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1.
J Interprof Care ; : 1-12, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32050821

RESUMO

There are many calls for increased rigor in interprofessional research, and scale validation improvements are particularly needed. Specifically, current validation efforts are limited, as few interprofessional scale development studies report evidence of convergent and discriminant validity. These are core aspects of establishing nomological networks and construct validity, and thus form the foundation of interprofessional theory, research, and practice. This paper focuses on the importance of construct validation for interprofessional measurement tools, reviewing key concepts, extant scales and their validation efforts, and providing recommendations for future interprofessional scale validation. We also provide a step-by-step guide for scale development and validation that we hope will be valuable for future researchers and scale developers in the interprofessional literature.

2.
Sci Total Environ ; 712: 136470, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-31931190

RESUMO

OBJECTIVES: Prenatal exposure to air pollutant has been associated with congenital heart defect (CHD). However, no study has investigated this effect in pre-pregnancy overweighted women. This study aimed to evaluate gestational exposure to particulate pollutant (PM2.5) and gaseous air pollutants (O3 and NO2) on the risk of CHD, and explore the potential effect modifiers including maternal age, pre-pregnancy BMI and pregestational diseases. METHODS: In this birth cohort study, a total of 63,213 pregnant women in Foshan, China were initially recruited and followed from their first hospital visit for pregnancy to delivery during 2015-2019. CHD cases were confirmed by the records in hospital- and population- based birth defect surveillance systems. Air pollutant exposures were estimated by the daily concentrations measured in air monitoring stations in each participant's residential county. Mixed-effects regression models, adjusted for potential confounding factors were applied to estimate the associations between air pollutant and CHD during the first three months of the pregnancy. RESULTS: A total of 985 (1.6%) newborns were identified as CHD cases. For each 10 µg/m3 increase in ambient O3 during the 1st month, the OR values for CHD were 1.03 (95% CI: 0.94, 1.13) in pre-pregnancy normal weighted women and 1.24 (95% CI: 1.01, 1.53) in pre-pregnancy overweighted women. For each 10 µg/m3 increase in NO2 during the 3rd month, the OR values for CHD were 1.09 (95% CI: 1.01, 1.18) in pre-pregnancy normal weighted women and 1.27 (95% CI: 1.07, 1.51) in pre-pregnancy overweighted women. No significant associations were found between PM2.5 exposure and CHD in our analysis. CONCLUSIONS: This study demonstrates that gaseous air pollutants (O3 and NO2) exposure during the cardiac embryogenesis period is associated with an increased risk of CHD, particularly for pre-pregnancy overweighted women.


Assuntos
Poluição do Ar , Cardiopatias Congênitas , Poluentes Atmosféricos , China , Estudos de Coortes , Feminino , Cardiopatias Congênitas/induzido quimicamente , Humanos , Recém-Nascido , Exposição Materna , Material Particulado , Gravidez
3.
Environ Pollut ; 256: 113434, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31672350

RESUMO

BACKGROUND: Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and adolescents. METHODS: A cross-sectional study was investigated during 2012-2013 in 94 schools from Seven Northeastern Cities (SNEC) in China. Questionnaires surveys were obtained from 56 137 children and adolescents aged 2-17 years. Influenza vaccination was defined as receipt of the influenza vaccine. We estimated air pollutants exposure [nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤1 µm (PM1), ≤2.5 µm (PM2.5) and ≤10 µm (PM10)] using machine learning methods. We employed two-level generalized linear mix effects model to examine interactive effects between influenza vaccination and air pollution exposure on allergic respiratory diseases (asthma, asthma-related symptoms and allergic rhinitis), after controlling for important covariates. RESULTS: We found statistically significant interactions between influenza vaccination and air pollutants on allergic respiratory diseases and related symptoms (doctor-diagnosed asthma, current wheeze, wheeze, persistent phlegm and allergic rhinitis). The adjusted ORs for doctor-diagnosed asthma, current wheeze and allergic rhinitis among the unvaccinated group per interquartile range (IQR) increase in PM1 and PM2.5 were significantly higher than the corresponding ORs among the vaccinated group [For PM1, doctor-diagnosed asthma: OR: 1.89 (95%CI: 1.57-2.27) vs 1.65 (95%CI: 1.36-2.00); current wheeze: OR: 1.50 (95%CI: 1.22-1.85) vs 1.10 (95%CI: 0.89-1.37); allergic rhinitis: OR: 1.38 (95%CI: 1.15-1.66) vs 1.21 (95%CI: 1.00-1.46). For PM2.5, doctor-diagnosed asthma: OR: 1.81 (95%CI: 1.52-2.14) vs 1.57 (95%CI: 1.32-1.88); current wheeze: OR: 1.46 (95%CI: 1.21-1.76) vs 1.11 (95%CI: 0.91-1.35); allergic rhinitis: OR: 1.35 (95%CI: 1.14-1.60) vs 1.19 (95%CI: 1.00-1.42)]. The similar patterns were observed for wheeze and persistent phlegm. The corresponding p values for interactions were less than 0.05, respectively. We assessed the risks of PM1-related and PM2.5-related current wheeze were decreased by 26.67% (95%CI: 1.04%-45.66%) and 23.97% (95%CI: 0.21%-42.08%) respectively, which was attributable to influenza vaccination (both p for efficiency <0.05). CONCLUSIONS: Influenza vaccination may play an important role in mitigating the detrimental effects of long-term exposure to ambient air pollution on childhood allergic respiratory diseases. Policy targeted at increasing influenza vaccination may yield co-benefits in terms of reduced allergic respiratory diseases.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Adolescente , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Asma/epidemiologia , Criança , Pré-Escolar , China , Cidades , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/epidemiologia , Influenza Humana , Modelos Logísticos , Masculino , Dióxido de Nitrogênio , Material Particulado/análise , Transtornos Respiratórios , Sons Respiratórios , Fatores de Risco , Instituições Acadêmicas , Inquéritos e Questionários , Vacinação
4.
Sci Total Environ ; 696: 133956, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31450053

RESUMO

BACKGROUND: Most studies on the short-term health effects of air pollution have been conducted on a daily time scale, while hourly associations remain unclear. METHODS: We collected the hourly data of emergency ambulance calls (EACs), ambient air pollution, and meteorological variables from 2014 to 2016 in Luoyang, a central Chinese city in Henan Province. We used a generalized additive model to estimate the hourly effects of ambient air pollutants (PM2.5, PM10, SO2, and NO2) on EACs for all natural causes and cardiovascular and respiratory morbidity, with adjustment for potential confounding factors. We further examined the effect modification by temperature, relative humidity, wind speed, and atmospheric pressure using stratified analyses. RESULTS: In the single-pollutant models, PM2.5, PM10, SO2, and NO2 were associated with an immediate increase in all-cause morbidity at 0, 0, 12, 10 h, separately, after exposure to these pollutants (excess risks: 0.19% (95% confidence interval (CI): 0.03%, 0.35%), 0.13% (95% CI: 0.02%, 0.24%), 0.28% (95% CI: 0.01%, 0.54%) and 0.52% (95% CI: 0.06%, 0.99%), respectively). These effects remained generally stable in two-pollutant models. SO2 and NO2 were significantly associated with an immediate increase in risk of cardiovascular morbidity, but the effects on respiratory morbidity were relatively more delayed. The stratified analyses suggested that temperature could modify the association between PM2.5 and EACs, humidity and atmospheric pressure could modify the association between SO2 and EACs. CONCLUSIONS: Our study provides new evidence that higher concentrations of PM2.5, PM10, SO2, and NO2 may have transiently acute effects on all-cause morbidity and subacute effects on respiratory morbidity. SO2 and NO2 may also have immediate effects on cardiovascular morbidity. Findings of this study have important implications for the formation of hourly air quality standards.


Assuntos
Poluição do Ar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Poluentes Atmosféricos/análise , Ambulâncias , China/epidemiologia , Humanos , Material Particulado/análise
5.
Ann Surg Oncol ; 26(11): 3577-3585, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31102094

RESUMO

BACKGROUND: Primary gallbladder neuroendocrine tumors (NETs) are rare, poorly understood cancers infrequently encountered at even the largest of tertiary referral centers. We therefore sought to identify a large cohort of patients with gallbladder NETs using a national database, with the aim of defining treatment modalities employed and survival associated with these uncommon malignancies. METHODS: Patients with primary gallbladder NETs were identified in the National Cancer Database, and clinicopathologic characteristics were recorded. A univariate log-rank survival analysis was completed for patients who underwent resection. Parameters found to be significant were entered into a multivariate accelerated failure time analysis. For context, survival comparisons were included for patients who underwent resections for NETs at any gastrointestinal site and for gallbladder adenocarcinoma. RESULTS: Overall, 754 patients with gallbladder NETs were identified. Patients were predominantly female (n = 518, 69%), White (n = 503, 67%), presented with stage IV disease (n = 295, 39%) and had high-grade lesions (n = 312, 41%). The majority underwent resection (n = 480, 64%), primarily simple cholecystectomy (n = 431, 90%), whereas a minority received multimodal therapy (n = 145, 21%). Among patients who underwent resection, older age (p = 0.001), large cell histology (p = 0.012), and positive margins (p = 0.030) were independently associated with worse overall survival. Patients with gallbladder NETs had improved survival relative to those with gallbladder adenocarcinoma (p = 0.001), but significantly worse survival than patients with NETs from other gastrointestinal sites (p < 0.001). CONCLUSIONS: Primary gallbladder NETs are aggressive lesions that carry a worse prognosis than NETs of other gastrointestinal sites. Older age, positive margins, and large cell histology are associated with abbreviated survival after resection.


Assuntos
Adenocarcinoma/mortalidade , Bases de Dados Factuais , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias Gastrointestinais/mortalidade , Tumores Neuroendócrinos/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Masculino , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
6.
Int J Cancer ; 145(1): 143-153, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30613963

RESUMO

While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking-related cancers. The current study was a population-based study of patients diagnosed with a primary malignancy from the top 10 smoking-related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking-related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50-1.52) and the EAR was 73.3 cases per 10,000 PYR compared to the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR = 2.06) and urinary bladder cancer had the highest excess burden (EAR = 151.4 per 10,000 PYR). The excess burden of SPM for all smoking-related cancers decreased between 2000 and 2003 (annual percentage change [APC] = -13.7%; p = 0.007) but increased slightly between 2003 and 2014 (APC = 1.6%, p = 0.032). We show that 1-in-12 survivors of smoking-related cancers developed an SPM. With the significant increase in the burden of SPM from smoking-related cancers in the last decade, clinicians should be cognizant of long-term smoking-related cancer risks among these patients as part of their survivorship care plans.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Segunda Neoplasia Primária/epidemiologia , Fumar/epidemiologia , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Risco , Programa de SEER , Carga Tumoral , Estados Unidos/epidemiologia , Adulto Jovem
8.
Chemosphere ; 218: 1042-1049, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30609483

RESUMO

Perfluoroalkyl substances (PFASs) are widely-utilized synthetic chemicals commonly found in industrial and consumer products. Previous studies have examined associations between PFASs and renal function, yet the results are mixed. Moreover, evidence on the associations of isomers of PFASs with renal function in population from high polluted areas is scant. To help to address this data gap, we used high performance liquid chromatography-mass spectrometry to measure serum isomers of perfluorooctanoate (PFOA), perfluorooctanesulfonate (PFOS), and other PFASs from 1612 adults residing in Shenyang, China, and characterized their associations with estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD). Results showed that after adjusted for multiple confounding factors, most of the higher fluorinated PFASs, except for PFOA and PFDA, were negatively associated with eGFR and positively associated with CKD. Compared with linear PFOS (n-PFOS), branched PFOS isomers (Br-PFOS) were more strongly associated with eGFR (Br-PFOS; ß = -1.22, 95%CI: 2.02, -0.42; p = 0.003 vs. n-PFOS; ß = -0.16, 95%CI: 0.98, 0.65; p = 0.691) and CKD (Br-PFOS; OR = 1.27; 95% CI: 1.02, 1.58; p = 0.037 vs. n-PFOS; OR = 0.98; 95% CI: 0.80, 1.20; p = 0.834). In conclusion, branched PFOS isomers were negatively associated with renal function whereas their linear counterparts were not. Given widespread exposure to PFASs, potential nephrotoxic effects are of great public health concern, Furthermore, longitudinal research on the potential nephrotoxic effects of PFASs isomers will be necessary to more definitively assess the risk.


Assuntos
Ácidos Alcanossulfônicos/química , Caprilatos/química , Poluentes Ambientais/química , Fluorcarbonetos/química , Taxa de Filtração Glomerular/fisiologia , China , Humanos , Testes de Função Renal
9.
Breast J ; 25(1): 112-116, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30536478

RESUMO

The purpose of this study was to determine whether racial disparities in reconstruction in the United States vary by geographic region. The SEER database years 2000-2013 was queried for all mastectomies in women ages 20-85+. Logistic regression was used to examine the main effects and interaction of race and geographic region on reconstruction. Hot spot Analysis was used to examine clustering of reconstruction across counties by race. We found large regional variation in racial differences in the rate of immediate postmastectomy reconstruction. Understanding how racial disparities vary by region can identify important factors for intervention to reduce disparities in practice.


Assuntos
Neoplasias da Mama/cirurgia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mamoplastia/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Modelos Logísticos , Mastectomia , Pessoa de Meia-Idade , Programa de SEER , Estados Unidos
10.
Am J Clin Oncol ; 42(2): 172-178, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30300170

RESUMO

OBJECTIVES: The aim of the study was to estimate hospitalization cost, and factors associated with hospitalization costs and length of stay (LOS) of patients treated for head and neck cancer in the United States. METHODS: Data on 71,440 weighted hospital admissions from the 2014 National Inpatient Sample with a diagnosis of head and neck cancer were examined. Multivariable linear regression models estimated factors associated with hospitalization costs, and negative binomial regression models were used to identify factors associated with hospital LOS. Factor variables included characteristics of the patient, clinical, and hospital characteristics. RESULTS: The average hospitalization cost was US $18,371 and the average LOS was 6.6 days. LOS was significantly associated with admissions involving bacterial infection, major operating procedures, chemo procedure, and radiation procedure as well as admissions at medium or small bed size hospitals, and rural hospitals. Admissions among black patients, elective admissions, admissions involving bacterial infection, major operating procedures, chemo procedure, radiation procedure, and advance comorbidities were associated with increased hospitalization costs. In contrast, admissions at urban nonteaching or rural had increased hospitalization costs. CONCLUSIONS: Admissions that involve higher number of comorbidities, metastasis, bacterial infection, radiation, and chemo procedures had longer hospital stay and higher cost whereas admissions are rural hospitals had shorter hospital stay and lower cost. Understanding these factors associated with increased LOS and hospitalization cost will help efforts to decrease health care cost and improve quality of care.


Assuntos
Neoplasias de Cabeça e Pescoço/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Tempo de Internação/economia , Idoso , Terapia Combinada , Comorbidade , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
11.
Eval Health Prof ; 42(4): 450-472, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29334770

RESUMO

An integral component of interprofessional education (IPE) is the development of a collaboration-ready health-care workforce. While collaboration is a fundamental element of IPE, there is no existing measure of collaboration skills that is not context specific. This article describes the development and initial validation of the Self-Assessed Collaboration Skills (SACS) measure. Items were initially drawn from the Collaboration Skills Assessment Tool rubric, an educational assessment tool. The SACS measure was piloted in a sample of students in an introductory IPE course. Following scale revision, the SACS was piloted a second time in a sample of students in an IPE health systems course and then validated in a sample of students in an introductory IPE course. Exploratory factor analysis was used to assess scale factor structure in Pilots 1 and 2 and confirmatory factor analysis to confirm factor structure in the validation sample. Convergent and discriminant validity were also assessed. The final SACS measure is an 11-item scale consisting of three dimensions of collaboration: information sharing, learning, and team support. The SACS measure demonstrates high internal consistency and both convergent and discriminant validity as a measure of collaboration. The SACS can be implemented in any setting for assessing collaboration in clinical and nonclinical contexts.

12.
Laryngoscope ; 129(8): 1828-1835, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30582167

RESUMO

OBJECTIVES/HYPOTHESIS: To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) and HPV-unrelated HNSCC and to 2) compare overall survival between those with HPV-related and HPV-unrelated index HNSCC among patients who develop SPM. STUDY DESIGN: Retrospective cohort analysis. METHODS: A retrospective study was conducted of 113,259 patients who were diagnosed with HNSCC from 2000 to 2014. SPM was defined as the first subsequent primary cancer occurring at least 2 months after index cancer diagnosis, and HPV-relatedness was based on whether patients' index HNSCC was potentially HPV-related or HPV-unrelated. Multivariable Fine and Gray (FG) competing-risks regression models were used to estimate factors associated with risk of SPM by HPV-relatedness. Among patients with SPM, an adjusted Cox proportional hazards (PH) regression model was used to assess the association between HPV-relatedness and survival. RESULTS: Approximately 13,900 patients (12.3%) developed SPM. In the FG model, patients with HPV-unrelated HNSCC had a 15% higher risk of developing SPM (adjusted hazard ratio: 1.15, 95% confidence interval: 1.10-1.20) than those with potentially HPV-related HNSCC, but the same characteristics were associated with SPM development. In the Cox PH model, patients with SPM whose index HNSCC was HPV-unrelated had higher risk of death than those whose index HNSCC was potentially HPV-related (adjusted hazard ratio: 1.06; 95% confidence interval: 1.02-1.11). CONCLUSIONS: Patients with HPV-unrelated HNSCC have a higher risk of SPM development than do those with HPV-related HNSCC. Effective secondary disease-prevention strategies should be established to improve long-term patient outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1828-1835, 2019.


Assuntos
Segunda Neoplasia Primária/mortalidade , Papillomaviridae , Infecções por Papillomavirus/complicações , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Segunda Neoplasia Primária/virologia , Infecções por Papillomavirus/virologia , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia
13.
Public Health Rep ; 133(6): 685-691, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30223759

RESUMO

OBJECTIVE: Research outside the United States shows that certain subgroups of patients (eg, those who are older, male, of low socioeconomic status, and uninsured) are less likely than others to report receiving diabetes self-management education (DSME); however, less is known about DSME uptake in the United States. We examined sociodemographic, patient, and behavioral characteristics associated with DSME in a nationally representative sample. METHODS: We analyzed data from the 2011-2013 Behavioral Risk Factor Surveillance System for 84 179 adults who self-identified receiving a diagnosis of diabetes. We constructed weighted, multivariate logistic regression models to examine the associations between DSME and sociodemographic characteristics (age, sex, race/ethnicity, marital status, education, and annual household income), patient characteristics (body mass index, having a regular provider, health insurance status, health status, and insulin use), and self-management behaviors (home foot examination, home blood glucose testing, and physical activity). RESULTS: More than half (n = 45 557, 53.7% [weighted]) of respondents reported engaging in DSME. Compared with non-Hispanic white adults, non-Hispanic black adults were more likely to engage in DSME (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI], 1.07-1.29). Respondents were less likely to engage in DSME if they were male (aOR = 0.85; 95% CI, 0.80-0.91) or Hispanic (aOR = 0.81; 95% CI, 0.71-0.92), were a high school graduate (but no college; aOR = 0.71; 95% CI, 0.66-0.78) or less than a high school graduate (aOR = 0.51; 95% CI, 0.45-0.59), had an annual household income of $15 000-$24 999 (aOR = 0.81; 95% CI, 0.73-0.89) or <$15 000 (aOR = 0.70; 95% CI, 0.62-0.78), or had no health insurance (aOR = 0.87; 95% CI, 0.76-0.98). DSME was significantly associated with all 3 self-management behaviors. CONCLUSIONS: Increasing public health interventions aimed at educating people with diabetes about self-management could improve outcomes.


Assuntos
Diabetes Mellitus/terapia , Educação de Pacientes como Assunto/estatística & dados numéricos , Autogestão/educação , Adolescente , Adulto , Fatores Etários , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Grupos de Populações Continentais/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30111688

RESUMO

To examine the association between oral health literacy (OHL) with sociodemographic variables and dental visitation in adults presenting to an urban emergency department (ED). Methods: This was a cross-sectional study of a convenience sample of 556 adults aged 18⁻90. Interview data from the study were used to collect self-reported sociodemographic characteristics and dental visitation history. The OHL of the study participants was measured using the Health Literacy in Dentistry scale (HeLD-14), and the score was dichotomized into low and high OHL. Bivariate associations between sociodemographic variables and OHL were conducted using chi-square tests, and logistic regression was used to examine the association between OHL and dental visitation within the past year. Results: Sixty percent of participants reported having visited a dentist within the past year. Over two-thirds of the sample was classified as having low OHL. Low OHL was more common in non-White races, less-educated, single, unemployed, and lower-income individuals, and those without a primary care physician or dental insurance (p < 0.05). Patients with low oral health literacy were 39% less likely to have visited the dentist in the past year (OR = 0.61; 95% CI 0.38, 0.96). Conclusions: This study highlights significant disparities in OHL. Interventions targeted toward the unique needs of underserved populations should be developed to improve health outcomes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Letramento em Saúde , Saúde Bucal , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Idoso , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Autorrelato , Adulto Jovem
15.
JAMA Otolaryngol Head Neck Surg ; 144(8): 727-737, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30027284

RESUMO

Importance: Second primary malignant neoplasms (SPMNs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Recently, human papillomavirus (HPV) has emerged as a risk factor for oropharyngeal squamous cell carcinoma and has different prognosis from classic tobacco/alcohol-associated HNSCC. This suggests that there also may be different risks and burden of SPMNs among patients who's HNSCC were from HPV or tobacco and/or alcohol. Objective: To assess SPMN risks and burden in a large US cohort of patients with a first potentially HPV-associated HNSCC vs non-HPV-associated HNSCC. Design, Setting, and Participants: In this population-based retrospective cohort study, 109 512 adult patients diagnosed with HNSCC between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results registry. Exposures: HPV-relatedness based on whether patients' first HNSCC was potentially associated with HPV. Patients were grouped into 2 cohorts: potentially HPV-associated HNSCC, and non-HPV-associated HNSCC. Main Outcomes and Measures: The primary outcome was incidence of SPMN (defined as the first subsequent primary cancer occurring at least 2 months after first cancer diagnosis). Excess SPMN risk was calculated using relative (standardized incidence ratios [SIRs]) and absolute (excess absolute risk [EAR] per 10 000 person-years at risk [PYR]). Results: A total of 109 512 patients with HNSCC (mean [SD] age, 61.9 [12.1] years; 83 305 [76.1%] men) were identified. The overall SIR was 2.18 (95% CI, 2.14-2.22) corresponding to 160 excess cases per 10 000 PYR. The risk among patients with first potentially HPV-associated HNSCC (SIR, 1.98; EAR, 114 excess cases per 10 000 PYR) was lower than those with first non-HPV-associated HNSCC (SIR, 2.28; EAR, 188 excess cases per 10 000 PYR). Overall, the largest SIRs and EARs were observed for cancers of the head and neck, lung, and esophagus. However, the risks of SPMN were lower among potentially HPV-associated HNSCC patients. Conclusions and Relevance: Patients diagnosed with HNSCC experience excess risk of SPMN, which was higher among those with non-HPV-associated HNSCC than from potentially HPV-associated HNSCC. Clinicians should implement strategies that prevent or detect SPMN early in patients with HNSCC.


Assuntos
Neoplasias de Cabeça e Pescoço , Segunda Neoplasia Primária/etiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/epidemiologia , Infecções por Papillomavirus/complicações , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Programa de SEER , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Estados Unidos
16.
Am J Hosp Palliat Care ; 35(11): 1369-1376, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29929381

RESUMO

BACKGROUND: Although practitioners overwhelmingly agree on the importance of advance care planning (ACP) and preparing for the end of life (EOL), the process is fraught with barriers. OBJECTIVE: The goal of this research was to explore potential connections between providers' own personal experiences and current professional practices in ACP and EOL care. DESIGN: A cross-sectional survey design, gathering voluntary, anonymous responses from participants between August and December 2016. The survey sought information from providers in 3 distinct areas: (1) personal experiences of loss, (2) personal ACP, and (3) professional practices related to ACP and EOL care. SETTING/PARTICIPANTS: One hundred and ninety health-care professionals (primarily physicians, nurses, and social workers) participated in the survey across a greater, Metropolitan area in the Midwest. MEASUREMENTS: Questions for professional practices were subscales from the End-of-Life Professional Caregiver Survey: Patient- and Family-Centered Communication (PFCC) and Effective Care Delivery (ECD). Questions developed by the research team were evaluated by judges chosen for clinical and/or research expertise. RESULTS: Numerous connections were found between professionals' histories of loss, personal ACP, and professional practices. For example, both clinicians with personal experience caring for someone who is dying and clinicians who had completed their own ACP scored higher in both PFCC and ECD and were more likely to refer patients to hospice and palliative care. CONCLUSIONS: Results support educational interventions involving opportunities for reflection and completion and communication about ACP. Additionally, educational opportunities for students in health care should focus on incorporating both ACP and greater exposure to hospice and palliative care.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Pessoal de Saúde/psicologia , Assistentes Sociais/psicologia , Assistência Terminal/organização & administração , Assistência Terminal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Artigo em Inglês | MEDLINE | ID: mdl-29695038

RESUMO

Foodborne illness is a serious and preventable public health problem affecting 1 in 6 Americans with cost estimates over $50 billion annually. Local health departments license and inspect restaurants to ensure food safety and respond to reports of suspected foodborne illness. The City of St. Louis Department of Health adopted the HealthMap Foodborne Dashboard (Dashboard), a tool that monitors Twitter for tweets about food poisoning in a geographic area and allows the health department to respond. We evaluated the implementation by interviewing employees of the City of St. Louis Department of Health involved in food safety. We interviewed epidemiologists, environmental health specialists, health services specialists, food inspectors, and public information officers. Participants viewed engaging innovation participants and executing the innovation as challenges while they felt the Dashboard had relative advantage over existing reporting methods and was not complex once in place. This study is the first to examine practitioner perceptions of the implementation of a new technology in a local health department. Similar implementation projects should focus more on process by developing clear and comprehensive plans to educate and involve stakeholders prior to implementation.


Assuntos
Inocuidade dos Alimentos/métodos , Doenças Transmitidas por Alimentos/epidemiologia , Saúde Pública , Restaurantes/normas , Mídias Sociais , Algoritmos , Assistência à Saúde , Doenças Transmitidas por Alimentos/prevenção & controle , Humanos , Entrevistas como Assunto , Estados Unidos
18.
J Natl Compr Canc Netw ; 16(2): 136-143, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29439174

RESUMO

Background: This study aimed to determine patient-, tumor-, and hospital-level characteristics associated with venous thromboembolism (VTE), and to assess the impact of VTE on in-hospital mortality and length of hospital stay in hospitalized patients with metastatic cancer. Methods: Using the Nationwide Inpatient Sample database, a cross-sectional analysis was performed of patients aged ≥18 years with at least 1 diagnosis of primary solid tumor and subsequent secondary or metastatic tumor between 2008 and 2013. Results: Among 850,570 patients with metastatic cancer, 6.6% were diagnosed with VTE. A significant trend for increasing VTE rates were observed from 2008 to 2013 (5.7%-7.2%; P<.0001). Using an adjusted multilevel hierarchical regression model, higher odds of VTE were seen among women (odds ratio [OR], 1.04; 95% CI, 1.02-1.06), black versus white patients (OR, 1.14; 95% CI, 1.11-1.18), and those with an Elixhauser comorbidity index score of ≥3 (OR, 2.50; 95% CI, 2.38-2.63). Hospital-level correlates of VTE included treatment in a teaching hospital (OR, 1.05; 95% CI, 1.01-1.11) and an urban location (OR, 1.18; 95% CI, 1.09-1.27), and admission to hospitals in the Northeast (OR, 1.16; 95% CI, 1.08-1.24) and West (OR, 1.09; 95% CI, 1.03-1.16) versus the South. Patients with metastasis to the liver, brain, or respiratory organs and those with multiple (≥2) metastatic sites had higher odds of VTE, whereas those with metastasis to lymph nodes and genital organs had lower odds. Patients diagnosed with versus without VTE had higher odds of in-hospital mortality (OR, 1.50; 95% CI, 1.38-1.63) and prolonged hospital stay (OR, 1.65; 95% CI, 1.57-1.73). Conclusions: The frequency of VTE in patients with metastatic cancer is increasing. Patient characteristics, hospital factors, and site of metastasis independently predict the occurrence of VTE and allow for better stratification of patients with cancer according to their VTE risk.


Assuntos
Hospitalização , Neoplasias/complicações , Neoplasias/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias/diagnóstico , Razão de Chances , Avaliação de Resultados da Assistência ao Paciente , Tromboembolia Venosa/diagnóstico , Adulto Jovem
19.
Am J Crit Care ; 27(1): 24-31, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29292272

RESUMO

BACKGROUND: Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown. OBJECTIVE: To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube. METHODS: Patients' data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ2 test, and logistic regression was used to examine odds of sinusitis development by tube type. RESULTS: Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes. CONCLUSION: Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.


Assuntos
Intubação Gastrointestinal/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Grupos de Populações Continentais , Feminino , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sinusite/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
20.
Am J Crit Care ; 26(6): 466-473, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29092869

RESUMO

BACKGROUND: Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative. OBJECTIVES: To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (< 4.0, < 4.5, < 5.0, and < 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates. METHODS: Gastric and tracheal aspirates were collected from critically ill infants undergoing mechanical ventilation who had nasogastric or orogastric feeding tubes. Aspirates were tested with colorimetric pH indicators and a rapid pepsin assay. Information about treatment conditions was obtained from medical records. RESULTS: Two hundred twelve gastric aspirates and 60 tracheal aspirates were collected from 212 patients. Sensitivity was highest and specificity was lowest at the gastric aspirate pH cut point of less than 5.5. Positive predictive values were 100% at all pH cut points less than 5.0. Negative predictive values were higher at the pH cut point of less than 5.0 than at cut points less than 4.5. A higher percentage of pepsin-positive readings was found in gastric aspirates (88.3%) than in tracheal aspirates (5.4%). CONCLUSION: For a desired positive predictive value of 100%, a pH cut point of less than 5.0 provides the best negative predictive values, regardless of gastric acid inhibitor administration and feeding status. The pepsin assay is promising as an additional marker to distinguish gastric from tracheal aspirates.


Assuntos
Nutrição Enteral/métodos , Suco Gástrico/química , Terapia Intensiva Neonatal/métodos , Intubação Gastrointestinal/métodos , Educação Continuada em Enfermagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes
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