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3.
MMWR Morb Mortal Wkly Rep ; 69(3): 90-94, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971931

RESUMO

Since August 2019, CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders have been investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products analyzed through the National Syndromic Surveillance Program (NSSP). As of January 14, 2020, a total of 2,668 hospitalized EVALI cases had been reported to CDC. Median patient age was 24 years, and 66% were male. Overall, 82% of EVALI patients reported using any tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (including 33% with exclusive THC-containing product use), and 57% of EVALI patients reported using any nicotine-containing product (including 14% with exclusive nicotine-containing product use). Syndromic surveillance indicates that ED visits related to e-cigarette, or vaping, products continue to decline after sharply increasing in August 2019 and peaking in September 2019. Clinicians and public health practitioners should remain vigilant for new EVALI cases. CDC recommends that persons not use THC-containing e-cigarette, or vaping, products, especially those acquired from informal sources such as friends, family members, or from in-person or online dealers. Vitamin E acetate is strongly linked to the EVALI outbreak and should not be added to any e-cigarette, or vaping, products (2). However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC-containing products, in some reported EVALI cases.


Assuntos
Surtos de Doenças , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Dronabinol/toxicidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lesão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Vitamina E/toxicidade , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 68(41): 928-933, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31622286

RESUMO

Each year, tobacco use is responsible for approximately 8 million deaths worldwide, including 7 million deaths among persons who use tobacco and 1.2 million deaths among nonsmokers exposed to secondhand smoke (SHS) (1). Approximately 80% of the 1.1 billion persons who smoke tobacco worldwide reside in low- and middle-income countries (2,3). The World Health Organization's (WHO's) Framework Convention on Tobacco Control (FCTC) provides the foundation for countries to implement and manage tobacco control through the MPOWER policy package,* which includes monitoring tobacco use, protecting persons from SHS, warning them about the danger of tobacco, and enforcing bans on tobacco advertising, promotion, or sponsorship (tobacco advertising) (4). CDC analyzed data from 11 countries that completed two or more rounds of the Global Adult Tobacco Survey (GATS) during 2008-2017. Tobacco use and tobacco-related behaviors that were assessed included current tobacco use, SHS exposure, thinking about quitting because of warning labels, and exposure to tobacco advertising. Across the assessed countries, the estimated percentage change in tobacco use from the first round to the most recent round ranged from -21.5% in Russia to 1.1% in Turkey. Estimated percentage change in SHS exposure ranged from -71.5% in Turkey to 72.9% in Thailand. Estimated percentage change in thinking about quitting because of warning labels ranged from 77.4% in India to -33.0% in Turkey. Estimated percentage change in exposure to tobacco advertising ranged from -66.1% in Russia to 44.2% in Thailand. Continued implementation and enforcement of proven tobacco control interventions and strategies at the country level, as outlined in MPOWER, can help reduce tobacco-related morbidity and mortality worldwide (3,5,6).


Assuntos
Saúde Global/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/psicologia , Adulto , Inquéritos Epidemiológicos , Humanos
5.
Midwifery ; 69: 92-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30453122

RESUMO

BACKGROUND: Labor and birth companionship is a key aspect of respectful maternity care. Lack of companionship deters women from accessing facility-based delivery care, though formal and informal policies against companionship are common in sub-Saharan African countries. AIM: To identify client and provider factors associated with labor and birth companionship DESIGN: Cross-sectional evaluation among delivery clients and providers in 61 health facilities in Kigoma Region, Tanzania, April-July 2016. METHODS: Multilevel, mixed effects logistic regression analyses were conducted on linked data from providers (n = 249) and delivery clients (n = 935). Outcome variables were Companion in labor and Companion at the time of birth. FINDINGS: Less than half of women reported having a labor companion (44.7%) and 12% reported having a birth companion. Among providers, 26.1% and 10.0% reported allowing a labor and birth companion, respectively. Clients had significantly greater odds of having a labor companion if their provider reported the following traits: working more than 55 hours/week (aOR 2.46, 95% CI 1.23-4.97), feeling very satisfied with their job (aOR 3.66, 95% CI 1.36-9.85), and allowing women to have a labor companion (aOR 3.73, 95% CI 1.58-8.81). Clients had significantly lower odds of having a labor companion if their provider reported having an on-site supervisor (aOR 0.48, 95% CI 0.24-0.95). Clients had significantly greater odds of having a birth companion if they self-reported labor complications (aOR 2.82, 95% CI 1.02-7.81) and had a labor companion (aOR 44.74, 95% CI 11.99-166.91). Clients had significantly greater odds of having a birth companion if their provider attended more than 10 deliveries in the last month (aOR 3.43, 95% CI 1.08-10.96) compared to fewer deliveries. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These results suggest that health providers are the gatekeepers of companionship, and the work environment influences providers' allowance of companionship. Facilities where providers experience staff shortages and high workload may be particularly responsive to programmatic interventions that aim to increase staff acceptance of birth companionship.


Assuntos
Parto Obstétrico/normas , Amigos/psicologia , Relações Interpessoais , Enfermeiras Obstétricas/psicologia , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Doulas/estatística & dados numéricos , Feminino , Política de Saúde/tendências , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Tanzânia , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
6.
MMWR Morb Mortal Wkly Rep ; 64(3): 63-6, 2015 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-25632954

RESUMO

Before the current Ebola epidemic in West Africa, there were few documented cases of symptomatic Ebola patients traveling by commercial airline, and no evidence of transmission to passengers or crew members during airline travel. In July 2014 two persons with confirmed Ebola virus infection who were infected early in the Nigeria outbreak traveled by commercial airline while symptomatic, involving a total of four flights (two international flights and two Nigeria domestic flights). It is not clear what symptoms either of these two passengers experienced during flight; however, one collapsed in the airport shortly after landing, and the other was documented to have fever, vomiting, and diarrhea on the day the flight arrived. Neither infected passenger transmitted Ebola to other passengers or crew on these flights. In October 2014, another airline passenger, a U.S. health care worker who had traveled domestically on two commercial flights, was confirmed to have Ebola virus infection. Given that the time of onset of symptoms was uncertain, an Ebola airline contact investigation in the United States was conducted. In total, follow-up was conducted for 268 contacts in nine states, including all 247 passengers from both flights, 12 flight crew members, eight cleaning crew members, and one federal airport worker (81 of these contacts were documented in a report published previously). All contacts were accounted for by state and local jurisdictions and followed until completion of their 21-day incubation periods. No secondary cases of Ebola were identified in this investigation, confirming that transmission of Ebola during commercial air travel did not occur.


Assuntos
Aeronaves , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Prática de Saúde Pública , Viagem , Busca de Comunicante , Pessoal de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Nigéria/epidemiologia , Doenças Profissionais , Estados Unidos/epidemiologia
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