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1.
Sci Total Environ ; 711: 134580, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32000313

RESUMEN

Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during tuberculosis treatment, we evaluated patients diagnosed with active tuberculosis in California from 2000 through 2012, obtaining patient data from the California tuberculosis registry. Our primary outcome was all-cause mortality during tuberculosis treatment. We determined percent tree cover using 1 mresolution color infrared orthoimagery categorized into land cover classes, then linked tree cover to four circular buffer zones of 50-300 m radii around patient residential addresses. We used the Kaplan-Meier method to estimate survival probabilities and Cox regression models to determine mortality hazard ratios, adjusting for demographic, socioeconomic, and clinical covariates. Our cohort included 33,962 tuberculosis patients of median age 47, 59% male, 51% unemployed, and 4.9% HIV positive. Tuberculosis was microbiologically confirmed in 79%, and 1.17% were multi-drug resistant (MDR). Median tree cover was 7.9% (50 m buffer). Patients were followed for 23,280 person-years with 2370 deaths during tuberculosis treatment resulting in a crude mortality rate of 1018 deaths per 10,000 person-years. Increasing tree cover quintiles were associated with decreasing mortality risk during tuberculosis treatment in all buffers, and the magnitude of association decreased incrementally with increasing buffer radius: In the 50 m buffer, patients living in neighborhoods with the highest quintile tree cover experienced a 22% reduction in mortality (HR 0.78, 95%CI 0.68-0.90) compared to those living in lowest quintile tree cover; whereas for 100, 200, and 300 m buffers, a 21%, 13%, and 11% mortality risk reduction was evident. In conclusion, urban tree canopy was associated with decreased mortality during tuberculosis treatment even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that trees might play a role in improving tuberculosis outcomes.


Asunto(s)
Tuberculosis , Adulto , Anciano , Contaminantes Atmosféricos , Contaminación del Aire , California/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia , Árboles , Tuberculosis/mortalidad , Servicios Urbanos de Salud
2.
Ann Otol Rhinol Laryngol ; 129(3): 265-272, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31658833

RESUMEN

OBJECTIVES: To examine the association between treatment status and mortality risk among patients with papillary thyroid cancer (PTC). METHODS: We identified 3,679 adults with PTC. Thirty-one untreated patients were matched to 155 treated patients. Hazards ratios (HR) and 95% confidence intervals (CIs) were calculated to estimate all-cause and disease-specific mortality. A low-risk subgroup was analyzed for differences in all-cause mortality. RESULTS: The adjusted HRs (95% CIs) for all-cause mortality at 5 and 10 years were 4.2 (1.7-10.3) and 4.1 (1.9-9.4) and for disease- specific mortality were 14.1 (3.4-59.3) and 10.2 (2.9-36.4), respectively, for untreated versus treated patients. The adjusted HRs (95% CIs) for all- cause mortality was 0.7 (0.1-6.4) for low-risk untreated versus matched treated patients. CONCLUSIONS: Compared to treated patients, untreated PTC patients were at higher risk of death while low-risk untreated PTC patients had comparable rate of metastasis and no increased risk of all-cause mortality. Level of evidence: 3.


Asunto(s)
Cáncer Papilar Tiroideo/mortalidad , Cáncer Papilar Tiroideo/terapia , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/terapia , Espera Vigilante , Anciano , California/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Metástasis de la Neoplasia , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos
3.
J Stroke Cerebrovasc Dis ; 29(2): 104474, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31784381

RESUMEN

OBJECTIVE: To study the rate of symptomatic intracerebral hemorrhage (SxICH) and major systemic hemorrhage (MSH) after acute stroke treatments among different ethnicities/races. BACKGROUND: Studies have reported ethnic/racial disparities in intravenous tPA treatment (IV tPA). The adverse outcome of tPA and/or intra-arterial intervention (IA) among different ethnicities/races requires investigation. METHODS: We retrospectively reviewed all patients from an IRB-approved registry between June 2004 and June 2018. Patients who received IV tPA, IA, or both for acute stroke were identified and classified into 2 ethnic groups: non-Hispanics or Hispanics (NH/H) and 4 racial groups: Asian, Black, Other (Native Americans and Pacific Islanders), and White (A/B/O/W). RESULTS: We identified 916 patients that received acute therapy (A/B/O/W: n = 50/104/16/746, H/NH: n = 184/730). For those received IV tPA only (n = 759), IA only (n = 85), and IV tPA+IA (n = 72), the SxICH rate was 4.3%, 4.7%, and 6.9%; the MSH rate was 1.3%, 0%, and 0%, respectively. No significant difference in the rate of SxICH or MSH among different racial or ethnic groups was found after either therapy. Asian race (OR 14.17, P = .01), in association with age, international normalized value (INR), and Partial thromboplastin time (PTT) (OR 1.06, 46.52, and 1.18, P = .020, 0.037, and 0.042, respectively), was predictive of SxICH after IV tPA. There was a significant correlation between age and National Institute of Health Stroke Scale with SxICH (P < .01, P = .02, respectively). Age, INR, and PTT were independent predictors of SxICH after IV tPA (OR 1.06, 46.52, and 1.18, P = .02, 0.04, and 0.04, respectively). CONCLUSIONS: There was no significant difference in the rate of SxICH or MSH after IV tPA, IA, or IV tPA+IA among different racial or ethnic groups. Larger studies are needed to elucidate the race specific causes of SxICH and MSH after acute stroke treatment.


Asunto(s)
Grupos de Población Continentales , Procedimientos Endovasculares , Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/terapia , Trombectomía , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Afroamericanos , Factores de Edad , Americanos Asiáticos , California/epidemiología , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/etnología , Terapia Combinada , Procedimientos Endovasculares/efectos adversos , Grupo de Ascendencia Continental Europea , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Relación Normalizada Internacional , Tiempo de Tromboplastina Parcial , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/diagnóstico , Trombectomía/efectos adversos , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento
4.
Int J Cancer ; 146(3): 617-626, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30861114

RESUMEN

US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5-year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55-64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003-2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow-up. Five-year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%-0.046%), 0.041% (95% CI: 0.007%-0.076%) and 0.016% (95% CI: 0.000%-0.052%), respectively (ptrend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5-year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer-term follow-up given that exiting is a long-term decision.


Asunto(s)
Adenocarcinoma in Situ/epidemiología , Neoplasia Intraepitelial Cervical/epidemiología , Infecciones por Papillomavirus/epidemiología , Lesiones Precancerosas/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Adenocarcinoma in Situ/diagnóstico , Adenocarcinoma in Situ/patología , California/epidemiología , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/patología , Cuello del Útero/patología , Detección Precóz del Cáncer/normas , Femenino , Humanos , Tamizaje Masivo/normas , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/patología , Estudios Prospectivos , Medición de Riesgo/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología
5.
Int J Cancer ; 146(3): 699-711, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30924138

RESUMEN

Previous studies using different exposure methods to assess air pollution and breast cancer risk among primarily whites have been inconclusive. Air pollutant exposures of particulate matter and oxides of nitrogen were estimated by kriging (NOx , NO2 , PM10 , PM2.5 ), land use regression (LUR, NOx , NO2 ) and California Line Source Dispersion model (CALINE4, NOx , PM2.5 ) for 57,589 females from the Multiethnic Cohort, residing largely in Los Angeles County from recruitment (1993-1996) through 2010. Cox proportional hazards models were used to examine the associations between time-varying air pollution and breast cancer incidence adjusting for confounding factors. Stratified analyses were conducted by race/ethnicity and distance to major roads. Among all women, breast cancer risk was positively but not significantly associated with NOx (per 50 parts per billion [ppb]) and NO2 (per 20 ppb) determined by kriging and LUR and with PM2.5 and PM10 (per 10 µg/m3 ) determined by kriging. However, among women who lived within 500 m of major roads, significantly increased risks were observed with NOx (hazard ratio [HR] = 1.35, 95% confidence interval [95% CI]: 1.02-1.79), NO2 (HR = 1.44, 95% CI: 1.04-1.99), PM10 (HR = 1.29, 95% CI: 1.07-1.55) and PM2.5 (HR = 1.85, 95% CI: 1.15-2.99) determined by kriging and NOx (HR = 1.21, 95% CI:1.01-1.45) and NO2 (HR = 1.26, 95% CI: 1.00-1.59) determined by LUR. No overall associations were observed with exposures assessed by CALINE4. Subgroup analyses suggested stronger associations of NOx and NO2 among African Americans and Japanese Americans. Further studies of multiethnic populations to confirm the effects of air pollution, particularly near-roadway exposures, on the risk of breast cancer is warranted.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Neoplasias de la Mama/epidemiología , Material Particulado/efectos adversos , Afroamericanos/estadística & datos numéricos , Anciano , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Americanos Asiáticos/estadística & datos numéricos , Neoplasias de la Mama/etiología , California/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Material Particulado/análisis , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
6.
BJOG ; 127(1): 70-78, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31571337

RESUMEN

OBJECTIVE: To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort. DESIGN: Retrospective cohort study. SETTING: California, USA. POPULATION: All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). METHODS: Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. MAIN OUTCOME MEASURES: Preterm birth (PTB) was assessed overall (20-36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31 weeks of gestation) and late (32-36 weeks of gestation). RESULTS: Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01-3.56), RA (RR 2.04, 95% CI 1.79-2.33), SSc (RR 3.74, 95% CI 2.51-5.58), JIA (RR 2.23, 95% CI 1.54-3.23), and DM/PM (RR 5.26, 95% CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well. CONCLUSIONS: Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. TWEETABLE ABSTRACT: This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.


Asunto(s)
Enfermedades Autoinmunes/epidemiología , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Enfermedades Reumáticas/epidemiología , Adulto , California/epidemiología , Femenino , Edad Gestacional , Humanos , Paridad , Fenotipo , Preeclampsia/epidemiología , Embarazo , Estudios Retrospectivos , Factores de Riesgo
7.
Int J Cancer ; 146(3): 664-670, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30895617

RESUMEN

Breast cancer is the most common cancer and the second-leading cause of cancer-related death among women. Inconsistent findings for the relationship between melatonin levels, sleep duration and breast cancer have been reported. We investigated the association of sleep duration at cohort entry and its interaction with body mass index (BMI) with risk of developing breast cancer in the large population-based Multiethnic Cohort study. Among the 74,481 at-risk participants, 5,790 breast cancer cases were identified during the study period. Although we detected no significant association between sleep duration and breast cancer incidence, higher risk estimates for short (HR = 1.03; 95% CI: 0.97-1.09) and long sleep (HR = 1.05; 95% CI: 0.95-1.15) compared to normal sleep (7-8 hr) were found. The patterns for models stratified by age, BMI, ethnicity and hormone receptor status were similar but did not indicate significant interaction effects. When examining the combined sleep duration and BMI interaction effect, in comparison to the normal BMI-normal sleep group, risk estimates for underweight, overweight and obesity were similar across categories of sleep duration (≤6, 7-8, and ≥9 hr). The underweight-normal sleep group had lower breast cancer incidence (HR = 0.66, 95% CI: 0.50-0.86), whereas the overweight-short sleep, overweight-normal sleep group and all obese women experienced elevated breast cancer incidence. The respective HRs for short, normal and long sleep among obese women were 1.35 (95% CI: 1.20-1.53), 1.27 (95% CI: 1.15-1.42) and 1.46 (95% CI: 1.21-1.76). Future perspectives need to examine the possibility that sleep quality, variations in circadian rhythm and melatonin are involved in breast cancer etiology.


Asunto(s)
Neoplasias de la Mama/epidemiología , Sobrepeso/epidemiología , Sueño/fisiología , Delgadez/epidemiología , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/etiología , California/epidemiología , Ritmo Circadiano/fisiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Sobrepeso/complicaciones , Medición de Riesgo , Factores de Riesgo , Delgadez/complicaciones , Factores de Tiempo
8.
Nephrol Nurs J ; 46(6): 629-640, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31872993

RESUMEN

Reducing the growing burden of acute kidney injury (AKI) is a real challenge. This article explores admissions and emergency visits of patients with AKI in California between 2005 and 2015. Data were drawn from California's Office of Statewide Health Planning and Development (OSHPD) hospital dataset. Trend analyses, including comorbidities and spatiotemporal analysis, were conducted. AKI hospital episodes almost doubled between 2005 and 2015 (25,495 vs. 48,845, respectively); the growing trend was largely attributable to an increasing number of patients with co-existing CKD and diabetes or hypertension (2,511 vs. 25,098 in 2005 and 2015, respectively). We also found an increasingly positive spatiotemporal correlation between diabetes prevalence and AKI hospitalization rate over time. Based on results of this study, we identified modifiable targets to reduce the growing number of AKI episodes and the potential escalating health care costs.


Asunto(s)
Lesión Renal Aguda , Complicaciones de la Diabetes , Diabetes Mellitus , Hospitalización , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/epidemiología , California/epidemiología , Complicaciones de la Diabetes/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Estudios Retrospectivos , Factores de Riesgo
9.
Gynecol Oncol ; 155(3): 461-467, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31706666

RESUMEN

OBJECTIVE: Although a high proportion of women with advanced stage ovarian cancer die within five years, approximately 30% will survive longer than this. The factors contributing to exceptional survival are currently poorly understood. The viewpoints of ovarian cancer survivors were qualitatively explored to determine the factors they felt have influenced their exceptional ovarian cancer survival. METHODS: Four focus groups, one each in Los Angeles (California), Ann Arbor (Michigan), New York (New York) and Edmonton (Alberta, Canada), were conducted with women who had survived at least five years. Physical activity, diet, meditation, prayer, treatment, complementary medicine, and side effects were explored in semi-structured discussions. The audiotaped sessions were transcribed and coded and then analyzed using Dedoose Version 8.0.35, a qualitative analysis software. RESULTS: Of the 26 women who participated, 23 had advanced stage disease. Three overarching themes emerged: (a) survivors had improved their 'lifestyles', including but not limited to fitness and diet; (b) survivors were able to draw on strong support systems, which included family, friends, support groups, faith communities, and healthcare workers; and (c) survivors had a strong life purpose, which manifested as positivity, taking charge of their lives, and advocating for themselves. CONCLUSIONS: Long-term survivors have varying experiences with their cancer, but identified lifestyle modification, motivation and persistence, strong life purpose, and strong support systems as key elements in their better survival. These preliminary findings indicate the need for further prospective studies to determine whether meaningful differences exist between short term and long term survivors on these characteristics.


Asunto(s)
Supervivientes de Cáncer/psicología , Neoplasias Ováricas/psicología , Alberta/epidemiología , California/epidemiología , Femenino , Grupos Focales , Estilo de Vida Saludable , Humanos , Michigan/epidemiología , Persona de Mediana Edad , Estadificación de Neoplasias , New York/epidemiología , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Apoyo Social
10.
J Surg Oncol ; 120(8): 1318-1326, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31701535

RESUMEN

BACKGROUND: While better outcomes at high-volume surgical centers have driven regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate travel patterns of patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer to assess willingness of patients to travel for surgical care. METHODS: The California Office of Statewide Health Planning database was used to identify patients who underwent PD between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed PD to get to a higher-volume center was assessed. Multivariate analyses were used to identify factors associated with bypassing a local hospital for a higher-volume center. RESULTS: Among 23 014 patients who underwent PD, individuals traveled a median distance of 18.0 miles to get to a hospital that performed PD. The overwhelming majority (84%) of patients bypassed the nearest providing hospital and traveled a median additional 16.6 miles to their destination hospital. Among patients who bypassed the nearest hospital, 13,269 (68.6%) did so for a high-volume destination hospital. Specifically, average annual PD volume at the nearest "bypassed" vs final destination hospital was 29.6 vs 56 cases, respectively. Outcomes at bypassed vs destination hospitals varied (incidence of complications: 39.2% vs 32.4%; failure-to-rescue: 14.5% vs 9.1%). PD at a high-volume center was associated with lower mortality (OR = 0.46 95% CI, 0.22-0.95). High-volume PD ( > 20 cases) was predictive of hospital bypass (OR = 3.8 95% CI, 3.3-4.4). Among patients who had surgery at a low-volume center, nearly 20% bypassed a high-volume hospital in route. Furthermore, among patients who did not bypass a high-volume hospital, one-third would have needed to travel only an additional 30 miles or less to reach the nearest high-volume hospital. CONCLUSION: Most patients undergoing PD bypassed the nearest providing hospital to seek care at a higher-volume hospital. While these data reflect increased regionalization of complex surgical care, nearly 1 in 5 patients still underwent PD at a low-volume center.


Asunto(s)
Conducta de Elección , Hospitales de Alto Volumen , Pancreaticoduodenectomía/estadística & datos numéricos , Viaje , Centros Médicos Académicos , Anciano , California/epidemiología , Femenino , Accesibilidad a los Servicios de Salud , Capacidad de Camas en Hospitales , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Análisis Multivariante , Personal de Enfermería en Hospital/estadística & datos numéricos , Quirófanos/estadística & datos numéricos
11.
BMC Public Health ; 19(1): 1551, 2019 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-31760942

RESUMEN

BACKGROUND: Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group. METHODS: This study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos. RESULTS: We found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m2 threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks. CONCLUSIONS: In a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.


Asunto(s)
Americanos Asiáticos/estadística & datos numéricos , Enfermedad Crónica/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , California/epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
12.
PLoS Med ; 16(11): e1002973, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31770373

RESUMEN

BACKGROUND: Injection drug use (IDU) is associated with multiple health harms. The vast majority of IDU initiation events (in which injection-naïve persons first adopt IDU) are assisted by a person who injects drugs (PWID), and as such, IDU could be considered as a dynamic behavioral transmission process. Data suggest that opioid agonist treatment (OAT) enrollment is associated with a reduced likelihood of assisting with IDU initiation. We assessed the association between recent OAT enrollment and assisting IDU initiation across several North American settings and used dynamic modeling to project the potential population-level impact of OAT scale-up within the PWID population on IDU initiation. METHODS AND FINDINGS: We employed data from a prospective multicohort study of PWID in 3 settings (Vancouver, Canada [n = 1,737]; San Diego, United States [n = 346]; and Tijuana, Mexico [n = 532]) from 2014 to 2017. Site-specific modified Poisson regression models were constructed to assess the association between recent (past 6 month) OAT enrollment and history of ever having assisted an IDU initiation with recently assisting IDU initiation. Findings were then pooled using linear mixed-effects techniques. A dynamic transmission model of IDU among the general population was developed, stratified by known factors associated with assisting IDU initiation and relevant drug use behaviors. The model was parameterized to a generic North American setting (approximately 1% PWID) and used to estimate the impact of increasing OAT coverage among PWID from baseline (approximately 21%) to 40%, 50%, and 60% on annual IDU initiation incidence and corresponding PWID population size across a decade. From Vancouver, San Diego, and Tijuana, respectively, 4.5%, 5.2%, and 4.3% of participants reported recently assisting an IDU initiation, and 49.4%, 19.7%, and 2.1% reported recent enrollment in OAT. Recent OAT enrollment was significantly associated with a 45% lower likelihood of providing recent IDU initiation assistance among PWID (relative risk [RR] 0.55 [95% CI 0.36-0.84], p = 0.006) compared to those not recently on OAT. Our dynamic model predicts a baseline mean of 1,067 (2.5%-97.5% interval [95% I 490-2,082]) annual IDU initiations per 1,000,000 individuals, of which 886 (95% I 406-1,750) are assisted by PWID. Based on our observed statistical associations, our dynamic model predicts that increasing OAT coverage from approximately 21% to 40%, 50%, or 60% among PWID could reduce annual IDU initiations by 11.5% (95% I 2.4-21.7), 17.3% (95% I 5.6-29.4), and 22.8% (95% I 8.1-36.8) and reduce the PWID population size by 5.4% (95% I 0.1-12.0), 8.2% (95% I 2.2-16.9), and 10.9% (95% I 3.2-21.8) relative to baseline, respectively, in a decade. Less impact occurs when the protective effect of OAT is diminished, when a greater proportion of IDU initiations are unassisted by PWID, and when average IDU career length is longer. The study's main limitations are uncertainty in the causal pathway between OAT enrollment and assisting with IDU initiation and the use of a simplified model of IDU initiation. CONCLUSIONS: In addition to its known benefits on preventing HIV, hepatitis C virus (HCV), and overdose among PWID, our modeling suggests that OAT scale-up may also reduce the number of IDU initiations and PWID population size.


Asunto(s)
Comportamiento de Búsqueda de Drogas/efectos de los fármacos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Analgésicos Opioides/uso terapéutico , California/epidemiología , Canadá/epidemiología , Estudios de Cohortes , Femenino , Predicción/métodos , Humanos , Incidencia , Masculino , México/epidemiología , Persona de Mediana Edad , Modelos Teóricos , Estudios Prospectivos , Análisis de Regresión
13.
Am Surg ; 85(10): 1094-1098, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657301

RESUMEN

On January 9, 2018, a catastrophic debris flow devastated Montecito, California. A 30-foot wall of boulders, mud, and debris ran down the hillsides at 15 miles per hour injuring dozens and causing 21 prehospital deaths. A retrospective review was conducted of the victims from the debris flow presenting to Cottage Health. Injury patterns, procedures performed, complications, length of stay, and outcomes were analyzed. Twenty-four patients were evaluated; 15 were admitted. Of the patients admitted, the most common presenting symptoms were soft tissue injuries (100%), hypothermia (67%), craniofacial injuries (67%), corneal abrasions (53%), and orthopedic injuries (47%), as well as loss of an immediate family member during the incident (73%). Procedures included skin irrigation (93%), operative soft tissue debridement (47%), body orifice irrigation due to mud impaction (40%), and orthopedic repair of fractures and ligaments (40%). All survived to discharge. "Debris flow syndrome" can be defined as a pattern of injuries, including soft tissue injuries, hypothermia, craniofacial trauma, corneal abrasions, orthopedic injuries, and mud impaction. Managing the debris flow syndrome requires co-ordinated and specialized care.


Asunto(s)
Huesos/lesiones , Lesiones de la Cornea/epidemiología , Desastres/estadística & datos numéricos , Traumatismos Faciales/epidemiología , Inundaciones/estadística & datos numéricos , Hipotermia/epidemiología , Deslizamientos de Tierra/estadística & datos numéricos , Traumatismos de los Tejidos Blandos/epidemiología , Adolescente , Adulto , Anciano , California/epidemiología , Niño , Preescolar , Lesiones de la Cornea/etiología , Lesiones de la Cornea/cirugía , Traumatismos Faciales/etiología , Traumatismos Faciales/cirugía , Femenino , Humanos , Hipotermia/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/cirugía , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Síndrome , Adulto Joven
14.
Am Surg ; 85(10): 1099-1103, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657302

RESUMEN

Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/etiología , Catéteres Urinarios/efectos adversos , Retención Urinaria/etiología , Distribución por Edad , Factores de Edad , Anciano , Anestesia General/efectos adversos , Anestesia General/estadística & datos numéricos , California/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Herniorrafia/métodos , Herniorrafia/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Catéteres Urinarios/estadística & datos numéricos , Retención Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología
15.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657311

RESUMEN

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Factores de Tiempo , Centros Traumatológicos/estadística & datos numéricos , Heridas no Penetrantes/etiología , Heridas Penetrantes/etiología , Escala Resumida de Traumatismos , Adulto , California/epidemiología , Tratamiento de Urgencia/estadística & datos numéricos , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Triaje , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/mortalidad , Heridas no Penetrantes/cirugía , Heridas Penetrantes/epidemiología , Heridas Penetrantes/mortalidad , Heridas Penetrantes/cirugía , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-31614424

RESUMEN

Residents of the Imperial Valley, a rural, agricultural border region in California, have raised concerns over high rates of pediatric asthma symptoms. There is an urgent need to understand the influences and predictors of children's respiratory health in Imperial Valley. We assessed the impacts of sociodemographic, lifestyle, and household factors on children's respiratory health and asthma prevalence by administering a survey to parents of elementary school children (n = 357) in northern Imperial Valley. We observed an overall asthma prevalence of 22.4% and respiratory symptoms and allergies were widely reported, including wheezing (35.3%), allergies (36.1%), bronchitic symptoms (28.6%), and dry cough (33.3%). Asthmatics were significantly more likely to report respiratory symptoms, but high rates of wheezing, allergies, and dry cough were observed among nonasthmatics, suggesting the possibility for underdiagnosis of respiratory impairment in our school-age population. Having an asthmatic mother and exposure to environmental tobacco smoke were also associated with greater odds of asthma. Our findings provide evidence to support community concerns about children's respiratory health, while also suggesting that household and demographic characteristics have limited explanatory power for assessing asthma in this population. This work provides critical baseline data with which to evaluate local environmental factors and their influence on asthma and respiratory symptoms.


Asunto(s)
Asma/epidemiología , Clima Desértico , Medición de Riesgo/métodos , California/epidemiología , Niño , Salud del Niño , Preescolar , Femenino , Humanos , Lagos , Masculino , Prevalencia , Factores Socioeconómicos , Encuestas y Cuestionarios
17.
PLoS Med ; 16(10): e1002891, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31584944

RESUMEN

BACKGROUND: Excellent adherence to tuberculosis (TB) treatment is critical to cure TB and avoid the emergence of resistance. Wirelessly observed therapy (WOT) is a novel patient self-management system consisting of an edible ingestion sensor (IS), external wearable patch, and paired mobile device that can detect and digitally record medication ingestions. Our study determined the accuracy of ingestion detection in clinical and home settings using WOT and subsequently compared, in a randomized control trial (RCT), confirmed daily adherence to medication in persons using WOT or directly observed therapy (DOT) during TB treatment. METHODS AND FINDINGS: We evaluated WOT in persons with active Mycobacterium tuberculosis complex disease using IS-enabled combination isoniazid 150 mg/rifampin 300 mg (IS-Rifamate). Seventy-seven participants with drug-susceptible TB in the continuation phase of treatment, prescribed daily isoniazid 300 mg and rifampin 600 mg, used IS-Rifamate. The primary endpoints of the trial were determination of the positive detection accuracy (PDA) of WOT, defined as the percentage of ingestions detected by WOT administered under direct observation, and subsequently the proportion of prescribed doses confirmed by WOT compared to DOT. Initially participants received DOT and WOT simultaneously for 2-3 weeks to allow calculation of WOT PDA, and the 95% confidence interval (CI) was estimated using the bootstrap method with 10,000 samples. Sixty-one participants subsequently participated in an RCT to compare the proportion of prescribed doses confirmed by WOT and DOT. Participants were randomized 2:1 to receive WOT or maximal in-person DOT. In the WOT arm, if ingestions were not remotely confirmed, the participant was contacted within 24 hours by text or cell phone to provide support. The number of doses confirmed was collected, and nonparametric methods were used for group and individual comparisons to estimate the proportions of confirmed doses in each randomized arm with 95% CIs. Sensitivity analyses, not prespecified in the trial registration, were also performed, removing all nonworking (weekend and public holiday) and held-dose days. Participants, recruited from San Diego (SD) and Orange County (OC) Divisions of TB Control and Refugee Health, were 43.1 (range 18-80) years old, 57% male, 42% Asian, and 39% white with 49% Hispanic ethnicity. The PDA of WOT was 99.3% (CI 98.1; 100). Intent-to-treat (ITT) analysis within the RCT showed WOT confirmed 93% versus 63% DOT (p < 0.001) of daily doses prescribed. Secondary analysis removing all nonworking days (weekends and public holidays) and held doses from each arm showed WOT confirmed 95.6% versus 92.7% (p = 0.31); WOT was non-inferior to DOT (difference 2.8% CI [-1.8%, 9.1%]). One hundred percent of participants preferred using WOT. WOT associated adverse events were <10%, consisting of minor skin rash and pruritus associated with the patch. WOT provided longitudinal digital reporting in near real time, supporting patient self-management and allowing rapid remote identification of those who needed more support to maintain adherence. This study was conducted during the continuation phase of TB treatment, limiting its generalizability to the entire TB treatment course. CONCLUSIONS: In terms of accuracy, WOT was equivalent to DOT. WOT was superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment and was overwhelmingly preferred by participants. WOT should be tested in high-burden TB settings, where it may substantially support low- and middle-income country (LMIC) TB programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT01960257.


Asunto(s)
Antituberculosos/administración & dosificación , Terapia por Observación Directa/métodos , Cumplimiento de la Medicación , Tuberculosis/tratamiento farmacológico , Tecnología Inalámbrica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Esquema de Medicación , Monitoreo de Drogas , Femenino , Humanos , Isoniazida/administración & dosificación , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Estudios Prospectivos , Rifampin/administración & dosificación , Autoadministración , Resultado del Tratamiento , Adulto Joven
18.
BMC Musculoskelet Disord ; 20(1): 419, 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31506075

RESUMEN

BACKGROUND: Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. METHODS: The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005-2011), Florida (2005-2014), and New York (2008-2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. RESULTS: At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p < 0.0001). All-cause in-hospital mortality was 9.8% for patients managed non-operatively, 8.8% for ORIF, and 10.0% for arthroplasty (p = 0.003). CONCLUSIONS: A majority of patients with proximal humeral fractures underwent non-operative treatment. There was a relatively high all-cause in-hospital mortality irrespective of treatment. Given the recent debate on operative versus non-operative treatment for proximal humeral fractures, our study provides valuable information on the need for revision surgery after initial treatment. The differences in rates of revision surgery between patients treated non-operatively, with ORIF, and with arthroplasty were small in magnitude. At nine years of follow-up, ORIF had the lowest probability of needing follow-up surgery, and arthroplasty had the highest.


Asunto(s)
Artroplastia/efectos adversos , Fijación de Fractura/efectos adversos , Complicaciones Posoperatorias/epidemiología , Fracturas del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia/métodos , Artroplastia/estadística & datos numéricos , California/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Florida/epidemiología , Estudios de Seguimiento , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Húmero/lesiones , Húmero/cirugía , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Persona de Mediana Edad , New York/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Fracturas del Hombro/mortalidad , Resultado del Tratamiento
19.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31537634

RESUMEN

BACKGROUND: Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI. METHODS: We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization. RESULTS: Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20). CONCLUSIONS: Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI.


Asunto(s)
Atención Dental para Niños , Discapacidad Intelectual/complicaciones , Neumonía/prevención & control , Prevención Secundaria/métodos , Adolescente , Antibacterianos/efectos adversos , California/epidemiología , Niño , Preescolar , Femenino , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Oportunidad Relativa , Neumonía/epidemiología , Neumonía/etiología , Puntaje de Propensión , Recurrencia , Terapia Respiratoria/efectos adversos , Estudios Retrospectivos , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-31491843

RESUMEN

Valley Fever, or Coccidioidomycosis, a fungal respiratory disease, is prevalent with increasing incidence in the Southwestern United States, especially in the central region of California. Public health agencies in the region do not have a consistent strategy for communication and health promotion targeting vulnerable communities about this climate-sensitive disease. We used the behavior adaptation communication model to design and conduct semi-structured interviews with representatives of public health agencies in five California counties: Fresno, Kern, Kings, San Luis Obispo, and Tulare County. While none of the agencies currently include climate change information into their Valley Fever risk messaging, the agencies discuss future communication methods similar to other health risk factors such as poor air quality days and influenza virus season. For political reasons, some public health agencies deliberately avoided the use of climate change language in communicating health risk factors to farmers who are particularly vulnerable to soil and dust-borne fungal spores. The effectiveness of health communication activities of the public health agencies has not been measured in reducing the prevalence of Valley Fever in impacted communities. Given the transboundary nature of climate influence on Valley Fever risk, a concerted and consistent health communication strategy is expected to be more effective than current practices.


Asunto(s)
Clima , Coccidioidomicosis/epidemiología , California/epidemiología , Coccidioidomicosis/prevención & control , Humanos , Salud Pública , Factores de Riesgo
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