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2.
N Engl J Med ; 382(11): 1009-1017, 2020 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-32160662

RESUMEN

BACKGROUND: Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS: We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS: A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS: Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.


Asunto(s)
Vacuna contra el Sarampión-Parotiditis-Rubéola , Sarampión , Vacunación , Adolescente , Adulto , Anciano , Niño , Preescolar , Brotes de Enfermedades , Femenino , Recursos en Salud/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Anamnesis , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Índice de Severidad de la Enfermedad , Vacunación/estadística & datos numéricos , Adulto Joven
4.
Mar Pollut Bull ; 151: 110721, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32056581

RESUMEN

Sediment cores from Staten Island's salt marsh contain multiple historical oil spill events that impact ecological health. Microtox solid phase bioassay indicated moderate to high toxicity. Multiple spikes of TPH (6524 to 9586 mg/kg) and Σ16 PAH (15.5 to 18.9 mg/kg) were co-incident with known oil spills. A high TPH background of 400-700 mg/kg was attributed to diffuse sources. Depth-profiled metals Cu (1243 mg/kg), Zn (1814 mg/kg), Pb (1140 mg/kg), Ni (109 mg/kg), Hg (7 mg/kg), Cd 15 (mg/kg) exceeded sediment quality guidelines confirming adverse biological effects. Changes in Pb206/207 suggested three metal contaminant sources and diatom assemblages responded to two contamination events. Organic and metal contamination in Saw Mill Creek Marsh may harm sensitive biota, we recommend caution in the management of the 20-50 cm sediment interval because disturbance could lead to remobilisation of pre-existing legacy contamination into the waterway.


Asunto(s)
Monitoreo del Ambiente , Contaminantes Químicos del Agua/análisis , Humedales , Sedimentos Geológicos , Islas , Metales Pesados , Ciudad de Nueva York , Contaminación por Petróleo , Contaminantes Químicos del Agua/toxicidad
6.
J Environ Manage ; 256: 109977, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31989967

RESUMEN

Food waste measurement and policy often seek to differentiate between edible food and associated inedible parts, acknowledging different underlying causes for discard and different preferred solutions for waste management. Given the varying views of edibility within and across cultures, there is no widely agreed upon or universal categorization. To understand how edibility influences the outcome of food waste quantification, we applied four different categorizations to 489 household kitchen diaries from Denver, CO and New York City, NY. We also compared them to how respondents self-characterized edibility. We found that the percentage of total food discarded considered edible ranged from 52% to 71% and that the top ten lists of most discarded edible foods changed based on the categorization used. We found that edibility does matter when studying household food waste in terms of defining the extent of the problem, identifying hot spots for intervention, and tracking progress over time. Additionally, we found that respondents' perceptions of edibility varied and were not aligned with any of the four categorizations. Our findings suggest that how edibility is defined should be rigorously and transparently considered and that the varied perceptions of edibility may influence what and how interventions to reduce wasted food are designed, targeted, and evaluated.


Asunto(s)
Brassica , Eliminación de Residuos , Administración de Residuos , Alimentos , Ciudad de Nueva York
7.
J Environ Manage ; 258: 110023, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31929063

RESUMEN

River water quality and habitats are degraded by thermal pollution from urban areas caused by warm surface runoff, lack of riparian forests, and impervious channels that transfer heat and block cool subsurface flows. This study updates the i-Tree Cool River model to simulate restoration of these processes to reverse the urban river syndrome, while using the HEC-RAS model water surface profiles needed for flood hazard analysis in restoration planning. The new model was tested in a mountain river within the New York City drinking water supply area (Sawmill, SM, Creek), and then used for base case and restoration scenarios on the 17.5 km reach of the Los Angeles (LA) River where a multi-million dollar riverine restoration project is planned. The model simulated the LA River average temperature in the base case decreased from 29.5 °C by 0.3 °C when warm surface inflows were converted to cooler groundwater inflows by terrestrial green infrastructure; by 0.7 °C when subsurface hyporheic exchange was increased by removal of armoring and installation of riffle-pool bedforms; by 3.6 °C when riparian forests shaded the river; and by 6.4 °C when floodplain forests were added to riparian forests to cool surface reservoirs and local air temperatures. Applying all four restoration treatments lowered river temperature by 7.2 °C. The simulated decreases in river temperature lead to increased saturated dissolved oxygen levels, reaching 8.7 mg/L, up from the 7.6 mg/L in the base case scenario, providing improved fish habitat and reducing eutrophication and hypoxic zones. This study evaluating the performance of environmental management scenarios could help managers control the thermal pollution in rivers.


Asunto(s)
Ecosistema , Ríos , Animales , Bosques , Los Angeles , Ciudad de Nueva York
8.
Sports Health ; 12(1): 74-79, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31642726

RESUMEN

BACKGROUND: Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. HYPOTHESIS: A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. STUDY DESIGN: Randomized trial. LEVEL OF EVIDENCE: Level 2. METHODS: Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. RESULTS: A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). CONCLUSION: There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. CLINICAL RELEVANCE: Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.


Asunto(s)
Trastornos de Traumas Acumulados/prevención & control , Extremidad Inferior/lesiones , Fuerza Muscular/fisiología , Resistencia Física/fisiología , Entrenamiento de Resistencia , Carrera/lesiones , Adulto , Trastornos de Traumas Acumulados/epidemiología , Trastornos de Traumas Acumulados/fisiopatología , Humanos , Ciudad de Nueva York/epidemiología , Factores de Riesgo , Carrera/fisiología
9.
Endocr Pract ; 26(1): 6-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31461357

RESUMEN

Objective: Transgender and gender-nonbinary individuals (TGNB) are disproportionately impacted by obesity. In addition to the associated health impact, obesity represents a significant barrier to accessing gender-confirmation surgery (GCS). The purpose of this study was to determine the prevalence of obesity among TGNB surgical candidates at an urban academic medical center and evaluate the efficacy of self-monitored weight management. Methods: The study was conducted at the Center for Transgender Medicine and Surgery at Mount Sinai in New York City. Data abstraction from a quality improvement database was completed for patients with a documented body mass index (BMI) and a GCS consult from October 2015 through February 2019. A total of 1,457 TGNB patients with a documented BMI and a GCS consult in the historical period of review were included in analysis. Data were abstracted to determine the prevalence of obesity among GCS candidates and evaluate the current default pre-operative self-monitored weight management protocol. Results: Of 1,457 TGNB patients, 382 (26%) were obese (BMI ≥30 kg/m2) at initial surgical consult. In addition, 369 (27%) were obese at a subsequent follow-up, suggesting no statistically significant change in the rate of obesity among evaluated TGNB despite self-monitored weight management (P = .5272). Conclusion: Obesity is a significant barrier to gender affirming surgery for transgender individuals. Self-monitored weight management is an unsuccessful strategy for improvement even among individuals who would be predicted to be motivated. Abbreviations: BMI = body mass index; CTMS = Center for Transgender Medicine and Surgery (at Mount Sinai); GCS = gender confirmation surgery; TGNB = transgender and gender-nonbinary.


Asunto(s)
Cirugía de Reasignación de Sexo , Personas Transgénero , Transexualismo , Índice de Masa Corporal , Humanos , Ciudad de Nueva York
10.
Sci Total Environ ; 704: 135322, 2020 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-31787288

RESUMEN

BACKGROUND: Tobacco remains the leading cause of preventable death in the United States, with 41,000 deaths attributable to secondhand smoke (SHS) exposure. On July 30, 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. OBJECTIVES: Prior to SFH policy implementation, we measured self-reported and objective SHS incursions in a purposeful sample of 21 high-rise buildings (>15 floors) in New York City (NYC): 10 public housing and 11 private sector buildings where most residents receive federal housing subsidies (herein 'Section 8' buildings). METHODS: We conducted a baseline telephone survey targeting all residents living on the 3rd floor or higher of selected buildings: NYC Housing Authority (NYCHA) residents were surveyed in April-July 2018 (n = 559), and residents in 'Section 8' buildings in August-November 2018 (n = 471). We invited non-smoking household participants to enroll into a longitudinal air monitoring study to track SHS exposure using: (1) nicotine concentration from passive, bisulfate-coated nicotine filters and (2) particulate matter (PM2.5) from low-cost particle monitors. SHS was measured for 7-days in non-smoking households (NYCHA n = 157, Section 8 n = 118 households) and in building common areas (n = 91 hallways and stairwells). RESULTS: Smoking prevalence among residents in the 21 buildings was 15.5%. Two-thirds of residents reported seeing people smoke in common areas in the past year (67%) and 60% reported smelling smoke in their apartments coming from elsewhere. Most stairwells (88%) and hallways (74%) had detectable nicotine levels, but nicotine was detected in only 9.9% of non-smoking apartments. Substantial variation in nicotine and PM2.5 was observed between and within buildings; on average nicotine concentrations were higher in NYCHA apartments and hallways than in Section 8 buildings (p < 0.05), and NYCHA residents reported seeing smokers in common areas more frequently. CONCLUSIONS: SFH policies may help in successfully reducing SHS exposure in public housing, but widespread pre-policy incursions suggest achieving SFH will be challenging.


Asunto(s)
Contaminación del Aire Interior/estadística & datos numéricos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminación por Humo de Tabaco/estadística & datos numéricos , Composición Familiar , Femenino , Vivienda , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Prevalencia , Vivienda Popular , Política para Fumadores , Adulto Joven
11.
Water Res ; 170: 115350, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31830651

RESUMEN

To better control and manage harbor water quality is an important mission for coastal cities such as New York City (NYC). To achieve this, managers and governors need keep track of key quality indicators, such as temperature, pH, and dissolved oxygen. Among these, the Biochemical Oxygen Demand (BOD) over five days is a critical indicator that requires much time and effort to detect, causing great inconvenience in both academia and industry. Existing experimental and statistical methods cannot effectively solve the detection time problem or provide limited accuracy. Also, due to various human-made mistakes or facility issues, the data used for BOD detection and prediction contain many missing values, resulting in a sparse matrix. Few studies have addressed the sparse matrix problem while developing statistical detection methods. To address these gaps, we propose a deep learning based model that combines Deep Matrix Factorization (DMF) and Deep Neural Network (DNN). The model was able to solve the sparse matrix problem more intelligently and predict the BOD value more accurately. To test its effectiveness, we conducted a case study on the NYC harbor water, based on 32,323 water samples. The results showed that the proposed method achieved 11.54%-17.23% lower RMSE than conventional matrix completion methods, and 19.20%-25.16% lower RMSE than traditional machine learning algorithms.


Asunto(s)
Aprendizaje Profundo , Agua , Ciudades , Humanos , Aprendizaje Automático , Ciudad de Nueva York
13.
Ann Vasc Surg ; 62: 183-190.e1, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30710629

RESUMEN

BACKGROUND: There is varying evidence regarding the effects of body mass index (BMI) on outcomes of endovascular aneurysm repair (EVAR). This study investigates the effects of BMI on an index of perioperative and postoperative outcomes after EVAR. METHODS: Four hundred ninety-two patients who underwent elective EVAR at Mount Sinai Hospital were included in this study. Patients were classified as either normal weight (BMI = 18.5-25), overweight (BMI = 25-30), or obese (BMI>30). Chi-squared tests were used to determine significant differences between weight classes across an index of outcomes. The following outcomes were collected: intraoperative complications (e.g., conversion to open), perioperative complications (e.g., hematoma, bowel ischemia, and so forth), and postoperative outcomes (endoleak, sac enlargement, sac shrinkage, access site infection, prolonged postoperative length of stay, reintervention, stroke, claudication/lower extremity ischemia, deep vein thrombosis, limb occlusion, renal complications, abdominal aortic aneurysm (AAA) rupture, AAA-related mortality, and all-cause mortality). Kaplan-Meier survival analysis and a log-rank test were used to determine meaningful differences in all-cause mortality following EVAR between the respective weight classes. Subsequently, multivariate Cox proportional hazards were performed for selection of outcomes, with weight classes as predictors. Finally, a multivariate logistic regression was performed for postoperative hospital stay. Subgroup multivariate analysis was also performed examining only class I obese patients, rather than all obese patients. RESULTS: Overweight patients were significantly less likely to experience all-cause mortality up to 9 years after EVAR than normal-weight patients in both Kaplan-Meier and multivariable Cox proportional hazards models. Obese patients similarly had a lower risk of mortality in Kaplan-Meier analysis, but this did not persist in the multivariate analysis. Overweight patients were also significantly less likely to require a postoperative hospital stay longer than 1 day when compared with normal-weight patients. Finally, obese patients were less likely to have a sac shrinkage greater than 5 mm after EVAR, but were also less likely to have an endoleak. CONCLUSIONS: This study adds to the debate on the effects of BMI on outcomes of EVAR. Obesity was not a risk factor for negative perioperative or postoperative outcomes after EVAR with the exception of decreased sac shrinkage. Obese patients were less likely to have an endoleak, and overweight patients were protected against all-cause mortality and longer postoperative hospital stays.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Índice de Masa Corporal , Procedimientos Endovasculares , Obesidad/complicaciones , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Obesidad/diagnóstico , Obesidad/mortalidad , Valor Predictivo de las Pruebas , Factores Protectores , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
14.
BMC Public Health ; 19(1): 1730, 2019 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-31870351

RESUMEN

BACKGROUND: Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users. METHODS: We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC3 project. RESULTS: Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity. CONCLUSIONS: SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.


Asunto(s)
Ejercicio , Observación , Parques Recreativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Reproducibilidad de los Resultados , Estaciones del Año , Adulto Joven
16.
J Stroke Cerebrovasc Dis ; 28(12): 104449, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31668582

RESUMEN

BACKGROUND: Visceral infarctions appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. METHODS: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 to 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory's upper limit of normal (.04 ng/ mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients' other characteristics. Multivariable logistic regression was used to evaluate the association between elevated troponin and visceral infarction. RESULTS: Among 2116 patients registered in CAESAR from 2011 to 2016, 153 patients had both a troponin assay and a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarction. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% confidence interval [CI], 16%-49%) than among patients without an elevated troponin (10%; 95% CI, 5%-17%) (P = .003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarction (odds ratio, 3.9; 95% CI, 1.5-10.4). CONCLUSIONS: Among patients with acute ischemic stroke, elevated troponin was associated with visceral infarction. Our results demonstrate that poststroke troponin elevation may indicate the presence of underlying embolic sources.


Asunto(s)
Isquemia Encefálica/sangre , Embolia/sangre , Infarto/sangre , Riñón/irrigación sanguínea , Bazo/irrigación sanguínea , Accidente Cerebrovascular/sangre , Troponina/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Embolia/diagnóstico , Embolia/epidemiología , Femenino , Humanos , Infarto/diagnóstico , Infarto/epidemiología , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Regulación hacia Arriba
17.
BMC Health Serv Res ; 19(1): 818, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703682

RESUMEN

BACKGROUND: While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York. CASE PRESENTATION: A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient's treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines. CONCLUSIONS: We employ this patient's narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.


Asunto(s)
Tormentas Ciclónicas , Prestación de Atención de Salud/normas , Desastres , Medicare/normas , Afecciones Crónicas Múltiples/terapia , Hispanoamericanos , Humanos , Seguro de Salud , Masculino , Turismo Médico , Persona de Mediana Edad , Afecciones Crónicas Múltiples/etnología , Ciudad de Nueva York , Aceptación de la Atención de Salud , Puerto Rico/etnología , Refugiados , Diálisis Renal , Estados Unidos
18.
Med Care ; 57(12): 960-967, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31730568

RESUMEN

OBJECTIVES: Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. METHODS: We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. RESULTS: Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). CONCLUSIONS: We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.


Asunto(s)
Grupos de Población Continentales/psicología , Accesibilidad a los Servicios de Salud , Estado de Salud , Salud Mental/etnología , Estigma Social , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Depresión/etnología , Diabetes Mellitus/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Aceptación de la Atención de Salud/etnología , Factores Socioeconómicos , Adulto Joven
19.
BMC Public Health ; 19(1): 1479, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31744491

RESUMEN

BACKGROUND: To determine if outdoor advertising density for non-alcoholic drinks, food, tobacco products, and alcohol, is associated with neighborhood poverty or other Census-level characteristics in New York City (NYC). METHODS: From June - July of 2015, photographs were taken of all street-level, stationary outdoor advertising (posters, stickers, decals, etc.) for consumable products in a sample of 953 NYC retail-dense street segments. Density of product images was analyzed by neighborhood poverty level and other characteristics using multivariate negative-binomial regression. RESULTS: A total of 16,305 discrete advertisements displaying 50,673 product images were photographed. Total product image prevalence relative to retail density was not significantly higher in high- vs. low-poverty neighborhoods, as hypothesized (OR: 1.31; 95% CI: 0.98, 1.77). However, total product image prevalence was higher in neighborhoods with a higher percentage of Black residents (OR: 1.08; 95% CI: 1.04, 1.12), and for sugary drinks in areas with a higher percentage of adults with

Asunto(s)
/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Adulto , Afroamericanos/estadística & datos numéricos , Bebidas Alcohólicas , Bebidas , Censos , Femenino , Alimentos , Humanos , Masculino , Ciudad de Nueva York/epidemiología , Productos de Tabaco
20.
Public Health Rep ; 134(6): 695-702, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31647883

RESUMEN

OBJECTIVES: Chronic hepatitis B virus (HBV) infection is a lifelong infection that can cause serious liver damage and liver cancer. The last surveillance-based prevalence estimate of chronic HBV infection in New York City was 1.2% in 2008; however, it did not account for persons with undiagnosed infection. The objective of this study was to calculate the prevalence of chronic HBV infection, including undiagnosed infection, for 2016 by using surveillance data and literature-based information. METHODS: We calculated the number of persons with diagnosed chronic HBV infection (2000-2016) who were alive and living in New York City in 2016 by using routine surveillance data. We estimated the percentage of persons with undiagnosed chronic HBV infection by using birth region-specific percentages from the literature, weighted by the proportion of the New York City population with diagnosed chronic HBV infection from the same birth region. We identified minimum, maximum, and most likely values for the percentage with undiagnosed chronic HBV infection to generate 95% certainty limits (CLs) of the prevalence estimate. RESULTS: The prevalence of chronic HBV infection in 2016, including undiagnosed infection, in New York City was 2.7% (95% CL, 2.2%-3.6%), representing approximately 230 000 persons. The prevalence of diagnosed chronic HBV infection was 1.5%. The estimated prevalence among non-US-born residents was 6.9% (95% CL, 5.4%-8.9%). CONCLUSIONS: The current burden of chronic HBV infection in New York City, especially for non-US-born residents, is substantial. A renewed focus and dedication of resources is required to increase the number of new diagnoses and improve provider capacity to care for the large number of persons with chronic HBV infection.


Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Hepatitis B Crónica/epidemiología , Vigilancia de la Población , Adulto , África/etnología , Asia/etnología , Femenino , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B Crónica/diagnóstico , Humanos , Masculino , Modelos Estadísticos , Ciudad de Nueva York/epidemiología , Prevalencia , Factores de Riesgo
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