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1.
Nephrol Nurs J ; 46(6): 629-640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872993

RESUMO

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


Assuntos
Lesão Renal Aguda , Complicações do Diabetes , Diabetes Mellitus , Hospitalização , Lesão Renal Aguda/complicações , Lesão Renal Aguda/epidemiologia , California/epidemiologia , Complicações do Diabetes/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Fatores de Risco
2.
Am J Ind Med ; 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31773783

RESUMO

BACKGROUND: Kidney damage is associated with an increased workload in high ambient temperatures and may represent a pathway to chronic kidney disease of unknown origin in agricultural workers. We tested the associations of workload and heat with acute kidney dysfunction in California agricultural workers. METHODS: We recruited a convenience sample of 471 agricultural workers from 29 farms in California during two summer harvest seasons. The sustained 3-minute maximum workload was estimated using accelerometer data collected from Actical monitors and individual heat load through elevations in core body temperature. Acute kidney injury (AKI) was defined by a change in serum creatinine of ≥0.3 mg/dL or ≥1.5 times the preshift creatinine over the course of the work shift. Associations between AKI and workload were modeled using logistic regression, controlling for demographic, physiologic, and occupational variables. RESULTS: Of the total, 357 workers (75.8%) had accelerometer readings in the moderate workload category, 93 (19.7%) had readings in the vigorous category. 177 (36%) had elevations of core body temperature ≥1°C; 72 workers (14.9%) demonstrated evidence of AKI after a single day of agricultural work. The workload category was associated with an increased adjusted odds of AKI (1.92; 95% confidence interval, 1.05-3.51). Piece-rate work was also associated with increased adjusted odds of AKI (3.02; 95% CI, 1.44-6.34). CONCLUSIONS: Heavy occupational workload and piece-rate work were associated with acute effects on the renal health of agricultural workers. This indicates that occupations requiring high physical effort put workers at risk for AKI, possibly independent of ambient and core body temperature. Changes to agricultural practices may reduce the risk of renal disorders for these workers.

3.
J Health Care Poor Underserved ; 30(4): 1289-1301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680099

RESUMO

Latino agricultural workers in California are a vulnerable population at risk for many undiagnosed health concerns. Principal among them is diabetes, and the prevalence of diagnosed and undiagnosed diabetes is difficult to estimate. In a convenience sample of 579 agricultural workers recruited through the California Heat Illness Prevention Study (CHIPS), we found HbA1c levels consistent with diabetes in 54 participants, of whom 33 (61.1%) were aware of their status. We found HbA1c levels consistent with pre-diabetes in 59 participants, of whom none was aware. Results indicate a health disparity between agricultural workers and other populations in the U.S. Many are unaware of having a chronic illness and lack resources or have other barriers to manage it. Nurses, midlevel providers, and health fairs are often the first or only point of health care contact for agricultural workers and can provide valuable information, screening, and support for this vulnerable population.

4.
Annu Rev Public Health ; 39: 351-365, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29400993

RESUMO

In 2015, approximately 244 million people were transnational migrants, approximately half of whom were workers, often engaged in jobs that are hazardous to their health. They work for less pay, for longer hours, and in worse conditions than do nonmigrants and are often subject to human rights violations, abuse, human trafficking, and violence. Worldwide, immigrant workers have higher rates of adverse occupational exposures and working conditions, which lead to poor health outcomes, workplace injuries, and occupational fatalities. Health disparities of immigrant workers are related to environmental and occupational exposures and are a result of language/cultural barriers, access to health care, documentation status, and the political climate of the host country. Recommendations on global and local scales are offered as potential solutions to improving the health of immigrant workers.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Exposição Ocupacional/estatística & dados numéricos , Direitos Humanos , Humanos , Saúde do Trabalhador , Ocupações/estatística & dados numéricos , Violência , Local de Trabalho
5.
Curr Environ Health Rep ; 4(3): 349-354, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28812286

RESUMO

PURPOSE OF REVIEW: Immigrants experience higher rates of occupational injury and fatality than their native-born counterparts. This review summarizes the current data related to occupational/environmental exposures and explores potential reasons for the disparities. RECENT FINDINGS: Immigrant workers are employed in sectors that expose them to dangerous working conditions. They experience increased risk for exposure to heat, pesticides, hazardous chemicals, and cleaning agents, as well as physical hazards such as falls. Immigrant workers are at increased risk for occupational injury and fatality due to the nature of the work they traditionally perform, a lack of enforced safety regulations, and limited access to health care or worker's compensation benefits.


Assuntos
Emigrantes e Imigrantes , Exposição Ocupacional , Saúde do Trabalhador/etnologia , Traumatismos Ocupacionais/etnologia , Emprego , Disparidades nos Níveis de Saúde , Humanos , Doenças Profissionais/etnologia , Fatores de Risco
6.
J Occup Environ Med ; 59(7): 649-658, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28414703

RESUMO

OBJECTIVE: The California heat illness prevention study (CHIPS) devised methodology and collected physiological data to assess heat related illness (HRI) risk in Latino farmworkers. METHODS: Bilingual researchers monitored HRI across a workshift, recording core temperature, work rate (metabolic equivalents [METs]), and heart rate at minute intervals. Hydration status was assessed by changes in weight and blood osmolality. Personal data loggers and a weather station measured exposure to heat. Interviewer administered questionnaires were used to collect demographic and occupational information. RESULTS: California farmworkers (n = 588) were assessed. Acceptable quality data was obtained from 80% of participants (core temperature) to 100% of participants (weight change). Workers (8.3%) experienced a core body temperature more than or equal to 38.5 °C and 11.8% experienced dehydration (lost more than 1.5% of body weight). CONCLUSIONS: Methodology is presented for the first comprehensive physiological assessment of HRI risk in California farmworkers.


Assuntos
Agricultura , Pesquisa Biomédica/métodos , Desidratação/fisiopatologia , Transtornos de Estresse por Calor/fisiopatologia , Hispano-Americanos , Exposição Ocupacional/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Química do Sangue , Temperatura Corporal , Peso Corporal , California , Desidratação/etiologia , Emigrantes e Imigrantes , Feminino , Frequência Cardíaca , Transtornos de Estresse por Calor/etiologia , Transtornos de Estresse por Calor/prevenção & controle , Temperatura Alta/efeitos adversos , Humanos , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Saúde do Trabalhador , Estado de Hidratação do Organismo , Concentração Osmolar , Seleção de Pacientes , Inquéritos e Questionários , Temperatura Ambiente , Adulto Jovem
7.
Occup Environ Med ; 74(6): 402-409, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28093502

RESUMO

BACKGROUND: Agricultural work can expose workers to increased risk of heat strain and volume depletion due to repeated exposures to high ambient temperatures, arduous physical exertion and limited rehydration. These risk factors may result in acute kidney injury (AKI). METHODS: We estimated AKI cumulative incidence in a convenience sample of 283 agricultural workers based on elevations of serum creatinine between preshift and postshift blood samples. Heat strain was assessed based on changes in core body temperature and heart rate. Volume depletion was assessed using changes in body mass over the work shift. Logistic regression models were used to estimate the associations of AKI with traditional risk factors (age, diabetes, hypertension and history of kidney disease) as well as with occupational risk factors (years in farm work, method of payment and farm task). RESULTS: 35 participants were characterised with incident AKI over the course of a work shift (12.3%). Workers who experienced heat strain had increased adjusted odds of AKI (1.34, 95% CI 1.04 to 1.74). Piece rate work was associated with 4.24 odds of AKI (95% CI 1.56 to 11.52). Females paid by the piece had 102.81 adjusted odds of AKI (95% CI 7.32 to 1443.20). DISCUSSION: Heat strain and piece rate work are associated with incident AKI after a single shift of agricultural work, though gender differences exist. Modifications to payment structures may help prevent AKI.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Doenças dos Trabalhadores Agrícolas/epidemiologia , Doenças dos Trabalhadores Agrícolas/etiologia , Transtornos de Estresse por Calor/epidemiologia , Temperatura Alta/efeitos adversos , Exposição Ocupacional/efeitos adversos , Lesão Renal Aguda/sangue , Adulto , Doenças dos Trabalhadores Agrícolas/sangue , Agricultura , Índice de Massa Corporal , California/epidemiologia , Creatinina/sangue , Fazendeiros , Feminino , Taxa de Filtração Glomerular , Transtornos de Estresse por Calor/sangue , Transtornos de Estresse por Calor/complicações , Humanos , Modelos Logísticos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Adulto Jovem
8.
J Interprof Care ; 31(1): 129-131, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27996355

RESUMO

Promoting interprofessional education (IPE) and practice is a priority in academic health centres; however, implementation of IPE can be challenging. Recognizing the need for faculty development in teaching, and specifically IPE, the University of California, Davis Schools of Health launched the Interprofessional Teaching Scholars Program (ITSP) in 2014. Two cohorts of 11 faculty scholars each completed the nine-month programme and participated in this longitudinal comparative study in which pre- and post-assessments using a validated survey instrument were administered to measure changes in faculty attitudes towards IPE and collaborative practice. There was a statistically significant increase in the summated scores on all three of the subscales: Attitudes Towards Interprofessional Health Care Teams, Attitudes Towards IPE, and Attitudes Towards Interprofessional Learning in the Academic Setting. The results suggest that the ITSP was associated with positive changes in faculty attitudes related to interprofessional collaboration and teamwork.


Assuntos
Atitude , Docentes/psicologia , Pessoal de Saúde/educação , Relações Interprofissionais , Humanos , Estudos Longitudinais , Desenvolvimento de Pessoal/organização & administração
9.
BMJ Open ; 6(8): e010905, 2016 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-27515749

RESUMO

OBJECTIVE: To examine the influence of neighbourhood socioeconomic position (NSEP) on development of diabetes over time. DESIGN: A longitudinal cohort study. SETTING: The data reported were from the Sacramento Area Latino Study on Aging, a longitudinal study of the health of 1789 older Latinos. PARTICIPANTS: Community-dwelling older Mexican Americans residing in the Sacramento Metropolitan Statistical Area. MAIN OUTCOME: Multistate Markov regression were used to model transitions through four possible states over time: 1=normal; 2=pre-diabetic; 3=diabetic; and 4=death without diabetes. RESULTS: At baseline, nearly 50% were non-diabetic, 17.5% were pre-diabetic and nearly 33% were diabetic. At the end of follow-up, there were a total of 824 people with type 2 diabetes. In a fully adjusted MSM regression model, among non-diabetics, higher NSEP was not associated with a transition to pre-diabetes. Among non-diabetics, higher NSEP was associated with an increased risk of diabetes (HR=1.66, 95% CI 1.14 to 2.42) and decreased risk of death without diabetes (HR: 0.56, 95% CI 0.33 to 0.96). Among pre-diabetics, higher NSEP was significantly associated with a transition to non-diabetic status (HR: 1.22, 95% CI 0.99 to 1.50). Adjusting for BMI, age, education, physical activity, smoking, alcohol consumption, medical insurance and nativity did not affect this relationship. CONCLUSIONS: Our findings show that high NSEP poses higher risk of progression from normal to diabetes compared with a lower risk of death without diabetes. This work presents a possibility that these associations are modified by nativity or culture.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Americanos Mexicanos , Estado Pré-Diabético/epidemiologia , Características de Residência , Classe Social , Idoso , Envelhecimento , California/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Progressão da Doença , Humanos , Estudos Longitudinais , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Biológicos , Prevalência , Fatores de Risco
10.
J Occup Environ Med ; 58(4): 391-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27058480

RESUMO

OBJECTIVE: Chronic kidney disease in Central America suggests that agricultural work is potentially harmful to the kidneys. We investigated the cumulative incidence of acute kidney injury (AKI) over one work shift among agricultural workers in California. METHODS: Serum creatinine was measured both before and after a work shift to estimate AKI. Associations of incident AKI with traditional and occupational risk factors were tested using Chi-square and trend tests and logistic regression. RESULTS: In 295 agricultural workers, AKI after a summer work shift was detected in 35 participants (11.8%). Piece-rate work was associated with 4.52 adjusted odds of AKI (95% confidence interval 1.61 to 12.70). CONCLUSION: The cumulative incidence of AKI after a single day of summer agricultural work is alarming due to an increased risk of long-term kidney damage and mortality.


Assuntos
Lesão Renal Aguda/epidemiologia , Doenças dos Trabalhadores Agrícolas/epidemiologia , Agricultura/estatística & dados numéricos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Doenças dos Trabalhadores Agrícolas/sangue , Doenças dos Trabalhadores Agrícolas/diagnóstico , California/epidemiologia , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Salários e Benefícios
11.
J Transcult Nurs ; 27(2): 181-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25636709

RESUMO

PURPOSE: Global nurse migration has a recognized impact on host and source countries, but the lived experience of foreign educated nurses is an important aspect of the success of this migration. A systematic review of the literature was conducted to understand the lived migration and acculturation experiences of foreign educated nurses. DESIGN: A systematic review of the literature, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted. Primary research articles or secondary analyses were selected based on keyword and citation-based searches (n = 44). FINDINGS: Nurses' experiences included migration and licensing barriers, difficulty with communication, racism and discrimination, skill underutilization, acculturation, and the role of the family. CONCLUSIONS: Barriers encountered in host countries may impede acculturation and successful nursing practice, resulting in circular migration and poor patient safety outcomes. IMPLICATIONS FOR PRACTICE: Social support systems and cultural orientation programs can mitigate the impacts of social isolation and racism. Addressing common barriers can help minimize deskilling and allow safe and effective transitions to host countries.


Assuntos
Emigrantes e Imigrantes , Recursos Humanos de Enfermagem no Hospital/psicologia , Padrões de Prática em Enfermagem , Barreiras de Comunicação , Emigrantes e Imigrantes/psicologia , Saúde Global , Humanos , Racismo , Enfermagem Transcultural
12.
Clin Pediatr (Phila) ; 54(14): 1366-74, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25926668

RESUMO

OBJECTIVE: It is uncertain whether children of all weight classifications receive the recommended screening and counseling and if these affect weight status in the subsequent year. METHODS: Data from the 2008-2011 Medical Expenditures Panel Survey were used to examine associations between weight classification and receipt of weight-related screening and counseling from the pediatric provider (n = 9835). Body mass index (BMI) z-score in the subsequent year was modeled as a function of the BMI z-score in year 1. RESULTS: Normal and overweight children have lower odds than obese children of receiving counseling regarding diet (adjusted odds ratio [AOR] = 0.58, 95% confidence interval [CI] = 0.50-0.68; AOR = 0.75, 95% CI = 0.63-0.89, respectively) and exercise (AOR = 0.56, 95% CI = 0.48-0.65; AOR = 0.75, 95% CI = 0.64-0.89, respectively). Counseling was associated with a small increase in BMI z-score in the subsequent year (ß = 0.06, 95% CI = 0.01-0.11), as was maternal weight class. CONCLUSIONS: Recommendations to focus prevention on the family unit may reduce childhood overweight and obesity.


Assuntos
Aconselhamento , Programas de Rastreamento , Obesidade Pediátrica/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Índice de Massa Corporal , Criança , Demografia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Obesidade Pediátrica/epidemiologia , Estados Unidos/epidemiologia
13.
J Rural Health ; 31(1): 27-34, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25040420

RESUMO

PURPOSE: Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. METHODS: A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. FINDINGS: Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. CONCLUSIONS: Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Seguro Saúde/normas , Adulto , Estudos Transversais , Feminino , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
14.
J Pediatr ; 165(4): 866-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25091259

RESUMO

We examined pediatric insurance status and receipt of weight-related anticipatory guidance in the 2008-2010 Medical Expenditures Panel Survey (n = 12,438). Hispanic children were more likely than white children to report diet and exercise counseling, regardless of insurance. Given the risks of overweight and obesity among Hispanic children, these findings are promising.


Assuntos
Hispano-Americanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde , Pediatria/métodos , Adolescente , Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/métodos , Pré-Escolar , Estudos Transversais , Dieta , Exercício , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Obesidade/etnologia , Obesidade/prevenção & controle , Razão de Chances , Pediatria/economia , Medicina Preventiva/economia , Medicina Preventiva/métodos
15.
J Nurs Adm ; 42(4): 202-7, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22441402

RESUMO

Helping nursing graduates transition to practice is a concern for nursing educators and employers. This article reports graduates' perceptions of transition both when jobs were plentiful and when jobs were scarce. Survey results from comparison of 2008 and 2010 graduates demonstrated few differences. Key indicators of successful transition were positive feedback at the work site, increased self-confidence on the part of the new graduate, and acceptance by the care team. Presence of good role models, ability to ask questions safely, and ongoing feedback on performance assisted successful transition.


Assuntos
Atitude do Pessoal de Saúde , Economia , Emprego , Enfermeiras e Enfermeiros/psicologia , Inovação Organizacional , Humanos , Estados Unidos
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