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1.
Am J Public Health ; 111(8): 1443-1447, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34464195

RESUMO

To investigate how heat-health behaviors changed in summer 2020 compared with previous summers, our community-academic partnership conducted telephone surveys to collect data on cooling behaviors, safety concerns, and preferences for cooling alternatives for 101 participants living in Alabama. Participants indicating they would visit cooling centers declined from 23% in previous summers to 10% in summer 2020. The use of cooling centers and other public spaces may be less effective in reducing heat-related illness because of safety concerns amid the COVID-19 pandemic and police brutality.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/epidemiologia , Comportamentos Relacionados com a Saúde , Transtornos de Estresse por Calor/prevenção & controle , Temperatura Alta , Características de Residência/estatística & dados numéricos , Alabama , COVID-19/psicologia , Habitação , Humanos
2.
Nutr Metab Cardiovasc Dis ; 31(10): 2959-2968, 2021 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-34344546

RESUMO

BACKGROUND AND AIMS: Watermelon juice is a rich food source of cardioprotective compounds such as arginine, citrulline, and lycopene. Preventative interventions are warranted as risk of cardiovascular disease increases among women after menopause, and age alone is an independent risk factor for vascular dysfunction. Thus, this study evaluated the effects of 100% watermelon juice on measures of vascular function. METHODS AND RESULTS: In this randomized, double-blind, placebo-controlled, crossover trial, 21 healthy postmenopausal women were randomized to consume two 360 mL servings of 100% watermelon juice per day or an isocaloric placebo for four weeks. Following a two-week washout period, they consumed the other beverage for an additional four weeks. Before and after each treatment arm, a fasting blood sample was taken for measurement of serum arginine, citrulline, lycopene, glucose, and insulin. Assessments of vascular function included pulse pressure, pulse wave velocity, 24-h ambulatory blood pressure, and flow-mediated dilation. General linear mixed models with intent-to-treat analyses were used to examine the effects of the intervention. Despite a significant treatment effect for circulating lycopene (p = 0.002), no changes in arginine, citrulline, or any vascular measures were observed. Although the juice intervention resulted in a slight but significant increase in fasting serum glucose (p = 0.001), changes in glucose homeostasis were not clinically significant. CONCLUSION: In contrast to findings from previous studies in younger adults and those with pre-existing hypertension, measures of vascular function in this cohort of healthy postmenopausal women were not impacted by supplemental watermelon juice. CLINICALTRIALS. GOV IDENTIFIER: NCT03626168.


Assuntos
Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Citrullus , Sucos de Frutas e Vegetais , Pós-Menopausa/sangue , Rigidez Vascular/efeitos dos fármacos , Idoso , Alabama , Biomarcadores/sangue , Estudos Cross-Over , Método Duplo-Cego , Feminino , Homeostase , Humanos , Licopeno/sangue , Pessoa de Meia-Idade , Fatores de Tempo
3.
Accid Anal Prev ; 160: 106303, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303495

RESUMO

The effects of freeway incident clearance times on the flow of traffic have recently increased interests in understanding what factors influence incident durations. This has particularly become topical due to the financial and economic implications of traffic gridlocks caused by freeway incidents on industries and personal mobility. This paper presents two advanced econometric modeling methods, random parameters duration modeling and latent class duration modeling in understanding the factors that impact freeway incident clearance times in the State of Alabama. These two modeling approaches were further compared to identify which of them provides the best fit for the data with respect to accounting for unobserved heterogeneity. A total of 2206 freeway crash incident data from January 1 to December 31, 2018 were examined in developing the models. The study was based on a unique dataset that involved merging and matching Traffic Incident Management response data from the Alabama Department of Transportation (ALDOT) Traffic Management Center (TMC), freeway crash data from the Center for Advanced Public Safety (CAPS) at the University of Alabama, Alabama Service and Assistance Patrol (ASAP) data from ALDOT and traffic volume from ALDOT's Highway Performance Management System (HPMS). The model estimation results reveal that a total of nineteen variables were found statistically significant with five random variables (on-road, nighttime, rain, AADT, and ASAP existing coverage area) and fourteen fixed effects variables for the random parameters model. For latent class model, a total of eighteen variables were observed statistically significant within two distinct latent classes (Latent Class 1 with class membership probability of 0.23 and Latent Class 2 with class membership probability of 0.77) at a 0.05 significance level. A comparison of the two models reveals that the latent class model provides the better fit for the incident duration data. The findings of this study are expected to contribute to the body of knowledge on incident duration by employing two advanced econometric modeling methods and to inform statewide efforts in significantly reducing the duration of freeway incident clearance time. Moreover, this is to ensure that policy decisions that may arise from the findings of the study are sound and based on data-driven evidence.


Assuntos
Acidentes de Trânsito , Alabama , Humanos , Análise de Classes Latentes , Probabilidade
4.
BMC Public Health ; 21(1): 1266, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187438

RESUMO

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education. METHODS: The current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention's feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data. RESULTS: Over the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10-18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year. CONCLUSIONS: Findings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.


Assuntos
Vacinas Meningocócicas , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Farmácias , Farmácia , Adolescente , Alabama , Criança , Estudos de Viabilidade , Humanos , Infecções por Papillomavirus/prevenção & controle , Projetos Piloto , População Rural , Vacinação
5.
Emerg Infect Dis ; 27(7): 1949-1952, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34152958

RESUMO

A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine.


Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Alabama , Surtos de Doenças , Humanos , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas , Prisões , Sorogrupo
6.
Emerg Infect Dis ; 27(7): 1886-1892, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34152960

RESUMO

Eastern equine encephalitis virus (EEEV) is an arbovirus in the family Togaviridae, genus Alphavirus, found in North America and associated with freshwater/hardwood swamps in the Atlantic, Gulf Coast, and Great Lakes regions. EEEV disease in humans is rare but causes substantial illness and death. To investigate the molecular epidemiology and microevolution of EEEV from a fatal case in Alabama, USA, in 2019, we used next-generation sequencing of serum and cerebrospinal fluid (CSF). Phylogenetic inference indicated that the infecting strain may be closely related to isolates from Florida detected during 2010-2014, suggesting potential seeding from Florida. EEEV detected in serum displayed a higher degree of variability with more single-nucleotide variants than that detected in the CSF. These data refine our knowledge of EEEV molecular epidemiologic dynamics in the Gulf Coast region and demonstrate potential quasispecies bottlenecking within the central nervous system of a human host.


Assuntos
Vírus da Encefalite Equina do Leste , Alabama , Animais , Florida , Cavalos , Humanos , América do Norte , Filogenia
7.
J Trauma Acute Care Surg ; 91(3): 514-520, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33990533

RESUMO

BACKGROUND: Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical US setting. METHODS: We conducted a prospective observational/simulation study at a level I trauma center and two associated emergency medical service (EMS) agencies over a 9-month period. The participating EMS agencies were asked to identify actual patients who might benefit from the activation of a hypothetical trauma center-based ARC team. This decision was then communicated in real time to the study team. RESULTS: Sixty-three patients were determined to require activation. The number of activations per month ranged from 2 to 15. The highest incidence of calls occurred between 4 pm to midnight. Of the 63 patients, 33 were transported to the trauma center. The most common presentation was with penetrating trauma. The median age was 27 years (interquartile range, 24-45 years), 75% were male, and the median Injury Severity Score was 11 (interquartile range, 7-20). Based on injury patterns, treatment received, and outcomes, it was determined that 6 (18%) of 33 patients might have benefited from ARC. Three of the patients died en-route to or soon after arrival at the trauma center. CONCLUSION: The prehospital identification of patients who might benefit from ARC is possible but faces challenges. Identifying strategies to adapt existing processes may allow better utilization of the existing infrastructure and should be a focus of future efforts. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level III.


Assuntos
Serviços Médicos de Emergência/organização & administração , Hemorragia/mortalidade , Ressuscitação/métodos , Ferimentos e Lesões/mortalidade , Adulto , Alabama/epidemiologia , Serviços Médicos de Emergência/métodos , Feminino , Hemorragia/etiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Estudos Prospectivos , Centros de Traumatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto Jovem
8.
Psychol Assess ; 33(10): 940-951, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33939455

RESUMO

The Alabama Parenting Questionnaire-9 (APQ-9) is a widely used brief measure of parenting behaviors. However, the reliability coefficients of the three APQ-9 subscales vary substantially. A reliability generalization meta-analysis was conducted on the three APQ-9 subscales to (a) estimate mean internal consistency reliability values and (b) examine the sources of variance. A total of 113 coefficient alphas from 31,572 informants, across 32 studies were included in this meta-analysis. Results showed acceptable mean α values (.84 for positive parenting, .66 for inconsistent discipline, and .70 for poor supervision subscales). Moderator analyses results found that differences in coefficient αs of the three subscales were influenced by numerous variables including administration format, country, language version, population, the mean and standard deviation of scores, and sample size. Our findings support the utility of the parent-report APQ-9 as a useful measure of parenting behaviors. Future research direction is also discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Poder Familiar , Inquéritos e Questionários , Alabama , Humanos , Poder Familiar/psicologia , Reprodutibilidade dos Testes
9.
Nutr Res ; 90: 1-12, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34049184

RESUMO

Since the ongoing coronavirus disease 2019 (COVID-19) pandemic is linked to chronic inflammation, people with initial lower inflammatory status could have better outcomes from exposure to this disease. Because dietary habits are one of the most important modifiable risk factors for inflammation, identification of dietary components associated with inflammation could play a significant role in controlling or reducing the risk of COVID-19. We investigated the inflammatory potential of diets consumed by African American (AA) and Caucasian American (CA) women of childbearing age (n = 509) who are at high risk for exposure to COVID-19 by being residents of Birmingham, Alabama, a city severely affected by this pandemic. The overall pro- and anti- inflammatory scores were calculated using dietary intake data gathered using Block food frequency questionnaire. The proinflammatory potential of diets consumed by AAs was significantly higher compared to CAs. Several anti- and proinflammatory nutrients and food groups consumed differed by race. With consumption of a greater number of antioxidants and B-vitamins, CAs switched toward an anti-inflammatory score more effectively than AAs while AAs performed better than CAs in improving the anti-inflammatory score with the consumption of a greater number of minerals and vitamin D. Effective race-specific dietary modifications or supplementation with nutrients identified will be useful to improve proinflammatory diets toward anti-inflammatory. This approach could aid in controlling the current COVID-19 pandemic and future pandemics of a similar nature in women at risk for exposure.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/prevenção & controle , Dieta/métodos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Inflamação/fisiopatologia , Adulto , Alabama , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
11.
Nurs Clin North Am ; 56(2): 189-202, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023115

RESUMO

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.


Assuntos
Infecções por HIV/complicações , Terapia de Relaxamento/tendências , Transtornos do Sono-Vigília/terapia , Alabama , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Humanos , Malaui , Terapia de Relaxamento/métodos , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia
12.
Acad Med ; 96(10): 1401-1407, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33830950

RESUMO

The University of Alabama at Birmingham academic medical center (UAB AMC) had achieved great success and growth during the 50 years since its founding. However, the challenging and more competitive environment of the 2000s left the UAB AMC on a downward trajectory. The UAB AMC had to overcome difficult internal cultural and structural barriers that stood in the way of the transformational change needed to remain competitive. Competition rather than collaborative and strategic financial investment were the primary cultural barriers for the UAB AMC, while people were the primary structural barrier. Leadership identified 5 steps that were critical for the transformation that occurred between 2013 and 2018: alignment of leadership; creating a compelling and credible shared vision; identifying cultural and structural barriers; creating a thoughtful, data-driven intervention; and improved communication and accountability. Following these steps enabled the UAB AMC to transform its institutional structure and culture. As a result, the UAB AMC thrived, returning to substantial growth in research and clinical care. UAB AMC School of Medicine grew by $100 million in National Institutes of Health funding and moved up 10 spots in ranking. In 2018, UAB Hospital had 10 specialties ranked by U.S. News & World Report, 7 more than in 2013. This article outlines the approach taken and provides a conceptual framework for other AMCs eager to transform their structure and culture and position themselves for growth.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Gestão de Mudança , Centros Médicos Acadêmicos/economia , Alabama , Financiamento Governamental , Humanos , Liderança , Cultura Organizacional , Objetivos Organizacionais , Apoio à Pesquisa como Assunto , Comunicação Acadêmica , Responsabilidade Social
13.
J Econ Entomol ; 114(3): 1189-1200, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-33885781

RESUMO

The southern pine beetle, Dendroctonus frontalis Zimmermann (Coleoptera: Curculionidae: Scolytinae) is a major destructive pest of Pinus L. In the southeastern United States, numbers of this species and a major predator, Thanasimus dubius (Fabricius) (Coleoptera: Cleridae), captured during an annual springtime trapping survey are used to make forecasts of the likelihood and severity of an outbreak during the following summer. We investigated responses by both species to six lure formulations to evaluate their suitability for the survey and allow integration of historical data sets produced with differing lure compositions. Trapping trials were performed at four locations across three states (Louisiana, Mississippi, and Alabama) during spring, and at these and one additional location (North Carolina) in fall 2016. All lures included the pheromone component frontalin. Southern pine beetle preferred lures that additionally included the pheromone component endo-brevicomin and turpentine as a source of host odors (rather than a 7:3 mixture of monoterpenes alpha- and beta-pinene). Thanasimus dubius displayed little discrimination among lure compositions. Lure preferences by southern pine beetle did not differ significantly among locations in spring but were influenced by season. Gas chromatography (GC)-electroantennographic detection analyses with southern pine beetle and GC-mass spectrometry identified numerous known and potential semiochemicals that distinguished volatiles released by the tested host odor devices. The lure combination that included endo-brevicomin and alpha/beta-pinene is recommended for the trapping survey because of its high sensitivity for southern pine beetle and potential for greater data integrity resulting from its reproducible composition.


Assuntos
Besouros , Pinus , Alabama , Animais , Surtos de Doenças , Cromatografia Gasosa-Espectrometria de Massas , Louisiana , Mississippi , North Carolina , Feromônios
14.
Ann Epidemiol ; 59: 64-71, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33895246

RESUMO

PURPOSE: Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic status may make some groups more vulnerable. An exploratory spatial clustering method is described for identifying clusters of vulnerability to skin cancer incidence and mortality based on composite indices, which combine data from environmental and demographic risk factors. METHODS: Based on county-level ultraviolet data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality. RESULTS: Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area. CONCLUSIONS: Future skin cancer research and screening initiatives may use these innovative composite vulnerability indices and identified clusters to better target resources based on anticipated risk from underlying demographic and environmental factors.


Assuntos
Neoplasias Cutâneas , Raios Ultravioleta , Alabama , Colorado , Florida , Georgia , Humanos , North Carolina , Neoplasias Cutâneas/epidemiologia , Tennessee , Raios Ultravioleta/efeitos adversos , Estados Unidos/epidemiologia , Utah
15.
Artigo em Inglês | MEDLINE | ID: mdl-33835910

RESUMO

A beige-pigmented, oxidase-positive bacterial isolate, Wesi-4T, isolated from charcoal in 2012, was examined in detail by applying a polyphasic taxonomic approach. Cells of the isolates were rod shaped and Gram-stain negative. Examination of the 16S rRNA gene sequence of the isolate revealed highest sequence similarities to the type strains of Pseudomonas matsuisoli and Pseudomonas nosocomialis (both 97.3 %). Phylogenetic analyses on the basis of the 16S rRNA gene sequences indicated a separate position of Wesi-4T, which was confirmed by multilocus sequence analyses (MLSA) based on the three loci gyrB, rpoB and rpoD and a core genome-based phylogenetic tree. Genome sequence based comparison of Wesi-4T and the type strains of P. matsuisoli and P. nosocomialis yielded average nucleotide identity values <95 % and in silico DNA-DNA hybridization values <70 %, respectively. The polyamine pattern contains the major amines putrescine, cadaverine and spermidine. The quinone system contains predominantly ubiquinone Q-9 and in the polar lipid profile diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine are the major lipids. The fatty acid contains predominantly C16 : 0, summed feature 3 (C16 : 1ω7c and/or C16 : 1ω6c) and summed feature 8 (C18 : 1ω7c and/or C18 : 1 ω6c). In addition, physiological and biochemical tests revealed a clear phenotypic difference from P. matsuisoli. These cumulative data indicate that the isolate represents a novel species of the genus Pseudomonas for which the name Pseudomonas carbonaria sp. nov. is proposed with Wesi-4T (=DSM 110367T=CIP 111764T=CCM 9017T) as the type strain.


Assuntos
Carvão Vegetal , Filogenia , Pseudomonas/classificação , Alabama , Técnicas de Tipagem Bacteriana , Composição de Bases , DNA Bacteriano/genética , Ácidos Graxos/química , Genes Bacterianos , Tipagem de Sequências Multilocus , Hibridização de Ácido Nucleico , Fosfolipídeos/química , Pseudomonas/isolamento & purificação , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Ubiquinona/química
16.
Artigo em Inglês | MEDLINE | ID: mdl-33917408

RESUMO

Abortion funds are key actors in mitigating barriers to abortion access, particularly in contexts where state-level abortion access restrictions are concentrated. Using 2017-2019 case management data from a regional abortion fund in the southeastern U.S., we described the sociodemographic and service use characteristics of cases overall (n = 9585) and stratified by state of residence (Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee). Overall, cases represented people seeking abortion fund assistance who predominately identified as non-Hispanic Black (81%), 18-34 years of age (84%), publicly or uninsured (87%), having completed a high school degree or some college (70%), having one or more children (77%), and as Christian (58%). Most cases involved an in-state clinic (81%), clinic travel distance under 50 miles (63%), surgical abortion (66%), and pregnancy under 13 weeks' gestation (73%), with variation across states. The median abortion fund contribution pledge was $75 (interquartile range (IQR): 60-100), supplementing median caller contributions of $200 (IQR: 40-300). These data provide a unique snapshot of a population navigating disproportionate, intersecting barriers to abortion access, and abortion fund capacity for social care and science. Findings can inform abortion fund development, data quality improvement efforts, as well as reproductive health, rights and justice advocacy, policy, and research.


Assuntos
Aborto Induzido , Administração Financeira , Alabama , Criança , Feminino , Florida , Georgia , Humanos , Mississippi , Gravidez , South Carolina , Tennessee , Estados Unidos
17.
Am J Physiol Renal Physiol ; 320(5): F870-F882, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33779316

RESUMO

Acute kidney injury (AKI) remains a significant clinical problem through its diverse etiologies, the challenges of robust measurements of injury and recovery, and its progression to chronic kidney disease (CKD). Bridging the gap in our knowledge of this disorder requires bringing together not only the technical resources for research but also the investigators currently endeavoring to expand our knowledge and those who might bring novel ideas and expertise to this important challenge. The University of Alabama at Birmingham-University of California-San Diego O'Brien Center for Acute Kidney Injury Research brings together technical expertise and programmatic and educational efforts to advance our knowledge in these diverse issues and the required infrastructure to develop areas of novel exploration. Since its inception in 2008, this O'Brien Center has grown its impact by providing state-of-the-art resources in clinical and preclinical modeling of AKI, a bioanalytical core that facilitates measurement of critical biomarkers, including serum creatinine via LC-MS/MS among others, and a biostatistical resource that assists from design to analysis. Through these core resources and with additional educational efforts, our center has grown its investigator base to include >200 members from 51 institutions. Importantly, this center has translated its pilot and catalyst funding program with a $37 return per dollar invested. Over 500 publications have resulted from the support provided with a relative citation ratio of 2.18 ± 0.12 (iCite). Through its efforts, this disease-centric O'Brien Center is providing the infrastructure and focus to help the development of the next generation of researchers in the basic and clinical science of AKI. This center creates the promise of the application at the bedside of the advances in AKI made by current and future investigators.


Assuntos
Injúria Renal Aguda/patologia , Injúria Renal Aguda/terapia , Pesquisa Biomédica/economia , Pesquisa Biomédica/organização & administração , Injúria Renal Aguda/sangue , Alabama , Biomarcadores/sangue , California , Humanos , Universidades
18.
J Health Care Poor Underserved ; 32(1): 523-536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33678711

RESUMO

Though a high proportion of Medicaid population in Alabama are women, little is known about their economic burdens of diabetes and hypertension. We used Alabama Medicaid claims data of 16,107 female enrollees aged 19-64 years to estimate per-capita total annual medical costs of hypertension by diabetes status. Hypertension prevalence was 60.0% and 17.3% among those with and without diabetes. The estimated annual medical cost for enrollees with hypertension was $6,689 (in 2017 $), of which $2,369 was associated with having hypertension. The hypertension-associated excess costs were $2,646 and $2,378 for enrollees with and without diabetes. All subgroups such as Blacks and those with Charlson Comorbidity Index ≥ 1, had higher medical costs when they had a combination of hypertension and diabetes compared with having diabetes without hypertension. Hypertension and diabetes increased medical costs substantially, and the findings can inform decision makers about effective resource utilizations for prevention and treatment strategies.


Assuntos
Diabetes Mellitus , Hipertensão , Alabama/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Medicaid , Prevalência , Estados Unidos/epidemiologia
19.
J Manag Care Spec Pharm ; 27(3): 339-353, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645247

RESUMO

BACKGROUND: Because Medicare plan coverage and costs change annually and older adults, the major beneficiaries of Medicare, are faced with multiple health conditions and changing medical needs, Medicare beneficiaries should evaluate their options during open enrollment every year. However, because of the complexity of plan selection, it may be challenging for Medicare beneficiaries to make an appropriate decision from among competing options. OBJECTIVES: To (a) identify factors that beneficiaries consider having influenced their plan selection decision and (b) describe the decision-making process according to the consumer decision-making model (CDM). The 2 research questions guiding this study included (a) factors Medicare beneficiaries considered having influenced their Medicare plan selection decision and (b) characteristics of decision-making processes employed by Medicare beneficiaries. METHODS: This is a phenomenological qualitative study. Semistructured in-person or telephone interviews with Alabama residents who have Medicare as the sole insurance provider were conducted between June and August 2019. Participant recruitment continued until reaching the saturation point. Each interview session consisted of structured questions identifying characteristics of participants and open-ended questions used to elicit participant Medicare plan decisionmaking process and factors affecting their decision. Data were analyzed using content analysis with a process of qualitative inductive coding. RESULTS: Twenty participants were interviewed. Twenty codes were identified and categorized into 5 themes regarding the factors influencing plan selection decisions by beneficiaries. When making a plan selection, participants were influenced by plan attributes (including cost, coverage, access to doctors, region, quality rating, and transportation); information resources and personal assistance; knowledge about Medicare; status and changes in personal situation; and experience with Medicare. Additionally, we identified 7 codes relating to beneficiary characteristics during decision-making processes, including being proactive, setting priorities, limiting choices, evaluating plans against personal needs, acquiescing to recommendations, sticking to the status quo, and weighing trade-offs. We consulted the CDM and created a conceptual model demonstrating a 5-step Medicare plan selection decision-making process and the factors influencing that process. DISCLOSURES: This study was supported by the Auburn University Undergraduate Research Program. The authors declare no conflicts of interest. CONCLUSIONS: This study created a step-by-step decision flowchart of Medicare plan selection to illustrate the complexity of the plan selection that Medicare beneficiaries must use. We uncovered the plan selection decision-making process among Medicare beneficiaries and factors affecting that process. Drawing from the CDM and the study findings, we developed a conceptual model. Findings will help researchers and community agencies target Medicare beneficiaries with different needs for assistance and design decision-making interventions/tools to help beneficiaries make rational decisions when selecting Medicare plans. These findings suggest that health care professionals should be involved in assistance programs to maximize efficiency of Medicare plan selection and to improve monitoring and consulting mechanisms to ensure the reliability of assistance information and services.


Assuntos
Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Medicare , Idoso , Alabama , Feminino , Humanos , Entrevistas como Assunto , Masculino , Estados Unidos
20.
Patient Educ Couns ; 104(3): 473-479, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33715773

RESUMO

BACKGROUND: Since 2015, the Information is Power initiative has offered free and reduced cost hereditary cancer screening to the North Alabama population with a consumer-initiated model. Patients received pre-test and post-test education through a genetic counseling video. Positive results also received a call from a genetic counselor. OBJECTIVE: We surveyed past Information is Power patients to assess if video education and electronic result delivery addressed the needs of a hereditary cancer screening population. METHODS: An electronic survey was sent out to Information is Power patients who opted into research contact. The survey assessed participant knowledge, satisfaction with result delivery, and perceived uncertainty after receiving test results. RESULTS: 213 participants completed the survey. Eighteen percent of participants would have preferred individual communication with a genetics specialist about their results. Over 99 % of survey participants correctly interpreted a positive result, while 73 % correctly interpreted a negative result. Overall, participants were certain about the impact of their genetic test results. PRACTICE IMPLICATIONS: These findings support a model of population genetic testing and genetic counseling that is sustainable while meeting the educational needs of most participants. Observed misconceptions surrounding a negative result should be highlighted in future population screening patient resources to meet patient needs.


Assuntos
Predisposição Genética para Doença , Neoplasias , Alabama , Detecção Precoce de Câncer , Aconselhamento Genético , Testes Genéticos , Humanos , Neoplasias/diagnóstico , Neoplasias/genética
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