HSP70 expression (mRNA and protein) were significantly increased in the afternoon compared to the morning time. Similarly, HSP70 protein expression in the duodenum was also significantly higher in the afternoon compared to the morning period. Together, these finding identify feather HSP70 as a novel non-invasive molecular signature that mirrors the intracellular and systemic stress, which can be useful to monitor well-being of chickens and other avian species under different challenges.


Asunto(s)
Crianza de Animales Domésticos/métodos , Pollos/fisiología , Plumas/química , Proteínas HSP70 de Choque Térmico/análisis , Calor/efectos adversos , Animales , Arkansas , Biomarcadores/análisis , Masculino , Fisiología/métodos , Estrés Fisiológico
16.
Diabetes Care ; 42(5): 849-858, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30862659

RESUMEN

OBJECTIVE: Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS: A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. RESULTS: Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005). CONCLUSIONS: Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.


Asunto(s)
Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/terapia , Educación del Paciente como Asunto/métodos , Automanejo/educación , Adolescente , Adulto , Anciano , Arkansas/epidemiología , Glucemia/análisis , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/psicología , Femenino , Hemoglobina A Glucada/análisis , Conductas Relacionadas con la Salud/fisiología , Humanos , Masculino , Micronesia/etnología , Persona de Mediana Edad , Educación del Paciente como Asunto/estadística & datos numéricos , Autocuidado/métodos , Autocuidado/estadística & datos numéricos , Automanejo/métodos , Automanejo/estadística & datos numéricos , Adulto Joven
17.
Environ Sci Pollut Res Int ; 26(15): 14920-14929, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30911970

RESUMEN

In 2008, the Mulberry River, a National Wild and Scenic River, was listed as impaired due to low pH (below pH 6.0). Over the last 50 years, the volume of conifers in the Ozark region has increased 115% since 1978 which may result in the acidification of nearby aquatic ecosystems. The objective of this study was to determine if differences exist in soil and litter chemical properties between deciduous and coniferous tree stands. Aboveground litter (n = 200) and soil (n = 400) at 0- to 5- and 5- to 15-cm depths were collected at paired deciduous and coniferous stands at 10 locations within the Mulberry River watershed and analyzed for a suite of chemical parameters. There were no differences (P > 0.05) in several measures of soil acidity between deciduous and coniferous stands. Litter collected from the coniferous stands was more acidic than deciduous litter (4.4 vs 4.7; P < 0.05). Cation exchange capacity, exchangeable Ca and Mg, and water-soluble P and Mg contents differed (P < 0.05) by stand and depth. Cation exchange capacity and exchangeable Ca and Mg were greatest in the 0- to 5-cm depth interval of the coniferous stands. Water-soluble P and Mg contents were greatest within the 0- to 5-cm depth interval which did not differ (P > 0.05) between stand but were greater than the 5- to 15-cm depth interval. Although limited to the top 15-cm of soil, the similarity in soil acidity between stands suggests that conifer growth may not be a substantial source of acidity to the Mulberry River.


Asunto(s)
Suelo/química , Tracheophyta , Arkansas , Calcio/análisis , Cationes/análisis , Ecosistema , Magnesio/análisis , Fósforo/análisis , Ríos , Tracheophyta/química , Árboles
18.
Otolaryngol Head Neck Surg ; 161(1): 91-97, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30912990

RESUMEN

OBJECTIVE: To evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway. STUDY DESIGN: Case series with chart review. SETTING: Single tertiary care academic institution. SUBJECTS AND METHODS: Data were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248). RESULTS: Total medical complication rates (P = .012) were mildly increased in the high-risk group, as a result of increased minor-not major-medical complication rates (P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group (P = .024). All other outcomes were not statistically different between the cohorts. CONCLUSION: The ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.


Asunto(s)
Colgajos Tisulares Libres , Cabeza/cirugía , Indicadores de Salud , Cuello/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Arkansas/epidemiología , Comorbilidad , Vías Clínicas/normas , Femenino , Supervivencia de Injerto , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
19.
Econ Hum Biol ; 33: 124-133, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30825861

RESUMEN

In this study, we estimate the effect of fast food environment surrounding schools on childhood body mass index (BMI). We use two methods that arrive at a similar conclusion, but with different implications. Using school distance from the nearest federal highway to instrument for restaurant location, we find the surrounding restaurants to only marginally affect a student's BMI measure. The effect size also decreases with increasing radial distances from school, 0.016 standard deviations at one-third of a mile and 0.0032 standard deviations at a mile radial distance. This indicates the decreasing influence of restaurants on a child's BMI as its distance from school increases. On a subset of students who were exogenously assigned to different school food environment, we find no effect of the fast food restaurants. An important contextual aspect is that nearly all schools in this sample observed closed campus policy, which does not allow students to leave campus during lunch hours.


Asunto(s)
Índice de Masa Corporal , Comida Rápida/estadística & datos numéricos , Restaurantes/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Adolescente , Arkansas , Niño , Femenino , Humanos , Masculino , Características de la Residencia , Factores Socioeconómicos
20.
BMJ Open ; 9(2): e023506, 2019 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-30782882

RESUMEN

OBJECTIVE: To determine the prevalence and associated factors for personal, work-related and patient/client-related burnout in clinical professionals and biomedical scientists in academic medicine. DESIGN: Prevalence survey using the Copenhagen Burnout Inventory. SETTING: Mid-size academic health centre. PARTICIPANTS: Clinical providers (n=6489) and biomedical scientists (n=248) were invited to complete the survey. 1646 completed responses (response rate 24.4%) were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence estimates and adjusted ORs (AOR) were stratified for gender, age and professional category. RESULTS: Type of burnout varies across professional categories, with significant differences between clinicians and scientists. The prevalence of personal burnout was 52.7% (95%CI 50% to 55%), work-related burnout 47.5% (95%CI 45% to 49%) and patient/client-related burnout 20.3% (95%CI 18% to 22%). The prevalence of personal and work-related burnout was higher among women, while those aged 20-30 had a higher prevalence of all three burnout categories. Overall, clinical professionals had higher personal and work-related burnout, while biomedical scientists had higher client-related burnout. Accounting for the effects of gender and age, a significantly higher risk for personal burnout was found for physicians (AOR 1.64; 95%CI 1.3 to 2.1) and nurses (AOR 1.5; 95%CI 1.03 to 2.2). Significantly higher odds of work-related burnout were found for nurses (AOR 1.5; 95%CI 1.2 to 1.9) and residents (AOR 1.9; 95%CI 1.04 to 3.6). Basic scientists (AOR 10.0; 95%CI 5.7 to 17.6), physicians (AOR 2.8; 95%CI 1.9 to 4.1) and nurses (AOR 2.1; 95%CI 1.3 to 3.5) had higher odds of patient/client-related burnout. CONCLUSIONS: Types of burnout are unevenly distributed in academic medical centres. Physicians have higher risk of personal and patient/client-related burnout, residents have higher risk of work-related burnout, basic scientists are at higher risk of client-related burnout and nurses have higher odds of all three types of burnout. Interventions addressing the problem of burnout in clinical environments may be inadequate to support biomedical scientists.


Asunto(s)
Agotamiento Profesional/epidemiología , Enfermeras y Enfermeros/psicología , Médicos/psicología , Investigadores/psicología , Centros Médicos Académicos , Adulto , Arkansas/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
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