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1.
Sex Transm Dis ; 51(3): 192-198, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38412466

RESUMO

BACKGROUND: As the incidence of syphilis continues to increase, examining benzathine penicillin G (BPG) treatment data provides valuable insight for public health strategies. This study analyzed the trends of where BPG is administered relative to the initial clinical site of syphilis diagnosis. Our findings are timely in the context of recent national BPG shortages. METHODS: The analysis included persons diagnosed with any syphilis stage in Maricopa County, Arizona, from January 1, 2021, to December 31, 2021. The Arizona surveillance database (PRISM) was the source of demographic, testing, and treatment data. RESULTS: Of a total of 4028 persons with syphilis, 3038 (75.4%) received at least 1 injection of BPG. Among persons who received an initial BPG injection, only 1719 (56.6%) were diagnosed and treated at the same clinical site type. The Maricopa County Sexually Transmitted Disease Clinic administered BPG to 48.8% (n = 1483) of persons with syphilis who received an initial injection. CONCLUSIONS: Our findings analyze trends in BPG administration that are likely due to treatment referral practices and medication cost. Administration of BPG is not guaranteed at the clinical site of diagnosis, highlighting concerns regarding access to BPG. A burden is placed on patients who are required to leave their diagnosing provider to seek syphilis treatment at other health facilities that administer BPG.


Assuntos
Penicilina G Benzatina , Sífilis , Humanos , Penicilina G Benzatina/uso terapêutico , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Arizona/epidemiologia , Saúde Pública , Instalações de Saúde , Antibacterianos/uso terapêutico
2.
Cancer Med ; 13(3): e7007, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38400688

RESUMO

BACKGROUND: Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease-free survival (DFS), and overall survival (OS). METHODS: Arizona Cancer Registry (2009-2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox-regression hazard models were used to test DFS and OS. RESULTS: Hispanic and AI patients with T1 tumors had a longer time to surgery than non-Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02-2.31) and cT2 (OR 2.32, 95% CI: 1.13-4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99-3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17-1.99) and OS (HR 1.63, 95% CI: 1.26-2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07-2.57). CONCLUSIONS: High social vulnerability was associated with increased time to surgery and poor survival after surgery.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Etnicidade , Arizona/epidemiologia , Vulnerabilidade Social , Grupos Minoritários , Neoplasias Renais/cirurgia , Rim
3.
BMC Public Health ; 24(1): 648, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38424548

RESUMO

BACKGROUND: Widespread transmission of COVID-19 continues to threaten public health, particularly of rural, American Indian communities. Although COVID-19 risk factors for severe disease and clinical characteristics are well described in the general population, there has been little shared on hospitalized American Indian populations. METHODS: In this observational study, we performed chart extractions on all persons hospitalized with COVID-19 from April 1 through July 31, 2020 among an exclusively American Indian population living on or near Tribal lands in eastern Arizona. We provide descriptive statistics for the cohort stratified by presentation, comparing those who self-presented or were referred by an outreach program. Exploratory analyses were performed to identify risk factors for morbidity and mortality. RESULTS: During the observation period, 2262 persons were diagnosed with COVID-19 and 490 (22%) were hospitalized. Hospitalized persons had a median age of 54 years; 92% had at least one comorbidity, 72% had greater than one comorbidity, and 60% had a BMI of > 30. Most persons required supplemental oxygen (83%), but the majority (62%) only required nasal cannula and only 11% were intubated. The case fatality rates were 1.7% for the population, 7.1% among hospitalizations, and 9.3% among hospitalized patients 50 years and older. All rates that are significantly lower than those reported nationally during the same period. CONCLUSIONS: We observed a cohort of American Indian patients hospitalized secondary to COVID-19 with greater number of comorbidities compared to the general population but with lower mortality rates. We posit that the primary driver of mortality reduction for this population and the hospitalized cohort was a community-based referral program that led to disproportionately lower fatality rates among the oldest persons.


Assuntos
COVID-19 , Hospitalização , Humanos , Pessoa de Meia-Idade , Indígena Americano ou Nativo do Alasca , Arizona/epidemiologia , Comorbidade , COVID-19/epidemiologia , COVID-19/mortalidade , Fatores de Risco
4.
Sci Rep ; 14(1): 1311, 2024 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-38225347

RESUMO

Coccidioides is the fungal causative agent of Valley fever, a primarily pulmonary disease caused by inhalation of fungal arthroconidia, or spores. Although Coccidioides has been an established pathogen for 120 years and is responsible for hundreds of thousands of infections per year, little is known about when and where infectious Coccidioides arthroconidia are present within the ambient air in endemic regions. Long-term air sampling programs provide a means to investigate these characteristics across space and time. Here we present data from > 18 months of collections from 11 air sampling sites across the Phoenix, Arizona, metropolitan area. Overall, prevalence was highly variable across space and time with no obvious spatial or temporal correlations. Several high prevalence periods were identified at select sites, with no obvious spatial or temporal associations. Comparing these data with weather and environmental factor data, wind gusts and temperature were positively associated with Coccidioides detection, while soil moisture was negatively associated with Coccidioides detection. These results provide critical insights into the frequency and distribution of airborne arthroconidia and the associated risk of inhalation and potential disease that is present across space and time in a highly endemic locale.


Assuntos
Coccidioidomicose , Coccidioidomicose/epidemiologia , Coccidioidomicose/microbiologia , Coccidioides , Arizona/epidemiologia , Tempo (Meteorologia) , Temperatura , Esporos Fúngicos
5.
Psychiatr Serv ; 75(2): 148-154, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37554005

RESUMO

OBJECTIVE: In July 2022, the 988 Suicide and Crisis Lifeline went live. The Lifeline is part of larger federal and state efforts to build comprehensive behavioral health crisis response systems that include mobile crisis units and crisis diversion and stabilization centers. Comprehensive response systems are anticipated to reduce hospitalizations for suicide and other behavioral health crises; however, research testing this assumption has been limited. The authors used Arizona-a state known for its comprehensive crisis system-to determine the association between state implementation of a comprehensive behavioral health crisis response system and suicide-related hospitalizations. METHODS: A comparative interrupted time-series (CITS) design was used to compare changes in suicide-related hospitalizations after the 2015 implementation of Arizona's crisis response system (N=215,063). Data were from the 2010-2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Nevada (N=84,091 hospitalizations) was used as a comparison state because it is a western state that had not yet implemented a comprehensive crisis system and had available HCUP SID data. The CITS model included controls for time-varying differences in state demographic composition. RESULTS: From 2010 to 2014 to 2019, annual suicide-related hospitalizations in Arizona increased from 122.0 to 324.2 to 584.5, respectively, per 100,000 people, and in Nevada, hospitalizations increased from 94.7 to 263.2 to 595.5, respectively, per 100,000 people. Arizona's crisis response system was associated with a significant relative decrease in the quarterly trend of 2.57 suicide-related hospitalizations per 100,000 people (p=0.033). CONCLUSIONS: More research is needed to understand how the implementation of a comprehensive crisis response system may affect suicide-related hospitalizations.


Assuntos
Suicídio , Humanos , Arizona/epidemiologia , Custos de Cuidados de Saúde , Hospitalização , Demografia
6.
Sex Transm Dis ; 51(3): 156-161, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38100793

RESUMO

BACKGROUND: The United States has seen a significant rise in syphilis over the past 20 years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic. METHODS: We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of more than 18,000. Testing data were extracted from 2017 to 2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and nonparametric methods where appropriate. RESULTS: Among 5888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women aged 30 to 34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%), and no congenital syphilis cases during the observation period. CONCLUSIONS: We observed significantly elevated syphilis rates in American Indian/Alaska Native persons compared with the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables, and our experience may serve as a model to other communities.


Assuntos
Índios Norte-Americanos , Sífilis , Feminino , Humanos , Masculino , Arizona/epidemiologia , Sífilis/epidemiologia , Sífilis/prevenção & controle , Adulto
7.
PLoS One ; 18(11): e0291205, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38011229

RESUMO

COVID-19 was responsible for many deaths and economic losses around the globe since its first case report. Governments implemented a variety of policies to combat the pandemic in order to protect their citizens and save lives. Early in 2020, the first cases were reported in Arizona State and continued to rise until the discovery of the vaccine in 2021. A variety of strategies and interventions to stop or decelerate the spread of the pandemic has been considered. It is recommended to define which strategy was successful for disease propagation prevention and could be used in further similar situations. This study aimed to evaluate the effect of people's contact interventions strategies which were implemented in Arizona State and their effect on reducing the daily new COVID-19 cases and deaths. Their effect on daily COVID-19 cases and deaths were evaluated using an interrupted time series analysis during the pandemic's first peaks to better understand the onward situation. Canceling the order of staying at home (95% CI, 1718.52 to 6218.79; p<0.001) and expiring large gatherings (95% CI, 1984.99 to 7060.26; p<0.001) on June 30 and August 17, 2020, respectively, had a significant effect on the pandemic, leading to the daily cases to grow rapidly. Moreover, canceling the stay at home orders led to an increase in the number of COVID-19 daily deaths by 67.68 cases (95% CI, 27.96 to 107.40; p<0.001) after about 21 days while prohibiting large gatherings significantly decreased 66.76 (95% CI: 20.56 to 112.96; p = 0.004) the number of daily deaths with about 21 days' lag. The results showed that strategies aimed at reducing people's contact with one another could successfully help fight the pandemic. Findings from this study provide important evidence to support state-level policies that require observance of social distancing by the general public for future pandemics.


Assuntos
COVID-19 , Humanos , Arizona/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Análise de Séries Temporais Interrompida , Pandemias/prevenção & controle , SARS-CoV-2 , Estados Unidos/epidemiologia
8.
Med Mycol ; 61(11)2023 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-37935009

RESUMO

Coccidioidomycosis is a fungal disease in arid regions of the United States that is predicted to expand with climate change. Cases in military personnel and military working dogs (MWDs) impact personnel readiness and result in healthcare costs. To examine Coccidioides exposure among MWDs, 276 banked serum samples were retrieved from dogs housed in California, Texas, Arizona, New Mexico, Nevada, and Utah. Using gel immunodiffusion, six (2.1%) specimens were IgG-positive and three (1.1%) were equivocally IgM-positive. The IgG-positive samples were from Arizona (2 [prevalence 8.0%]) and California (4 [3.7%]). These data will guide future efforts to study MWDs as sentinels for human coccidioidomycosis.


This study aimed to determine the prevalence of exposure to coccidioidomycosis, the cause of Valley Fever in both humans and animals, among military working dogs (MWDs)located in endemic regions of the United States. The data will be used to guide efforts to study MWDs as sentinels for human disease.


Assuntos
Coccidioides , Coccidioidomicose , Estados Unidos/epidemiologia , Humanos , Animais , Cães , Coccidioidomicose/epidemiologia , Coccidioidomicose/veterinária , Coccidioidomicose/microbiologia , Cães Trabalhadores , Arizona/epidemiologia , Imunoglobulina G
9.
Parasit Vectors ; 16(1): 351, 2023 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-37807069

RESUMO

BACKGROUND: Understanding coupled human-environment factors which promote Aedes aegypti abundance is critical to preventing the spread of Zika, chikungunya, yellow fever and dengue viruses. High temperatures and aridity theoretically make arid lands inhospitable for Ae. aegypti mosquitoes, yet their populations are well established in many desert cities. METHODS: We investigated associations between socioeconomic and built environment factors and Ae. aegypti abundance in Maricopa County, Arizona, home to Phoenix metropolitan area. Maricopa County Environmental Services conducts weekly mosquito surveillance with CO2-baited Encephalitis Vector Survey or BG-Sentinel traps at > 850 locations throughout the county. Counts of adult female Ae. aegypti from 2014 to 2017 were joined with US Census data, precipitation and temperature data, and 2015 land cover from high-resolution (1 m) aerial images from the National Agricultural Imagery Program. RESULTS: From 139,729 trap-nights, 107,116 Ae. aegypti females were captured. Counts were significantly positively associated with higher socioeconomic status. This association was partially explained by higher densities of non-native landscaping in wealthier neighborhoods; a 1% increase in the density of tree cover around the trap was associated with a ~ 7% higher count of Ae. aegypti (95% CI: 6-9%). CONCLUSIONS: Many models predict that climate change will drive aridification in some heavily populated regions, including those where Ae. aegypti are widespread. City climate change adaptation plans often include green spaces and vegetation cover to increase resilience to extreme heat, but these may unintentionally create hospitable microclimates for Ae. aegypti. This possible outcome should be addressed to reduce the potential for outbreaks of Aedes-borne diseases in desert cities.


Assuntos
Aedes , Vírus da Dengue , Dengue , Infecção por Zika virus , Zika virus , Adulto , Animais , Feminino , Humanos , Arizona/epidemiologia , Árvores , Mosquitos Vetores
10.
BMC Health Serv Res ; 23(1): 1118, 2023 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-37853403

RESUMO

BACKGROUND: Demands on health systems due to COVID-19 are substantial, but drivers of healthcare utilization are not well defined in non-severe SARS-CoV-2 infections. Among a prospective cohort of frontline workers from July 2020 to February 2023, we assessed predictors of healthcare utilization during SARS-CoV-2 infection. METHODS: Weekly specimens tested via real-time reverse transcriptase polymerase chain reaction analysis. Participants reported sociodemographic, health status information, and illness experience information. Primary outcome was healthcare utilization during SARS-CoV-2 infection. Predictors included sociodemographic characteristics, baseline health status, and measures of illness severity. Multivariable logistic regression was utilized to generate odds ratios for predictors of healthcare utilization. RESULTS: 1,923 SARS-CoV-2 infections (1,276 first infections and 647 reinfections from 4,208 participants): 1221 (63.5%) individuals were between 40 and 65 years old; 1115 (58.0%) were female; 449 (23.3%) were Hispanic and 1305 (67.9%) non-Hispanic White. 294 (15.3%) individuals sought medical care during first infection, 106 (5.5%) during reinfection. Sociodemographic and baseline health characteristics were not associated with healthcare utilization during infections from any variant for first infections, while age (OR 1.04, 95%CI 1.01-1.07) was during Omicron reinfection. In first infection, number of symptoms (OR 1.16, 95%CI 1.00-1.36 in Origin/Alpha, OR 1.12, 95%CI 1.00-1.49 in Delta, OR 1.09, 95%CI 1.01-1.16 in Omicron), number of days spent in bed (OR 1.13, 95%CI 1.02-1.33 in Origin/Alpha, OR 1.23, 95%CI 1.00-1.59 in Delta, OR 1.12, 95%CI 1.03-1.22 in Omicron), and illness duration (OR 1.01, 95%CI 1.00-1.04 in Origin/Alpha, OR 1.01, 95%CI 1.00-1.03 in Delta, OR 1.01, 95%CI 1.00-1.02 in Omicron) were related to healthcare utilization for all variants. Number of days in bed (OR 1.12, 95%CI 1.01-1.27), illness duration (OR 1.01, 95%CI 1.00-1.02), and hours of work missed (OR 2.24, 95%CI 1.11-4.74) were positively associated with healthcare utilization during Omicron reinfection. CONCLUSION: The main factors associated with healthcare utilization for SARS-CoV-2 infection were symptom severity and duration. Practices and therapeutics aimed at decreasing these factors would be most helpful in easing the burden on health systems.


Assuntos
COVID-19 , Fatores Sociais , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Arizona/epidemiologia , Estudos Prospectivos , Reinfecção , COVID-19/epidemiologia , COVID-19/terapia , SARS-CoV-2 , Aceitação pelo Paciente de Cuidados de Saúde
11.
Emerg Infect Dis ; 29(11): 2380-2382, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37705075

RESUMO

We conducted surveillance of respiratory syncytial virus (RSV) genomic sequences for 100 RSV-A and 27 RSV-B specimens collected during November 2022-April 2023 in Arizona, USA. We identified mutations within prefusion F-protein antigenic sites in both subtypes. Continued genomic surveillance will be critical to ensure RSV vaccine effectiveness.


Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Humanos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Arizona/epidemiologia , Proteínas Virais de Fusão/genética , Vírus Sincicial Respiratório Humano/genética , Anticorpos Neutralizantes , Anticorpos Antivirais , Mutação
12.
BMC Public Health ; 23(1): 1626, 2023 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-37626343

RESUMO

BACKGROUND: School health staff lead and provide a variety of care for children in schools. As school districts have navigated the COVID-19 pandemic, school health staff have faced unprecedented challenges in protecting the health of students and school staff. Our objective was to qualitatively characterize these pandemic challenges and experiences of school health staff in Pima County, Arizona to identify gaps in school health staff support for improving future emergency preparedness. METHODS: We conducted two focus group discussions (FGDs) with 48 school health staff in Pima County, Arizona in two school districts using a discussion guide including ten open-ended questions. The FGDs were audio recorded and transcribed verbatim. We used the socioecological model (SEM) to organize the thematic analysis and generate codes and themes; data were analyzed using Atlas.ti software. FINDINGS: The pandemic has significantly challenged school health staff with new pandemic-related job tasks: managing isolation, vaccination, and developing/implementing new and evolving COVID-19 guidelines. School health staff also reported increased stress related to interactions with parents and school administration as well as frustrations with rapid changes to guidance from the health department and policy makers. A common issue was not having enough staff or resources to complete regular job responsibilities, such as providing care for students with non-COVID-19 related health issues. CONCLUSIONS: Increased workload for school health staff resulted in physical burnout, mental distress, and disruption of core functions with long term implications for children's health. These focus groups highlight the need for improved emergency preparedness in schools during pandemics or infectious disease outbreaks. These include basic infrastructure changes (e.g., personnel support from health departments for tasks such as contact tracing to enable school nurses to continue core functions), and increased funding to allow for hazard pay and more school health personnel during emergency situations. In addition, basic school health infrastructure is lacking, and we should include a licensed school health nurse in every school.


Assuntos
COVID-19 , Iodeto de Potássio , Criança , Humanos , Arizona/epidemiologia , Pandemias , COVID-19/epidemiologia , Esgotamento Psicológico
13.
West J Emerg Med ; 24(4): 798-804, 2023 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-37527375

RESUMO

BACKGROUND: The Sonoran Desert region, encompassing most of southern Arizona, has an extreme climate that is famous for dust storms known as haboobs. These storms lead to decreased visibility and potentially hazardous driving conditions. In this study we evaluate the relationship between haboob events and emergency department (ED) visits due to motor vehicle collisions (MVCs) in Phoenix, Arizona. METHODS: This study is a retrospective analysis of MVC-related trauma presentations to Phoenix, AZ, hospitals before and following haboob dust storms. These events were identified from 2009-2017 primarily using Phoenix International Airport weather data. De-identified trauma data were obtained from the Arizona Department of Health Services (ADHS) Arizona State Trauma Registry (ASTR) from seven trauma centers within a 10-mile radius of the airport. We compared MVC-related trauma using six- and 24-hour windows before and following the onset of haboob events. RESULTS: There were 31,133 MVC-related trauma encounters included from 2009-2017 and 111 haboob events meeting meteorological criteria during that period. There was a 17% decrease in MVC-related ED encounters in the six hours following haboob onset compared to before onset (235 vs 283, P = 0.04), with proportionally more injuries among males (P < 0.001) and higher mortality (P = 0.02). There was no difference in frequency of presentations (P = 0.82), demographics, or outcomes among the 24-hour pre-and post-haboob groups. CONCLUSION: Haboob dust storms in Phoenix, Arizona, are associated with a decrease in MVC-related injuries during the six-hour period following storm onset, likely indicating the success of public safety messaging efforts. Males made up a higher proportion of those injured during the storms, suggesting a target for future interventions. Future public-targeted weather-safety initiatives should be accompanied more closely by monitoring and evaluation efforts to assess for effectiveness.


Assuntos
Acidentes de Trânsito , Poeira , Masculino , Humanos , Feminino , Arizona/epidemiologia , Estudos Retrospectivos , Veículos Automotores
14.
Emerg Infect Dis ; 29(8): 1663-1667, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37486231

RESUMO

We identified 2 fatal cases of persons infected with hantavirus in Arizona, USA, 2020; 1 person was co-infected with SARS-CoV-2. Delayed identification of the cause of death led to a public health investigation that lasted ≈9 months after their deaths, which complicated the identification of a vector or exposure.


Assuntos
COVID-19 , Doenças Transmissíveis , Infecções por Hantavirus , Orthohantavírus , Humanos , Arizona/epidemiologia , SARS-CoV-2 , Pandemias , Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/epidemiologia
15.
Am J Public Health ; 113(10): 1089-1092, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37499203

RESUMO

COVID-19 has disproportionately affected Indigenous communities. The Whiteriver Service Unit (WRSU) took an integrated public health-health care system delivery approach in collaboration with the White Mountain Apache Tribe to decrease the case fatality rate (CFR). The WRSU performed daily data analyses identifying risk factors, expeditiously treating and proactively vaccinating people during at-home visits. The WRSU's CFR was 0.3% lower than Arizona's (P = .04). Among communities disproportionally affected, an integrated approach using data to drive real-time decision-making among a culturally competent workforce can contribute to decreased CFR. (Am J Public Health. 2023;113(10):1089-1092. https://doi.org/10.2105/AJPH.2023.307364).


Assuntos
COVID-19 , Índios Norte-Americanos , Humanos , Arizona/epidemiologia , Indígena Americano ou Nativo do Alasca , COVID-19/prevenção & controle , Fatores de Risco
16.
Spat Spatiotemporal Epidemiol ; 46: 100590, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37500227

RESUMO

Recent studies and reports suggest an increased mortality rate of undocumented border crossers (UBCs) in Arizona is the result of heat extremes and climatic change. Conversely, others have shown that deaths have occurred in cooler environments than in previous years. We hypothesized that human locomotion plays a greater role in heat-related mortality and that such events are not simply the result of exposure. To test our hypothesis, we used a postmortem geographic application of the human heat balance equation for 2,746 UBC deaths between 1990 and 2022 and performed regression and cluster analyses to assess the impacts of ambient temperature and exertion. Results demonstrate exertion having greater explaining power, suggesting that heat-related mortality among UBCs is not simply a function of extreme temperatures, but more so a result of the required physical exertion. Additionally, the power of these variables is not static but changes with place, time, and policy.


Assuntos
Temperatura Alta , Esforço Físico , Humanos , Arizona/epidemiologia , Mudança Climática , Análise por Conglomerados
17.
Prenat Diagn ; 43(9): 1166-1175, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37489851

RESUMO

OBJECTIVE: To determine the prenatal detection rate (PDR) of congenital heart disease (CHD) in Arizona as well as describe various factors that may influence detection rates. METHODS: This was a retrospective chart review using the Society of Thoracic Surgeons and Phoenix Children's Fetal Cardiology databases. We included all cases of CHD requiring surgery <1 year of age between 2013 and 2018. A total of 1137 patients met the criteria, and various demographic, socioeconomic, and patient outcome data were collected. RESULTS: The overall PDR was 58% with an improving detection rate over the course of our study, with the final year having a PDR of 67%. Over time, PDR improved in urban communities, but this was not seen in rural communities. Rural address, public insurance, and Native American ethnicity were associated with lower PDR. Postnatal outcomes, including Apgars, initial pH, and lactate, did not differ with the presence of a prenatal diagnosis. Diagnoses typically identified with the outflow tract and 3-vessel views on the fetal echocardiogram were less likely to be detected prenatally. CONCLUSIONS: The PDR of CHD continues to improve with evolving technologies and guidelines. We highlight a discrepancy between urban, rural, and Native American populations. Additionally, by supplying descriptors of missed diagnosis and associated echocardiography views, we hope to provide data for future interventions.


Assuntos
Cardiopatias Congênitas , Ultrassonografia Pré-Natal , Gravidez , Criança , Feminino , Humanos , Estudos Retrospectivos , Arizona/epidemiologia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Coração Fetal/diagnóstico por imagem
18.
J Community Health ; 48(6): 945-950, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37316613

RESUMO

This study aimed to investigate the relationship between rurality and risk perception of getting or transmitting COVID-19 and willingness to get the COVID-19 vaccine in a sample of Latinos across Arizona and California's Central Valley (n = 419). The results revealed that rural Latinos are more concerned about getting and transmitting COVID-19, but less willing to get vaccinated. Our findings suggest that perceptions of risk alone do not play a sole role in influencing risk management behavior among rural Latinos. While rural Latinos may have heightened perception of the risks associated with COVID-19, vaccine hesitancy persists due to a variety of structural and cultural factors. These factors included limited access to healthcare facilities, language barriers, concerns about vaccine safety and effectiveness, and cultural factors such as strong family and community ties. The study highlights the need for culturally-tailored education and outreach efforts that address the specific needs and concerns of this community to increase vaccination rates and reduce the disproportionate burden of COVID-19 among Latino communities living in rural areas.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacinação , Humanos , Arizona/epidemiologia , California/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Hispânico ou Latino/psicologia , Vacinação/psicologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-37372712

RESUMO

Diabetes is the seventh leading cause of death in the United States, and it is particularly problematic among the Latine population. This study employed multivariable logistic regression models to examine how hypertension, depression, and sociodemographics were associated with diabetes in a cross-sectional sample of Mexican-origin adults living in three counties of Southern Arizona. The overall prevalence of diabetes from this primary care sample was 39.4%. Holding covariates at fixed values, individuals having hypertension were 2.36 (95% CI: 1.15, 4.83) times more likely to have diabetes, when compared to individuals not having hypertension. The odds of having diabetes for individuals with ≥12 years of educational attainment were 0.29 (95% CI: 0.14, 0.61) times the corresponding odds of individuals with <12 years of educational attainment. For individuals with depression, the odds of having diabetes for those who were born in Mexico and had <30 years living in the US were 0.04 (95% CI: 0, 0.42) times the corresponding odds of individuals without depression and who were born in the US. Findings suggest clinical and public health systems should be aware of the potential increased risk of diabetes among Mexican-origin adults with hypertension and lower educational attainment.


Assuntos
Diabetes Mellitus , Adulto , Humanos , Arizona/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/etiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Fatores de Risco , Estados Unidos/epidemiologia , Depressão/complicações , Depressão/epidemiologia , Escolaridade
20.
Artigo em Inglês | MEDLINE | ID: mdl-37297621

RESUMO

Using baseline data from three partnering federally qualified health centers, we examined factors associated with depressive symptoms among Mexican-origin adults at risk of chronic disease living in three counties in Southern Arizona (i.e., Pima, Yuma, and Santa Cruz). Multivariable linear regression models identified correlates of depressive symptoms for this population controlling for sociodemographic characteristics. Among 206 participants, 85.9% were female and 49% were between 45 and 64 years of age. The proportion of depressive symptoms was 26.8%. Low levels of physical pain and high levels of hope and social support were also reported. Physical pain was positively and significantly related to depressive symptoms (ß = 0.22; 95% CI = 0.13, 0.30). Conversely, hope was negatively and significantly associated with depressive symptoms (ß = -0.53; 95% CI = -0.78, -0.29). A better understanding of factors related to depressive symptoms among Mexican-origin adults is necessary to fulfill their mental health needs, as well as to achieve health equity and to eliminate health disparities in the US-Mexico border region.


Assuntos
Depressão , Americanos Mexicanos , Dor , Adulto , Feminino , Humanos , Masculino , Arizona/epidemiologia , Depressão/epidemiologia , Depressão/etnologia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Dor/epidemiologia , Dor/etnologia , Dor/psicologia
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