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1.
Sci Total Environ ; 792: 148403, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34465038

RESUMO

Soil or sediment redistribution prediction along hillslopes and within small watersheds is considered to be a great challenge for the application of watershed erosion models in predicting the impact of soil and water conservation measures as well as for the redistribution of pollution such as radioactive fallout. In this study, long-term soil loss and deposition were estimated for two nested semi-arid watersheds within the Walnut Gulch Experimental Watershed in Southeastern Arizona using the process-based Geo-spatial interface of WEPP (GeoWEPP). While soil parameters were previously parametrized and validated through watershed outlet runoff and sediment yields, the channel parameters were adjusted and validated based on reference values of soil redistribution generated from fallout radionuclide 137Cs samples within the watersheds. Two methods were applied for the soil redistribution analysis by comparing observed and simulated soil loss/deposition rates (a) at single pixels and reference values at the specific location of each 137Cs sample site; and (b) for average values of a 5 m radius around each 137Cs sample site to compensate for measurement and model uncertainties. Surprisingly, soil redistribution predictions improved as topographic data resolution increased from 5 m to 3 m and were best at 1 m without changing key model parameters that were originally derived at the watershed scale.


Assuntos
Cinza Radioativa , Solo , Arizona , Monitoramento Ambiental
2.
BMC Health Serv Res ; 21(1): 920, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488758

RESUMO

BACKGROUND: The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy's impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators' views on the ACA's impact on their patient population and organization. It specifically explores FQHC administrators' perspective on 1) patients' experience with gaining coverage 2) their ability to meet patients' healthcare needs. METHODS: Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. RESULTS: All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan's covered services, FQHCs' capacity to meet demand, and specialist providers' willingness to accept their coverage type. CONCLUSION: Gaining coverage helped improved newly insured patients' access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.


Assuntos
Cobertura do Seguro , Patient Protection and Affordable Care Act , Arizona , California , Acesso aos Serviços de Saúde , Humanos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Texas , Estados Unidos
4.
AANA J ; 89(4): 325-333, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34342570

RESUMO

Certified Registered Nurse Anesthetists (CRNAs) work in practice models ranging from full scope (independent) to limited scope (dependent). Little is known about the influence of population density on CRNAs' scope of practice (SOP) and job satisfaction in Arizona, an independent practice state. The objectives were to examine relationships between (1) SOP and population density and (2) job satisfaction and SOP. In this descriptive study, an 11-question survey was sent to CRNAs practicing in Arizona. A total of 515 surveys were distributed; 261 responses (50%) were received, and 230 respondents (46%) met inclusion criteria. Spearman rank-order correlation was used to analyze the relationship between SOP and population density and between SOP and job satisfaction. Rank biserial correlation was used to examine association between CRNAs' SOP and geographic location. More than half the participants were male (54%), and 46% were female (age range, 27-75 years; years' experience, 1-50 years). Population density had no association with SOP (P=.074). However, SOP and job satisfaction showed a positive correlation (P<.001). These findings suggest that removal of regulatory barriers to CRNAs' SOP could decrease costs and increase access to care. Autonomy plays a clear role in job satisfaction, which may have implications for recruitment and retention.


Assuntos
Satisfação no Emprego , Enfermeiras Anestesistas/psicologia , Enfermeiras Anestesistas/estatística & dados numéricos , Densidade Demográfica , Papel Profissional/psicologia , População Rural/estatística & dados numéricos , Âmbito da Prática , População Urbana/estatística & dados numéricos , Adulto , Arizona , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
PLoS One ; 16(8): e0254347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347785

RESUMO

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.


Assuntos
COVID-19/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/patologia , COVID-19/reabilitação , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , SARS-CoV-2/fisiologia , Adulto Jovem
6.
Environ Monit Assess ; 193(8): 522, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34313833

RESUMO

Yuma County, Arizona, is a large agricultural hub of the USA located in the southwestern corner of Arizona on the USA-Mexico border. Year-round use of agrichemicals at a massive scale along with the influx of aquatic contaminants in the Colorado River led to significant levels of environmental pollution and hence exposure risks for people and wildlife. Although hair is a recognized biomarker for metal exposure, there is no universal hair preparation protocol. This study evaluated two digestion methods for metal quantitation using inductively coupled plasma-mass spectrometry (ICP-MS) and three methods for mercury quantitation using cold vapor-atomic absorption spectroscopy (CV-AAS), both employing certified reference materials. The "overnight" and "heating" digestion methods were suitable for ICP-MS, while only the heating method was suitable for CV-AAS. These validated methods will be useful for a variety of human and wildlife assessments of toxic metal(loid) exposure.


Assuntos
Monitoramento Ambiental , Roedores , Animais , Arizona , Colorado , México , Espectrofotometria Atômica
7.
Subst Use Misuse ; 56(10): 1516-1526, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34196571

RESUMO

Background: Cigarette and other tobacco product use among youth has become a serious public health issue in the United States. Thus, it is important to understand the social and contextural factors of cigarette use, especially for the young population. This study explores the relationship between participation in the National School Lunch Program (NSLP) and youth cigarettes use. Further, this study examines how this relationship differs across racial/ethnic groups. Methods: The 2016 Arizona Youth Survey (n = 34,373) data and multivariate logistic regressions were used to examine the association between NSLP participation (free and reduced-cost) and youth cigarette use, both lifetime and past 30-day smoking behaviors. In addition, subgroup analyses were conducted to test the racial disparities in NSLP participation and cigarette use. Results: Results showed that free lunch participation was associated with significantly higher odds of youth cigarette use, both lifetime (OR = 1.25; p < .001) and in the past 30-days (OR = 1.14; p < .05). However, reduced-cost lunch participation was associated with significantly higher odds only for lifetime cigarette use (OR = 1.20; p < .01). Subgroup analyses revealed differences across the six racial/ethnic groups. White and Latinx youth showed a significant relationship between NSLP participation and lifetime cigarette smoking, whereas only Latinx youth showed a significant relationship between NSLP participation and past 30-day smoking. Implications: The findings suggest that intervention approaches to smoking cessation and prevention should be tailored to different racial/ethnic groups to account for their differences. Given the findings that youth (especially Latinxs) who participate in free and reduced-cost lunch programs are at a higher risk of using cigarettes than youth who do not, this study suggests that health intervention programs can enhance their reach and effectiveness by building partnerships with schools with sizable NSLP programs.


Assuntos
Abandono do Hábito de Fumar , Produtos do Tabaco , Adolescente , Arizona/epidemiologia , Humanos , Almoço , Instituições Acadêmicas , Estados Unidos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34208981

RESUMO

We aimed to estimate the prevalence of cardiovascular risk factors, including hypertension, diabetes, high cholesterol, cigarette smoking, alcohol consumption, and obesity among a sample of individuals incarcerated in an Arizona county jail and compare prevalence estimates to a matched non-institutionalized population. From 2017-2018, individuals housed at a county jail completed a cross-sectional health survey. We estimated the prevalence of hypertension, diabetes, cholesterol, overweight/obesity, cigarette smoking, binge drinking, and self-reported health among individuals incarcerated. We compared prevalence estimates of cardiovascular risk factors to a matched sample of 2017-2018 NHANES participants. Overall, 35.9%, 7.7%, and 17.8% of individuals incarcerated in jail self-reported hypertension, diabetes, and high cholesterol, respectively. Of individuals incarcerated, 59.6% were overweight or obese and 36.8% self-reported fair or poor general health. Over half of individuals incarcerated reported ever smoking cigarettes (72.3%) and binge drinking (60.7%). Compared to a matched sample of NHANES participants, individuals incarcerated in jail had a statistically higher prevalence of cigarette smoking and binge drinking. Screening of cardiovascular risk factors and providing preventive measures and interventions, such as healthy eating, physical activity, or pharmacological adherence interventions, while individuals are incarcerated may contribute to the prevention and management of cardiovascular risk factors and, eventually, cardiovascular disease.


Assuntos
Doenças Cardiovasculares , Prisioneiros , Arizona/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Humanos , Prisões Locais , Inquéritos Nutricionais , Prevalência , Fatores de Risco
9.
Front Public Health ; 9: 689946, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34195172

RESUMO

The COVID-19 pandemic has required the professional healthcare workforce not only to adjust methods of delivering care safely but also act as a trusted sources of information during a time of uncertainty and rapid research and discovery. The Community Health Worker COVID-19 Impact Survey is a cross-sectional study developed to better understand the impact of COVID-19 on this sector of the healthcare workforce, including training needs of those working through the pandemic. The survey was distributed in Texas, New Mexico, and Arizona. This study focuses on Texas, and the data presented (n = 693) is a sub-set of qualitative data from the larger survey. Results of the content analysis described in this paper are intended to inform current COVID-19-related CHW training curriculum, in addition to future infectious disease prevention and preparedness response trainings.


Assuntos
COVID-19 , Pandemias , Arizona , Agentes Comunitários de Saúde , Estudos Transversais , Humanos , New Mexico , SARS-CoV-2 , Texas
10.
BMC Public Health ; 21(1): 1415, 2021 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273951

RESUMO

BACKGROUND: Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes toward FGM/C and confidence for related clinical care may affect the quality of care, yet there are no validated instruments to measure these constructs. METHODS: We developed the instruments via review of the FGM/C literature, the development of scale items, expert review, and pre-testing. We validated the instruments using a convenience sample of providers in Arizona and Maryland. We used exploratory factor analysis (EFA) to confirm factor structures, and compared scores between known groups to assess validity. RESULTS: The EFA revealed a two-factor solution for attitudes, including subscales for Negative Attitudes and Empathetic Attitudes toward FGM/C and those who practice with Cronbach's alphas of 0.814 and 0.628 respectively. The EFA for confidence revealed a two-factor solution including Confidence in Clinical FGM/C Care and Confidence in Critical Communication Skills for FGM/C Care with Cronbach's alphas of 0.857 and 0.694 respectively. CONCLUSIONS: Health care provider attitudes and confidence toward FGM/C care may affect quality of care and health outcomes for women and girls. Our study describes the rigorous psychometric analysis to create reliable and valid instruments to assess health care provider attitudes and confidence for the care of women and girls who have experienced FGM/C. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03249649 . Registered on 15 August 2017. Retrospectively registered.


Assuntos
Circuncisão Feminina , Arizona , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde , Humanos , Maryland , Reprodutibilidade dos Testes
11.
JAMA Netw Open ; 4(7): e2117049, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34279648

RESUMO

Importance: Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. Objective: To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. Design, Setting, and Participants: In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Main Outcomes and Measures: Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. Results: A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). Conclusions and Relevance: In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.


Assuntos
COVID-19/prevenção & controle , Emigração e Imigração/tendências , Hispano-Americanos/estatística & dados numéricos , Adulto , Arizona/epidemiologia , COVID-19/epidemiologia , Teste para COVID-19/métodos , Teste para COVID-19/estatística & dados numéricos , Chicago/epidemiologia , Estudos Transversais , Emigração e Imigração/estatística & dados numéricos , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários
12.
BMC Public Health ; 21(1): 1484, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325692

RESUMO

BACKGROUND: Older adults are particularly vulnerable to the adverse health effects of extreme temperature-related events. A growing body of literature highlights the importance of the natural environment, including air pollution and sunlight, on cognitive health. However, the relationship between exposure to outdoor temperatures and cognitive functioning, and whether there exists any differences across climate region, remains largely unexplored. We address this gap by examining the temperature-cognition association, and whether there exists any variation across climate regions in a national cohort of aging adults. METHODS: In this cross-sectional study, we obtained data on temperature exposure based on geocoded residential location of participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. For each participant, this information was linked to their cognitive scores from Word List Learning and Recall tests to assess cognitive functioning. We used distributed lag non-linear models (dlnm) to model temperature effects over 2 days. Multivariable linear regression was used to compute temperature-cognitive functioning associations, adjusted for important covariates. Region-specific ("Dry", "Mediterranean/oceanic", "Tropical" and "Continental") associations were examined by including an interaction term between climate region and temperature. RESULTS: Amongst 20,687 individuals (mean age = 67.8; standard deviation = 9.2), exposure to region-specific extreme cold temperatures in the "dry" region (e.g., Arizona) over 2 days was associated with lower cognitive scores (Mean Difference [MD]: -0.76, 95% Confidence Interval [CI]: - 1.45, - 0.07). Associations remained significant for cumulative effects of temperature over 2 days. Extremely cold exposure in the "Mediterranean/oceanic" region (e.g., California) over 2 days was also associated with significantly lower cognitive performance (MD: -0.25, 95% CI: - 0.47, - 0.04). No significant associations were observed for exposure to hot temperatures. Cognitive performance was slightly higher in late summer and fall compared to early summer. CONCLUSION: We noted adverse cognitive associations with cold temperatures in traditionally warmer regions of the country and improved cognition in summer and early fall seasons. While we did not observe very large significant associations, this study deepens understanding of the impact of climate change on the cognitive health of aging adults and can inform clinical care and public health preparedness plans.


Assuntos
Temperatura Baixa , Temperatura Alta , Idoso , Envelhecimento , Arizona , Cognição , Estudos Transversais , Humanos , Temperatura , Estados Unidos/epidemiologia
13.
Front Public Health ; 9: 601908, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34164362

RESUMO

Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona - which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.


Assuntos
Agentes Comunitários de Saúde , Medicaid , Arizona , Humanos , Motivação , Estados Unidos , Recursos Humanos
14.
Int J Tuberc Lung Dis ; 25(7): 547-553, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183099

RESUMO

BACKGROUND: Individuals with both diabetes mellitus (DM) and TB infection are at higher risk of progressing to TB disease.OBJECTIVE: To determine DM prevalence in populations at high risk for latent TB infection (LTBI) and to identify the most accurate point-of-care (POC) method for DM screening.METHODS: Adults aged ≥25 years were recruited at health department clinics in Hawaii and Arizona, USA, and screened for LTBI and DM. Screening methods for DM included self-report, random blood glucose (RBG), and POC hemoglobin A1c (HbA1c). Using HbA1c ≥6.5% or self-reported history as the gold standard for DM, we compared test strategies to determine the most accurate method while keeping test costs low.RESULTS: Of 472 participants, 13% had DM and half were unaware of their diagnosis. Limiting HbA1c testing to ages ≥30 years with a RBG level of 120-180 mg/dL helped identify most participants with DM (sensitivity 85%, specificity 99%) at an average test cost of US$2.56 per person compared to US$9.56 per person using HbA1c for all patients.CONCLUSION: Self-report was insufficient to determine DM status because many participants were previously undiagnosed. Using a combination of POC RBG and HbA1c provided an inexpensive option to assess DM status in persons at high risk for LTBI.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Tuberculose Latente , Adulto , Algoritmos , Arizona , Glicemia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/análise , Hawaii , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Programas de Rastreamento , Sistemas Automatizados de Assistência Junto ao Leito
15.
West J Emerg Med ; 22(3): 561-564, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34125027

RESUMO

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, a reduction in emergency department (ED) visits was seen nationally according to the US Centers for Disease Control and Prevention. However, no data currently exists for the impact of ED transfers to a higher level of care during this same time period. The primary objective of the study was to determine whether the COVID-19 pandemic affected the rate of non-COVID-19 transfers from a rural community ED. METHODS: We completed a retrospective chart review of all ED patients who presented to Kingman Regional Medical Center in Kingman, Arizona, from March 1-June 31, 2019 and March 1-June 31, 2020. To ensure changes were not due to seasonal trends, we examined transfer rates from the same four-month period in 2019 and 2020. Patients were included in the study if they were transferred to an outside facility for a higher level of care not related to COVID-19. RESULTS: Between the time periods studied there was a 25.33% (P = 0.001) reduction in total ED volume and a 21.44% (P = 0.009) reduction in ED transfers to a higher level of care. No statistical difference was noted in ED transfer volume following adjustment for decreased ED volumes. Transfers for gastroenterology (45%; P = 0.021), neurosurgery (29.2%; P = 0.029), neurology (76.3%; P < 0.001), trauma (37.5%; P = 0.039), urology (41.8%; P = 0.012), and surgery (56.3%; P = 0.028) all experienced a decrease in transfer rates during the time period studied. When gender was considered, males exhibited an increased rate of transfers to psychiatric facilities (P = 0.018). CONCLUSION: Significant reductions in both ED volume and transfers have coincided with the emergence of the COVID-19 pandemic. Further research is needed to determine how the current pandemic has affected patient care.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Transferência de Pacientes/estatística & dados numéricos , Adulto , Arizona/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural , SARS-CoV-2
16.
BMJ Open ; 11(6): e045014, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135037

RESUMO

OBJECTIVE: To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB). DESIGN: Quasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006-2016. SETTING: Arizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans. PARTICIPANTS: 7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences. INTERVENTION: A statewide CHW MCH home visiting programme. PRIMARY AND SECONDARY OUTCOME MEASURES: LBW, VLBW, ELBW and PTB. RESULTS: Using Health Start Programme's administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI -4.07 to -0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI -5.82 to -0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI -0.69 to -0.01) and ELBW (62%; ATT: 0.31; 95% CI (-0.52 to -0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI -4.71 to -0.91). Other results were not statistically significant. CONCLUSION: A state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.


Assuntos
Equidade em Saúde , Nascimento Prematuro , Adolescente , Arizona/epidemiologia , Peso ao Nascer , Criança , Agentes Comunitários de Saúde , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal , Estudos Retrospectivos
17.
Proc Biol Sci ; 288(1952): 20210969, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34102887

RESUMO

Some researchers posit population continuity between Late Palaeolithic hunter-gatherers of the late Pleistocene and Holocene agriculturalists from Lower (northern) Nubia, in northeast Africa. Substantial craniodental differences in these time-successive groups are suggested to result from in situ evolution. Specifically, these populations are considered a model example for subsistence-related selection worldwide in the transition to agriculture. Others question continuity, with findings indicating that the largely homogeneous Holocene populations differ significantly from late Pleistocene Lower Nubians. If the latter are representative of the local populace, post-Pleistocene discontinuity is implied. So who was ancestral to the Holocene agriculturalists? Dental morphological analyses of 18 samples (1075 individuals), including one dated to the 12th millennium BCE from Al Khiday, near the Upper Nubian border, may provide an answer. It is the first Late Palaeolithic sample (n = 55) recovered within the region in approximately 50 years. Using the Arizona State University Dental Anthropology System to record traits and multivariate statistics to estimate biological affinities, Al Khiday is comparable to several Holocene samples, yet also highly divergent from contemporaneous Lower Nubians. Thus, population continuity is indicated after all, but with late Pleistocene Upper-rather than Lower Nubians as originally suggested-assuming dental traits are adequate proxies for ancient DNA.


Assuntos
Agricultura , Fósseis , África , Arizona , História Antiga , Humanos
18.
Am J Med ; 134(9): 1155-1159, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33974907

RESUMO

BACKGROUND: Mucormycosis (zygomycosis) is an invasive fungal infection that carries a high risk of morbidity and mortality. Uncontrolled diabetes mellitus and other immunocompromising conditions are risk factors for mucormycosis development. We here describe the differences in characteristics and outcomes of mucormycosis among solid organ transplant, hematological malignancy, and diabetes mellitus groups at our institution. METHODS: We conducted a retrospective chart review over the period of 2009-2020, with identifying patients using the International Classification of Diseases, Ninth and Tenth Revisions. Clinical, laboratory, and outcome data were collected. RESULTS: There were 28 patients identified: 7 solid organ transplant, 3 hematological malignancy, and 18 diabetes mellitus patients were included in the study. Three solid organ transplant patients experienced an episode of rejection, and another 3 had cytomegalovirus infection prior to presenting with mucormycosis. Four of seven solid organ transplant patients had a history of diabetes mellitus, but the median hemoglobin A1C was lower than in the diabetes mellitus group (6.3 vs 11.5; P = .006). The mortality rate difference between solid organ transplant and diabetes mellitus was not statistically significant: 2/7 (28.57%) vs 5/18 (27.78%); P = .66. Patients with bilateral disease (pulmonary or sinus) had significantly higher mortality (80% vs 13%, P = .008). There was no difference in mortality outcomes among the different types of antifungal therapies administered. CONCLUSION: A multispecialty approach is imperative in mucormycosis therapy. While the underlying risk factors were different, the outcomes were comparable for the solid organ transplant and diabetes mellitus groups. Future larger and longitudinal studies are recommended.


Assuntos
Antifúngicos/uso terapêutico , Diabetes Mellitus , Hospedeiro Imunocomprometido/imunologia , Mucormicose , Arizona/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/terapia , Feminino , Hemoglobina A Glicada/análise , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Mucormicose/diagnóstico , Mucormicose/imunologia , Mucormicose/mortalidade , Mucormicose/terapia , Estudos Retrospectivos , Fatores de Risco , Transplantados/estatística & dados numéricos
19.
Emerg Infect Dis ; 27(6): 1714-1717, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34013870

RESUMO

We investigated an autochthonous case of cutaneous leishmaniasis caused by a genetically different Leishmania sp. in a patient in Arizona, USA. This parasite was classified into the subgenus Leishmania on the basis of multilocus DNA sequence and phylogenetic analyses of the rRNA locus and 11 reference genes.


Assuntos
Leishmania , Leishmaniose Cutânea , Arizona , Humanos , Filogenia
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