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1.
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
2.
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
3.
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
5.
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
6.
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
7.
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
8.
Epidemiol Health ; 41: e2019041, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31623424

RESUMEN

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits. METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model. RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate. CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.


Asunto(s)
Trastornos Relacionados con Alcohol/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Renta/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos Relacionados con Alcohol/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Adulto Joven
9.
Public Health Rep ; 134(5): 477-483, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31424330

RESUMEN

During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Administración en Salud Pública , Adolescente , Adulto , Niño , Preescolar , Femenino , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/fisiopatología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Vigilancia de la Población , Medición de Riesgo , Adulto Joven
10.
Am J Public Health ; 109(9): 1212-1215, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31318600

RESUMEN

Objectives. To quantify sociodemographic disparities in prediagnosis preexposure prophylaxis (PrEP) use in persons recently diagnosed with HIV in New York City and assigned for partner services.Methods. We used partner services data from November 2015 to September 2017 from persons diagnosed with HIV in the past 12 months (n = 3739) to compare individuals with self-reported or documented pre-HIV diagnosis PrEP use ("prediagnosis PrEP users") with those having none ("never users"). We constructed a penalized likelihood regression model generating sociodemographic predictors of prediagnosis PrEP use, employing Firth's adjustment for the rare outcome.Results. We found report of prediagnosis PrEP use in 95 persons (3%). The adjusted odds ratios (AORs) of prediagnosis PrEP use were lower among non-Hispanic Blacks (AOR = 0.18; 95% confidence interval [CI] = 0.09, 0.32) and Hispanics (AOR = 0.31; 95% CI = 0.17, 0.55) than among non-Hispanic Whites, among persons aged 30 years or older (AOR = 0.45; 95% CI = 0.28, 0.72) than those younger than 30 years, among cis-women (AOR = 0.13; 95% CI = 0.02, 0.48) than cis-men, and among residents of Queens (AOR = 0.25; 95% CI = 0.10, 0.55) than those of Manhattan.Conclusions. Disparities in HIV prevention based on race/ethnicity, gender, age, and local geography may manifest themselves in differential PrEP use.


Asunto(s)
Infecciones por VIH , Disparidades en Atención de Salud/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto , Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Ciudad de Nueva York/epidemiología
11.
AIDS Behav ; 23(10): 2795-2802, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31321639

RESUMEN

Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.


Asunto(s)
Infecciones por VIH/prevención & control , Accesibilidad a los Servicios de Salud , Profilaxis Pre-Exposición , Características de la Residencia/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Incidencia , Cobertura del Seguro , Masculino , Ciudad de Nueva York/epidemiología , Pobreza , Factores Socioeconómicos , Análisis Espacial
12.
Psychiatry Res ; 273: 719-724, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31207858

RESUMEN

This study evaluated the impact of pre-Hurricane Sandy (Sandy) post-traumatic stress disorder (PTSD) trajectories on the relationship between Sandy exposures and post-Sandy 9/11-related PTSD among World Trade Center Health Registry (Registry) enrollees. The study population included 3,199 adult Registry enrollees who completed three surveys prior to Sandy in 2003-4, 2006-7, and 2011-12; a post-Hurricane Sandy survey (2013); and a follow-up survey in 2015-16. PTSD was assessed using the PTSD Checklist (PCL). Latent class growth analysis was used to identify groups of enrollees who shared a similar trajectory of change in PCL score in the time period prior to Sandy. We compared enrollees in each trajectory group to assess the impact of Sandy-related PTSD, Sandy exposures, and optimism on 9/11-related PTSD status post-Sandy (2015-16) using bivariate analyses and multivariable log-binomial regression. Sandy-related PTSD was the strongest predictor of subsequent 9/11-related PTSD. Lower optimism and higher Sandy exposure significantly predicted 9/11-related PTSD only in some trajectory groups. Hurricane Sandy may have exacerbated previously resolved symptoms of 9/11-related PTSD. This indicates a need after a disaster to assess and address mental health sequelae from previous traumatic exposures.


Asunto(s)
Tormentas Ciclónicas , Desastres , Ataques Terroristas del 11 de Septiembre/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Sobrevivientes/psicología , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Optimismo/psicología , Sistema de Registros , Ataques Terroristas del 11 de Septiembre/tendencias , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
13.
AIDS Patient Care STDS ; 33(7): 336-341, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31194578

RESUMEN

In the United States, undocumented African immigrants living with HIV enter care late, potentially leading to adverse individual and population health outcomes, yet little is known about the specific experiences of HIV diagnosis and linkage to care among this population. We conducted individual, semi-structured interviews with adults who were undocumented African immigrants living with HIV in New York City. Interviews explored perspectives regarding individual, social, institutional, and societal barriers and facilitators of HIV testing and linkage to care. Of 14 participants from 9 different African countries, 9 were women and the median age was 44 years (interquartile range: 42-50). Participants described fear of discovery by immigration authorities as a substantial barrier to HIV testing and linking to initial medical appointments. Actual and perceived structural barriers to both testing and care linkage included difficulty obtaining health insurance and a belief that undocumented immigrants are ineligible for any health services. Participants also expressed reluctance to be tested because of HIV-related stigma within the immigrant communities that they heavily relied on. After diagnosis, however, participants overwhelmingly described a positive role of health and social service providers in facilitating linkage to HIV care. Concerns about immigration status and HIV-related stigma are significant barriers to HIV testing and linkage to care among undocumented African immigrants. Multilevel efforts to reduce stigma and increase awareness of available services could enhance rates of HIV testing and care linkage in this population.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Accesibilidad a los Servicios de Salud , Seguro de Salud/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Inmigrantes Indocumentados/psicología , Adulto , África/etnología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Investigación Cualitativa , Pruebas Serológicas , Estigma Social , Inmigrantes Indocumentados/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
14.
J Prev Med Public Health ; 52(3): 179-187, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31163953

RESUMEN

OBJECTIVES: In the USA, certain races and ethnicities have a disproportionately higher gastric cancer burden. Selective screening might allow for earlier detection and curative resection. Among a USA-based multiracial and ethnic cohort diagnosed with non-cardia gastric cancer (NCGC), we aimed to identify factors associated with curable stage disease at diagnosis. METHODS: We retrospectively identified endoscopically diagnosed and histologically confirmed cases of NCGC at Mount Sinai Hospital in New York City. Demographic, clinical, endoscopic and histologic factors, as well as grade/stage of NCGC at diagnosis were documented. The primary outcome was the frequency of curable-stage NCGC (stage 0-1a) at diagnosis in patients with versus without an endoscopy negative for malignancy prior to their index exam diagnosing NCGC. Additional factors associated with curable-stage disease at diagnosis were determined. RESULTS: A total of 103 racially and ethnically diverse patients were included. Nearly 38% of NCGC were stage 0-Ia, 34% stage Ib-III, and 20.3% stage IV at diagnosis. A significantly higher frequency of NCGC was diagnosed in curable stages among patients who had undergone an endoscopy that was negative for malignancy prior to their index endoscopy that diagnosed NCGC, compared to patients without a negative endoscopy prior to their index exam (69.6% vs. 28.6%, p=0.003). A prior negative endoscopy was associated with 94.0% higher likelihood of diagnosing curable-stage NCGC (p=0.003). No other factors analyzed were associated with curable-stage NCGC at diagnosis. CONCLUSIONS: Endoscopic screening and surveillance in select high-risk populations might increase diagnoses of curable-stage NCGC. These findings warrant confirmation in larger, prospective studies.


Asunto(s)
Endoscopía/normas , Neoplasias Gástricas/diagnóstico , Población Urbana/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Endoscopía/métodos , Endoscopía/estadística & datos numéricos , Femenino , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/patogenicidad , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Estudios Retrospectivos , Neoplasias Gástricas/epidemiología
15.
Environ Res ; 175: 414-420, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31154231

RESUMEN

BACKGROUND: Emerging evidence suggests a potential association between ambient air pollution and risk of gestational diabetes mellitus (GDM), but results have been inconsistent. Accordingly, we assessed the associations between ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) levels with risk of GDM. METHODS: Using linked data from birth certificates, hospital discharge diagnoses, and air pollution estimates informed by the New York City Community Air Survey, we fit conditional logistic regression models to evaluate the association between residential levels of PM2.5 and NO2 with risk of GDM among 256,372 singleton live births of non-smoking mothers in New York City born 2008-2010, adjusting for sociodemographic factors and stratified on zip code of maternal address. RESULTS: GDM was identified in 17,065 women, yielding a risk of GDM in the study sample of 67 per 1000 deliveries. In single pollutant models, 1st and 2nd trimester PM2.5 was associated with a lower and higher risk of GDM, respectively. In models mutually adjusting for PM2.5 levels in both trimesters, GDM was associated with PM2.5 levels in the 2nd trimester (OR: 1.06, 95% CI: 1.02, 1.10 per interquartile range increase in PM2.5), but not the 1st trimester (OR: 0.99, 95% CI: 0.96, 1.02). Conversely, GDM was associated with NO2 during the 1st trimester (OR: 1.05, 95% CI: 1.01, 1.09), but not the 2nd trimester (OR: 1.02, 95% CI: 0.98, 1.06). The positive associations between pollutants and GDM were robust to different model specifications. PM2.5 in the 2nd trimester was more strongly associated with GDM among mothers who were aged <35 years and not Medicaid recipients. NO2 in the 1st trimester was more strongly associated with GDM among overweight and parous women. CONCLUSIONS: In this large cohort of singleton births in New York City, NO2 in the 1st trimester and PM2.5 in the 2nd trimester were associated with higher odds of GDM, while 1st trimester PM2.5 was weakly and inconsistently associated with lower odds of GDM.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire/estadística & datos numéricos , Diabetes Gestacional/epidemiología , Exposición Materna/estadística & datos numéricos , Adulto , Femenino , Humanos , Ciudad de Nueva York/epidemiología , Dióxido de Nitrógeno , Material Particulado , Embarazo
16.
Emerg Infect Dis ; 25(6): 1136-1143, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31107213

RESUMEN

Most tickborne disease studies in the United States are conducted in low-intensity residential development and forested areas, leaving much unknown about urban infection risks. To understand Lyme disease risk in New York, New York, USA, we conducted tick surveys in 24 parks throughout all 5 boroughs and assessed how park connectivity and landscape composition contribute to Ixodes scapularis tick nymphal densities and Borrelia burgdorferi infection. We used circuit theory models to determine how parks differentially maintain landscape connectivity for white-tailed deer, the reproductive host for I. scapularis ticks. We found forested parks with vegetated buffers and increased connectivity had higher nymph densities, and the degree of park connectivity strongly determined B. burgdorferi nymphal infection prevalence. Our study challenges the perspective that tickborne disease risk is restricted to suburban and natural settings and emphasizes the need to understand how green space design affects vector and host communities in areas of emerging urban tickborne disease.


Asunto(s)
Distribución Animal , Borrelia burgdorferi/aislamiento & purificación , Ixodes/microbiología , Enfermedad de Lyme/epidemiología , Parques Recreativos , Animales , Ecosistema , Humanos , Ixodes/fisiología , Enfermedad de Lyme/transmisión , Ciudad de Nueva York/epidemiología , Ninfa/microbiología , Ninfa/fisiología , Factores de Riesgo
17.
AIDS Behav ; 23(10): 2870-2878, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31054030

RESUMEN

Diagnosis and treatment of acute HIV infection (AHI) is crucial for ending the HIV epidemic. Individuals with AHI, who have high viral loads and often are unaware of their infection, are more likely to transmit HIV to others than those with chronic infection. In preparation for an educational intervention on AHI in primary health care settings in high HIV-prevalence areas of New York City, 22 clinic directors, 313 clinic providers, and 220 patients were surveyed on their knowledge and awareness of the topic from 2012-2015. Basic HIV knowledge was high among all groups while knowledge of AHI was partial among providers and virtually absent among patients. Inadequate knowledge about this crucial phase of HIV may be impeding timely identification of cases in the primary care setting.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , VIH-1/aislamiento & purificación , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Atención Primaria de Salud/organización & administración , Enfermedad Aguda , Adulto , Instituciones de Atención Ambulatoria , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Tamizaje Masivo , Ciudad de Nueva York/epidemiología , Vigilancia de la Población , Prevalencia , Encuestas y Cuestionarios , Carga Viral
18.
Sci Total Environ ; 678: 755-760, 2019 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-31085491

RESUMEN

BACKGROUND: The frequency and intensity of hurricane have increased greatly. However, whether hurricane exposure is associated with an increased risk of pregnancy complications is less known. OBJECTIVE: To assess the immediate impact and lasting impact of Hurricane Sandy (Sandy) on pregnancy complications. METHODS: Using time-series study, we estimated the relative risks (RRs) of emergency department (ED) visits for pregnancy complications in eight affected counties in New York State, based on data of 2005-2014. The immediate impact was estimated by comparing the ED visits of pregnancy complications during the Sandy period to the non-Sandy periods. For the lasting impact of Sandy, we estimated the RRs by contrasting the ED visits in the following 12 months after Sandy with the same months of other years. RESULTS: We found that ED visits for overall pregnancy complications increased 6.3% (95% confidence interval (CI): 2.2%, 10.5%) during the Sandy month. ED visits increased for threatened abortion (9.9%, 95% CI: 4.4%, 15.7%), threatened labor (10.1%, 95% CI: 1.9%, 18.9%), early onset of delivery (115.9%, 95% CI: 6.9%, 336.3%), renal disease (73.2%, 95% CI: 0.3%, 199.4%), and diabetes (42.3%, 95% CI: 15.0%, 76.0%). Gestational hypertension and renal disease were elevated 7-8 months after Sandy. The ED visits of mental illness increased gradually after Sandy and peaked eight months later with visits increasing 33.2%. CONCLUSIONS: This study suggests that hurricanes may impact pregnancy health immediately and that some negative health may last for months thereafter.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Tormentas Ciclónicas , Femenino , Humanos , New York/epidemiología , Ciudad de Nueva York/epidemiología , Embarazo , Complicaciones del Embarazo/etiología , Riesgo
19.
Ann Epidemiol ; 34: 18-25.e3, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31076212

RESUMEN

PURPOSE: The effect of tobacco exposure on the oral microbiome has not been established. METHODS: We performed amplicon sequencing of the 16S ribosomal RNA gene V4 variable region to estimate bacterial community characteristics in 259 oral rinse samples, selected based on self-reported smoking and serum cotinine levels, from the 2013-2014 New York City Health and Nutrition Examination Study. We identified differentially abundant operational taxonomic units (OTUs) by primary and secondhand tobacco exposure, and used "microbe set enrichment analysis" to assess shifts in microbial oxygen utilization. RESULTS: Cigarette smoking was associated with depletion of aerobic OTUs (Enrichment Score test statistic ES = -0.75, P = .002) with a minority (29%) of aerobic OTUs enriched in current smokers compared with never smokers. Consistent shifts in the microbiota were observed for current cigarette smokers as for nonsmokers with secondhand exposure as measured by serum cotinine levels. Differential abundance findings were similar in crude and adjusted analyses. CONCLUSIONS: Results support a plausible link between tobacco exposure and shifts in the oral microbiome at the population level through three lines of evidence: (1) a shift in microbiota oxygen utilization associated with primary tobacco smoke exposure; (2) consistency of abundance fold changes associated with current smoking and shifts along the gradient of secondhand smoke exposure among nonsmokers; and (3) consistency after adjusting for a priori hypothesized confounders.


Asunto(s)
Cotinina/sangre , Microbiota , Boca/microbiología , Saliva/química , Contaminación por Humo de Tabaco/análisis , Fumar Tabaco/sangre , Adulto , Biomarcadores/sangre , Femenino , Humanos , Masculino , Ciudad de Nueva York/epidemiología , ARN Ribosómico 16S/genética
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