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1.
J Environ Manage ; 269: 110808, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32561013

RESUMEN

With growing public interest in ecosystem restoration, wildlife agencies in the U.S. and around the world have adopted wildlife reintroduction program as a conservation strategy. In addition to their ecological benefits, stakeholders are often interested in economic benefits of wildlife reintroduction such as hunting opportunities once a viable population is established. Even though the trip-based travel cost models are widely used in economic valuation of hunting access, such models are not applicable in valuation of sites of recent restoration, where hunting opportunities are limited. With the case of recently completed elk restoration in Tennessee, USA, this study characterizes the economic benefit of hunting opportunity resulting from reintroduction. In doing so, it also presents a procedure to estimate the economic benefit of current use and unmet demand associated with hunting opportunities generated from a wildlife reintroduction program. The annual net economic benefit associated with current use and value of unmet demand is found to be over $2 million. The study also demonstrates the viability of permit-based models in producing reliable estimates of economic benefit of recreation access where demand is lottery-rationed or trip profile data is unavailable.


Asunto(s)
Ecosistema , Deportes , Animales , Animales Salvajes , Conservación de los Recursos Naturales , Tennessee
2.
J Grad Med Educ ; 12(3): 272-279, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32595843

RESUMEN

Background: Horizontal care, in which clinicians assume roles outside of their usual responsibilities, is an important health care systems response to emergency situations. Allocating residents and fellows into skill-concordant clinical roles, however, is challenging. The most efficient method to accomplish graduate medical education (GME) assessment and deployment for horizontal care is not known. Objective: We designed a categorization schema that can efficiently facilitate clinical and educational horizontal care delivery for trainees within a given institution. Methods: In September 2019, as part of a general emergency response preparation, a 4-tiered system of trainee categorization was developed at one academic medical center. All residents and fellows were mapped to this system. This single institution model was disseminated to other institutions in 2020 as the COVID-19 pandemic began to affect hospitals nationally. In March 2020, a multi-institution collaborative launched the Trainee Pandemic Role Allocation Tool (TPRAT), which allows institutions to map institutional programs to COVID-19 roles within minutes. This was disseminated to other GME programs for use and refinement. Results: The emergency response preparation plan was disseminated and selectively implemented with a positive response from the emergency preparedness team, program directors, and trainees. The TPRAT website was visited more than 100 times in the 2 weeks after its launch. Institutions suggested rapid refinements via webinars and e-mails, and we developed an online user's manual. Conclusions: This tool to assess and deploy trainees horizontally during emergency situations appears feasible and scalable to other GME institutions.


Asunto(s)
Infecciones por Coronavirus , Planificación en Desastres , Educación de Postgrado en Medicina/organización & administración , Becas/clasificación , Internado y Residencia/clasificación , Pandemias , Neumonía Viral , Centros Médicos Académicos , Betacoronavirus , Humanos , Tennessee
3.
South Med J ; 113(6): 285-291, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483638

RESUMEN

OBJECTIVE: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System. METHODS: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99). CONCLUSIONS: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Intervalo entre Nacimientos/estadística & datos numéricos , Conducta Anticonceptiva/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud , Periodo Posparto , Fumar/epidemiología , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Modelos Logísticos , Estado Civil/estadística & datos numéricos , Mississippi/epidemiología , Oportunidad Relativa , Nacimiento Prematuro/epidemiología , Tennessee/epidemiología , Adulto Joven
5.
PLoS One ; 15(3): e0230688, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32226037

RESUMEN

Nitrogen (N) fertilization affects bioenergy crop growth and productivity and consequently carbon (C) and N contents in soil, it however remains unclear whether N fertilization and crop type individually or interactively influence soil organic carbon (SOC) and total N (TN). In a three-year long fertilization experiment in switchgrass (SG: Panicum virgatum L.) and gamagrass (GG: Tripsacum dactyloides L.) croplands in Middle Tennessee USA, soil samples (0-15cm) were collected in plots with no N input (NN), low N input (LN: 84 kg N ha-1 yr-1 in urea) and high N input (HN: 168 kg N ha-1 yr-1 in urea). Besides SOC and TN, the aboveground plant biomass was also quantified. In addition to a summary of published root morphology data based on a separated mesocosm experiment, the root leachable dissolved organic matter (DOM) of both crops was also measured using archived samples. Results showed no significant interaction of N fertilization and crop type on SOC, TN or plant aboveground biomass (ABG). Relative to NN, HN (not LN) significantly increased SOC and TN in both crops. Though SG showed a 15-68% significantly higher ABG than GG, GG showed a 9.3-12% significantly higher SOC and TN than SG. The positive linear relationships of SOC or TN with ABG were identified for SG. However, GG showed structurally more complex and less readily decomposed root DOM, a larger root volume, total root length and surface area than SG. Collectively, these suggested that intensive N fertilization could increase C and N stocks in bioenergy cropland soils but these effects may be more likely mediated by the aboveground biomass in SG and root chemistry and morphology in GG. Future studies are expected to examine the root characteristics in different bioenergy croplands under the field fertilization experiment.


Asunto(s)
Carbono/análisis , Productos Agrícolas/crecimiento & desarrollo , Fertilizantes/análisis , Nitrógeno/análisis , Suelo/química , Biocombustibles , Biomasa , Tennessee
6.
South Med J ; 113(4): 150-155, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32239226

RESUMEN

OBJECTIVES: Despite studies demonstrating the negative impact of food insecurity on health in children, limited research has been done to assess the prevalence and sequelae of food insecurity in sickle cell disease (SCD). We tested the hypothesis that food insecurity is common in children with SCD and is associated with increased SCD morbidity. METHODS: Between May and November 2017, we conducted a single-center cross-sectional study using the previously validated, self-administered, US 18-item household food security survey module and the 9-item youth (12-17 years old) food security survey module during regular outpatient clinic visits. We also included the incidence of vaso-occlusive pain or acute chest syndrome requiring hospitalizations in the year before the questionnaire. RESULTS: A total of 75 caregivers and 24 children completed the surveys. The median age of the children was 10.4 years (interquartile range 5.5-15.3), 46.7% were boys. The rate of household food insecurity was 21.3% (16 of 75). Among the 24 children who completed the youth survey, 45.8% were classified as food insecure. Discordance occurred between caregivers' and children's assessment of food insecurity. A total of 81.8% (9 of 11) children reported being food insecure, whereas their caregivers reported to be food secure. The incidence for pain and acute chest syndrome in the year pre-enrollment was not different between food-secure and food-insecure children (59.3 and 43.8/100 patient-years, P = 0.54; 8.5 and 12.5/100 patient-years, P = 0.49, respectively). CONCLUSIONS: In a tertiary care medical center in Tennessee, one in five households with children with SCD were assessed as food insecure, with a substantial discordance between caregiver and child assessment of food insecurity.


Asunto(s)
Anemia de Células Falciformes/dietoterapia , Niños con Discapacidad/estadística & datos numéricos , Composición Familiar , Abastecimiento de Alimentos/normas , Adolescente , Anemia de Células Falciformes/epidemiología , Niño , Estudios Transversales , Femenino , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Masculino , Pacientes Ambulatorios/estadística & datos numéricos , Tennessee/epidemiología
7.
South Med J ; 113(3): 111-115, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32123924

RESUMEN

OBJECTIVES: To define the magnitude of buprenorphine presence in the urine drug screens of pregnant women and to assess the presence of illicit buprenorphine use versus the presence of prescribed buprenorphine use. METHODS: Initial prenatal drug screen results for all pregnant patients in our practice for a 1-year period were analyzed and tabulated. RESULTS: Buprenorphine was found in the urine drug screens of 16% of pregnant patients. The presence of buprenorphine was by far the highest for any substance associated with neonatal abstinence syndrome (NAS). We estimate that the exposure to buprenorphine of approximately one-third of individuals in our population is associated with illicit buprenorphine use. CONCLUSIONS: The high rate of NAS in our region is primarily associated with both illicit and prescribed buprenorphine rather than other substances. Buprenorphine usage at the time that prenatal care is initiated, rather than opiate use at the onset of prenatal care, is the underlying factor that must be addressed if our region is to successfully combat our high rates of NAS.


Asunto(s)
Buprenorfina/análisis , Evaluación Preclínica de Medicamentos/estadística & datos numéricos , Trastornos Relacionados con Opioides/diagnóstico , Adulto , Analgésicos Opioides , Buprenorfina/orina , Evaluación Preclínica de Medicamentos/métodos , Femenino , Humanos , Trastornos Relacionados con Opioides/epidemiología , Embarazo , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Prevalencia , Tennessee
8.
Phys Ther ; 100(3): 487-499, 2020 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-32031628

RESUMEN

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates. OBJECTIVE: This study describes associations between breast cancer-related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer. DESIGN: This is a cross-sectional, observational study that used a computer-assisted telephone interview. METHODS: Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics. RESULTS: The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of ≤$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs/symptoms of BCRL. Regardless of race and income, >50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL. LIMITATIONS: The main limitations of our study are the lack of medical chart data and longitudinal design. CONCLUSIONS: Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL-especially for women who are African American or have a low income-may be warranted. Cancer rehabilitation programs may be able to fill this gap.


Asunto(s)
Neoplasias de la Mama/complicaciones , Supervivientes de Cáncer , Linfedema/diagnóstico , Grupos Minoritarios , Pobreza , Evaluación de Síntomas , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/terapia , Distribución de Chi-Cuadrado , Estudios Transversales , Edema/diagnóstico , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Fibrosis/diagnóstico , Humanos , Entrevistas como Asunto , Linfedema/complicaciones , Linfedema/etnología , Persona de Mediana Edad , Factores Socioeconómicos , Sudeste de Estados Unidos , Tennessee
9.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32060140

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) prevalence doubled among pregnant women from 2009 to 2014, reaching 3.4 per 1000 births nationwide. Infants exposed to HCV may acquire HCV by vertical transmission. National guidelines recommend that infants exposed to HCV be tested; however, it is unclear if these recommendations are being followed. Our objectives were to determine if infants exposed to HCV were tested and to determine hospital- and patient-level factors associated with differences in testing. METHODS: In this retrospective cohort study of infants exposed to HCV who were enrolled in the Tennessee Medicaid program, we used vital statistics-linked administrative data for infants born between January 1, 2005, and December 31, 2014. Infants were followed until 2 years old. Multilevel logistic regression was used to assess the association of HCV testing and hospital- and patient-level characteristics. RESULTS: Only 23% of 4072 infants exposed to HCV were tested. Infants whose mothers were white versus African American (96.6% vs 3.1%; P <.001), used tobacco (78% vs 70%; P <.001), and had HIV (1.3% vs 0.4%; P = .002) were more likely to be tested. Infants exposed to HCV who had a higher median of well-child visits (7 vs 6; P <.001) were more likely to be tested. After accounting for maternal and infant characteristics and health care use patterns, African American infants were less likely to undergo general testing (adjusted odds ratio 0.32; 95% confidence interval, 0.13-0.78). CONCLUSIONS: Testing occurred in <1 in 4 infants exposed to HCV and less frequently among African American infants. Public health systems need to be bolstered to ensure that infants exposed to HCV are tested for seroconversion.


Asunto(s)
Hepatitis C/diagnóstico , Hepatitis C/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Tamizaje Neonatal , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Afroamericanos/estadística & datos numéricos , Preescolar , Estudios de Cohortes , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Intercambio Materno-Fetal , Medicaid , Visita a Consultorio Médico/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Fumar/epidemiología , Tennessee/epidemiología , Estados Unidos , Adulto Joven
10.
South Med J ; 113(2): 64-69, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32016435

RESUMEN

OBJECTIVES: A growing body of research has demonstrated the effect of local government spending on health outcomes; however, the effect of spending on different demographic groups is unclear. We combined national and local data to examine the impact of public spending on mortality rates in Tennessee. METHODS: Within-between random effects models to examine the relation between county-level spending and mortality rates. RESULTS: We found a significant association between per capita library and kindergarten through grade 12 education spending and mortality outcomes. We also found sex differences in the effects of per capita public health spending and highway spending. CONCLUSIONS: This study provides further evidence that local government spending plays a role in addressing and improving population health and suggests that public spending can have differential effects within a population.


Asunto(s)
Financiación Gubernamental/estadística & datos numéricos , Gobierno Local , Mortalidad , Salud Poblacional/estadística & datos numéricos , Factores Sexuales , Femenino , Humanos , Masculino , Salud Pública/economía , Tennessee
11.
Am J Clin Nutr ; 111(6): 1244-1251, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32077920

RESUMEN

BACKGROUND: Red and processed meat, recognized carcinogens, are risk factors for colorectal neoplasia, including polyps, the precursor for colorectal cancer. The mechanism is unclear. One possible explanation is the mutagenic activity of these foods, perhaps due to generation during cooking [e.g., heterocyclic amine (HCA) intake]. Few studies have evaluated meat intake and sessile serrated lesion (SSL) risk, a recently recognized precursor, and no study has evaluated meat cooking methods and meat-derived mutagens with SSL risk. OBJECTIVE: We evaluated intakes of meat, meat cooking methods, and inferred meat mutagens with SSL risk and in comparison to risk of other polyps. METHODS: Meat, well-done meat, and inferred meat mutagen intakes were evaluated. Polytomous logistic regression models were used to estimate ORs and 95% CIs among cases (556 hyperplastic polyp, 1753 adenoma, and 208 SSL) and controls (3804) in the large colonoscopy-based, case-control study, the Tennessee Colorectal Polyp Study. RESULTS: The highest quartile intakes of red meat (OR: 2.38; 95% CI: 1.44, 3.93), processed meat (OR: 2.03; 95% CI: 1.30, 3.17), well-done red meat (OR: 2.19; 95% CI: 1.34, 3.60), and the HCA 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQX; OR: 2.48; 95% CI: 1.49, 4.16) were associated with increased risk of SSLs in comparison to the lowest quartile intake. CONCLUSIONS: High intakes of red and processed meats are strongly and especially associated with SSL risk and part of the association may be due to HCA intake. Future studies should evaluate other mechanism(s) and the potential for primary prevention.


Asunto(s)
Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/patología , Culinaria/métodos , Exposición Dietética/efectos adversos , Carne/análisis , Mutágenos/efectos adversos , Aminas/efectos adversos , Aminas/análisis , Aminas/metabolismo , Estudios de Casos y Controles , Neoplasias Colorrectales/epidemiología , Exposición Dietética/análisis , Femenino , Calor , Humanos , Masculino , Persona de Mediana Edad , Mutágenos/análisis , Mutágenos/metabolismo , Factores de Riesgo , Tennessee/epidemiología
12.
BMC Infect Dis ; 20(1): 24, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914949

RESUMEN

BACKGROUND: Despite recent improvement in management, infective endocarditis (IE) continues to be associated with considerable risk of morbidity and mortality. Early identification of predictors of inpatient mortality is key in improving patient outcomes in IE. The aim of our study was to evaluate the role of serum troponin levels measurements as a marker of increased mortality. METHODS: A case-control study included adult patients with IE admitted to a tertiary care hospital in east Tennessee between December 2012 and July 2017. Cases were defined as patients with definitive IE who died in-hospital; controls were patients who did not die in hospital. First patient admission was included only. Data collected included the patients' demographic and baseline clinical information, microbiological data, injection drug use status, elevated serum troponins levels. RESULTS: Two hundred eighty three patients with definitive IE were included; median (IQR) age was 41 (30-57) years, and 153 (54%) patients were men. One-hundred sixty-four (58%) were injection drug users. The most frequent IE type was: 167 (59%) right-sided, 86 (30%) left-sided, 24 (9%) both left and right-sided, and 10 (4%) device related. The most commonly isolated organism was Staphylococcus aureus (n = 141), and 64% were methicillin-resistant. Two-hundred twelve (75%) patients had a troponin level obtained, and 57 (27%) had an elevated troponin value. Thirty-six (13%) patients died in-hospital; in-hospital mortality was associated elevated troponin values (adjusted odds ratio [adjOR], 7.3; 95%CI, 3.3-15.9), and methicillin-resistant S. aureus IE (adjOR 2.6; 95%CI, 1.2-5.8). Forty-four (16%) patients received IE valve surgery, and none of these patients died in the hospital. CONCLUSION: Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels.


Asunto(s)
Endocarditis/diagnóstico , Endocarditis/mortalidad , Mortalidad Hospitalaria , Troponina/sangre , Adulto , Anciano , Estudios de Casos y Controles , Consumidores de Drogas/estadística & datos numéricos , Endocarditis/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Abuso de Sustancias por Vía Intravenosa/microbiología , Abuso de Sustancias por Vía Intravenosa/mortalidad , Tennessee/epidemiología , Estados Unidos/epidemiología
13.
Sci Rep ; 10(1): 1211, 2020 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-31988309

RESUMEN

Nitrogen (N) fertilizers can potentially alter spatial distribution of soil organic carbon (SOC) and total nitrogen (TN)  concentrations in croplands such as switchgrass (SG: Panicum virgatum L.) and gamagrass (GG: Tripsacum dactyloides L.), but it remains unclear whether these effects are the same between crops and under different rates of fertilization. 13C and 15N are  two important proxy measures of soil biogeochemistry, but they were rarely examined as to their spatial distributions in soil. Based on a three-year long fertilization experiment in Middle Tennessee, USA, the top mineral horizon soils (0-15 cm) were collected using a spatially explicit design within two 15-m2 plots under three fertilization treatments in SG and GG croplands. A total of 288 samples were collected based on 12 plots and 24 samples in each plot. The fertilization treatments were no N input (NN), low N input (LN: 84 kg N ha-1 in urea) and high N input (HN: 168 kg N ha-1 in urea). The SOC, TN, SOC/TN (C: N), δ13C and δ15N were quantified and their within-plot variations and spatial distributions were achieved via descriptive and geostatistical methods. Results showed that SG generally displayed 10~120% higher plot-level variations in all variables than GG, and the plot-level variations were 20~77% higher in NN plots than LN and HN plots in SG but they were comparable in unfertilized and fertilized plots in GG. Relative to NN, LN and HN showed more significant surface trends and spatial structures in SOC and TN in both croplands, and the fertilization effect appeared more pronounced in SG. Spatial patterns in C: N, δ13C and δ15N were comparable among different fertilization treatments in both croplands. The descending within-plot variations were also identified among variables (SOC > TN > δ15N > C: N > δ13C). This study demonstrated that N fertilizations generally reduced the plot-level variance and simultaneously re-established spatial structures of SOC and TN in bioenergy croplands, which little varied with fertilization rate but was more responsive in switchgrass cropland.


Asunto(s)
Isótopos de Carbono/metabolismo , Productos Agrícolas/metabolismo , Fertilizantes , Isótopos de Nitrógeno/metabolismo , Compuestos Orgánicos/metabolismo , Panicum/metabolismo , Suelo/química , Ciclo del Carbono , Isótopos de Carbono/química , Isótopos de Nitrógeno/química , Concentración Osmolar , Tennessee
14.
Ann Epidemiol ; 41: 43-48.e1, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31928897

RESUMEN

PURPOSE: Population-based data on trends and characteristics on polydrug overdoses are critically needed to help understand the changing drug epidemic in the United States, and to identify risk patterns and targets for overdose prevention for prescription and illicit opioid deaths. We conducted a statewide study in Tennessee to evaluate characteristics and trends of polydrug overdose deaths during 2013-2017. METHODS: We identified polydrug overdose deaths using ICD-10 codes and literal cause-of-death text in the death statistical files. We evaluated trends, contributing drugs, and demographic characteristics of overdoses (n = 2567 single-drug and n = 4683 polydrug deaths). Average annual percent change estimates (AAPCs) with associated 95% CIs were estimated using Poisson regression. RESULTS: Polydrug overdoses increased annually, with higher AAPC for polydrug compared with single-drug overdoses (AAPC: 13.6%, 95% CI: 10.6%-16.7% and 5.2%, 95% CI: 2.9%-7.5%, respectively). The highest increases in polydrug overdoses were observed in males (AAPC: 15.4%, non-Hispanic blacks (AAPC: 33.3%), and decedents aged 18-34 years (AAPC: 21.3%). CONCLUSIONS: All drug and opioid polydrug deaths increased during 2013-2017, with the highest increases seen in males, blacks, and younger age groups. Over 80% of illicit opioid overdoses involved more than one drug, highlighting the need to go beyond opioids to prevent overdoses.


Asunto(s)
Analgésicos Opioides/envenenamiento , Certificado de Defunción , Sobredosis de Droga/mortalidad , Trastornos Relacionados con Sustancias/mortalidad , Adolescente , Adulto , Anciano , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Tennessee/epidemiología , Estados Unidos/epidemiología , Adulto Joven
15.
South Med J ; 113(1): 1-7, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31897491

RESUMEN

OBJECTIVES: Understanding the impact of poverty on health can inform efforts to target social programs and regional economic development. This study examined the effects of poverty on health among the 95 counties of Tennessee. METHODS: All of the counties of Tennessee were ranked by 5-year median household income, from the wealthiest to the poorest. The counties were divided into quintiles, from wealthiest to poorest, to reflect the general impact of wealth on health. Next, the five wealthiest counties and the five poorest counties were identified, allowing for examination of the extremes of poverty and wealth within Tennessee. Comparisons of quintiles and five wealthiest and poorest counties on key measures were performed using the independent t test. RESULTS: People living in the wealthiest quintile lived on average 2.5 to 4 years longer and had lower rates of all health behaviors and health outcomes investigated compared with those in the poorest quintile. This disparity was even more pronounced when comparing the wealthiest five counties to the poorest five. The five poorest counties, for example, had twice the years of potential life lost and were overwhelmingly rural in character, with similar accompanying disparities such as median income, high unemployment, and a more aged population. CONCLUSIONS: This study highlights the fact that lower income is associated with significantly worse health outcomes in Tennessee and reinforces the importance of economic development, specifically, and addresses the social determinants, more generally, in helping to improve Tennessee's overall health statistics.


Asunto(s)
Disparidades en el Estado de Salud , Salud Poblacional/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Humanos , Factores Socioeconómicos , Tennessee
16.
Nurs Outlook ; 68(2): 155-161, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31685235

RESUMEN

BACKGROUND: To-date, advocacy efforts to advance full practice authority for APRNs have primarily stressed arguments based on evidence on the cost effectiveness and quality of APRN-provided care, as well as the improved care access and patient satisfaction these providers offer. PURPOSE: The economic impact analysis forecasts the additional job and economic output associated with granting Tennessee APRNs full practice authority. METHODS: The IMPLAN software and a variety of data inputs were used to estimate the direct, indirect, and induced economic impact on jobs, labor income, value-added benefits, total output, and tax revenues. FINDINGS: From a 2017 baseline, the cumulative impact of granting Tennessee APRNs full practice authority is a net gain of 25,536 jobs and $3.2 billion in economic impact. DISCUSSION: Granting Tennessee APRNs full practice authority would confer substantial economic benefits and employment opportunities to the state.


Asunto(s)
Enfermería de Práctica Avanzada/economía , Enfermería de Práctica Avanzada/normas , Rol de la Enfermera/psicología , Enfermeras y Enfermeros/psicología , Autorización Previa/economía , Autorización Previa/estadística & datos numéricos , Autonomía Profesional , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/economía , Tennessee
17.
J Homosex ; 67(1): 79-103, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30307800

RESUMEN

Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.


Asunto(s)
Afroamericanos/psicología , Homosexualidad Masculina/psicología , Minorías Sexuales y de Género/psicología , Medios de Comunicación Sociales , Espiritualidad , Adolescente , Adulto , Grupos Focales , Infecciones por VIH/psicología , Humanos , Masculino , Estigma Social , Tennessee , Adulto Joven
18.
Public Health Rep ; 135(1): 90-96, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31738858

RESUMEN

OBJECTIVES: From 2006 through 2012, the number of acute hepatitis C virus (HCV) infections increased 364% among persons aged ≤30, including reproductive-aged women, in Central Appalachian states. Outreach to reproductive-aged women with newly diagnosed HCV infection affords a unique opportunity to provide counseling, further testing, and linkage to treatment. We modeled a centrally located statewide effort to reach this population and their health care providers to ascertain pregnancy status, HCV risk factors, and opportunities for linkage to additional services. METHODS: Using the Tennessee Department of Health's surveillance database, we identified women aged 18-45 residing in Tennessee with newly reported chronic HCV infection from May through October 2017. We contacted health care providers and patients to request information on pregnancy status and HCV risk factors as well as to provide linkage to treatment services. RESULTS: Of 1548 women included in this study, health care provider or patient contact information was available for 1316 (85.0%) women. Of the 1316 women, 806 (61.2%) women had a health care provider or patient response, of whom 242 (30.0%) were pregnant. Of 296 patients contacted, 194 (65.5%) reported intranasal drug use, 193 (65.2%) reported having been incarcerated for more than 24 hours, and 180 (60.8%) reported injection drug use. Ninety-eight (33.1%) patients were referred for confirmatory testing, and 174 (58.8%) were referred to treatment. CONCLUSION: A high proportion of reproductive-aged women with newly diagnosed HCV infection were pregnant. Surveillance-informed outreach to this population was feasible and provided opportunities for counseling and linkage to confirmatory testing and treatment. Future studies should evaluate whether a similar model would enhance testing and linkage to care of HCV-exposed infants.


Asunto(s)
Hepatitis C Crónica/epidemiología , Adolescente , Adulto , Región de los Apalaches/epidemiología , Femenino , Hepatitis C Crónica/diagnóstico , Humanos , Persona de Mediana Edad , Compartición de Agujas/estadística & datos numéricos , Embarazo , Prisioneros/estadística & datos numéricos , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Tatuaje/estadística & datos numéricos , Tennessee/epidemiología , Adulto Joven
20.
Acad Med ; 95(4): 553-558, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31876566

RESUMEN

PROBLEM: Designing and sustaining a longitudinal, clinic-based interprofessional learning experience is logistically challenging, which has limited the educational opportunities available in health professions schools. The authors discuss the Vanderbilt Program in Interprofessional Learning (VPIL), which addresses some of the challenges facing clinic-based interprofessional experiences. APPROACH: VPIL places first- and second-year students from 4 professional degree programs (medicine, nursing, pharmacy, social work) in Nashville, Tennessee, on teams where they work and learn together in authentic clinical environments over a 2-year period. The program was implemented in 2010 and includes 3 components: a summer immersion experience, seminar-based classroom and simulation sessions, and a weekly clinical experience. Students also complete a capstone quality improvement project. VPIL administrators have set up structures at the institutional, clinic, faculty, and student levels that have contributed to the sustainability of the program. OUTCOMES: Between 2010 and 2019, VPIL admitted 398 students who participated on 91 clinical teams. In addition, 55 clinical preceptors and 12 core faculty trained students for future collaborative practice. The program has received consistently high ratings from students, who have produced 69 quality improvement projects at their clinics. These projects have addressed aspects of the care delivery process and produced durable materials, showing that the program has contributed to important innovations in the health system. NEXT STEPS: VPIL faculty continue to improve the curriculum and administrative structures and work to expand the program to reach a wider variety of health professions students. Going forward, lessons from the program could assist educators in creating opportunities for students to learn interprofessionally and deliver high value health care in increasingly complex delivery systems.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Educación en Enfermería/métodos , Educación en Farmacia/métodos , Prácticas Interdisciplinarias , Servicio Social/educación , Curriculum , Humanos , Tennessee
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