Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 477
Filtrar
1.
J Stroke Cerebrovasc Dis ; 29(2): 104553, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31837920

RESUMO

BACKGROUND: To assess prevalence and to determine the impact of chronic obstructive pulmonary disease (COPD) on health care utilization in patients with cerebrovascular accident (CVA). METHODS: We performed retrospective analysis of data from 12,102 patients who had diagnosis of CVA from 2014 to 2019 at tertiary medical center. We calculated the prevalence of COPD among patients with diagnosis of CVA. We performed unadjusted, covariate adjusted, and propensity-matched analysis to evaluate differences in health care utilization in patients with CVA and COPD compared to patients with CVA without COPD. RESULTS: 12,102 patients were diagnosed with CVA episodes. The prevalence of COPD among CVA patients was 7.65 % (95%CI: 7.18-8.13). The unadjusted and covariate adjusted analysis demonstrated that the average number of hospitalizations among CVA patients with a diagnosis of COPD was significantly higher than CVA patients without COPD. After adjusting for modifiable and nonmodifiable confounders, CVA patients diagnosed with COPD have on average 1 more hospitalization (1.21; 95%CI: 1.12-1.30) than those who are not diagnosed with COPD. Subsequent analysis based on propensity-matched data suggests that CVA patients diagnosed with COPD have on average approximately 1 more hospitalization (1.44; 95% CI: 1.31-1.58) than CVA patients without COPD. CONCLUSIONS: Our study suggests significant prevalence of COPD among CVA patients. The presence of COPD as a comorbidity resulted in patients with COPD and CVA having increased number of hospitalizations compared to CVA patients without COPD.


Assuntos
Hospitalização , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Arkansas/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Centros de Atenção Terciária
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501233

RESUMO

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Assuntos
Desenvolvimento Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Arkansas/epidemiologia , Baltimore/epidemiologia , Boston/epidemiologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Inquéritos Nutricionais , Philadelphia/epidemiologia , Pobreza , Análise de Regressão
3.
Prev Chronic Dis ; 16: E61, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31095920

RESUMO

INTRODUCTION: Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined. METHODS: We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m2) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers' perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 "ride-alongs" and an environmental scan. RESULTS: Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage. CONCLUSION: Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers' body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers' health.


Assuntos
Condução de Veículo/estatística & dados numéricos , Veículos Automotores/estatística & dados numéricos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , População Rural/estatística & dados numéricos , Instituições Acadêmicas , Adulto , Arkansas/epidemiologia , Índice de Massa Corporal , Peso Corporal , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
4.
Narrat Inq Bioeth ; 9(1): 53-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031291

RESUMO

Marshallese migrating to the United States face numerous challenges in accessing health care and managing illness and chronic disease. This study explores health care providers' perceptions of and experiences with ethical dilemmas as they care for Marshallese patients. Utilizing a qualitative research design, we interviewed 21 providers to explore the ethical dilemmas they encountered while treating Marshallese patients. We used the framework of bioethical principlism to categorize and describe the ethical dilemmas reported by those providers. When explicitly asked whether they experienced such situations, approximately half (10/21) affirmed that they had, and analysis of the qualitative data indicated that all interviewees described an ethical dilemma at least once during their interviews. We characterized providers' ethical dilemmas in terms of conflicts that arise when prioritizing different ethical principles in the care of this complex patient population, including the principles of respect for autonomy, nonmaleficence, beneficence, and justice.


Assuntos
Pessoal de Saúde/ética , Migrantes , Adulto , Idoso , Arkansas/epidemiologia , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Beneficência , Ética Médica , Feminino , Acesso aos Serviços de Saúde/ética , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Micronésia/etnologia , Pessoa de Meia-Idade , Autonomia Pessoal , Justiça Social , Adulto Jovem
5.
Diabetes Care ; 42(5): 849-858, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30862659

RESUMO

OBJECTIVE: Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS: A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. RESULTS: Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005). CONCLUSIONS: Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Adolescente , Adulto , Idoso , Arkansas/epidemiologia , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Feminino , Hemoglobina A Glicada/análise , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Masculino , Micronésia/etnologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/estatística & dados numéricos , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Autogestão/métodos , Autogestão/estatística & dados numéricos , Adulto Jovem
6.
Otolaryngol Head Neck Surg ; 161(1): 91-97, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30912990

RESUMO

OBJECTIVE: To evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway. STUDY DESIGN: Case series with chart review. SETTING: Single tertiary care academic institution. SUBJECTS AND METHODS: Data were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248). RESULTS: Total medical complication rates (P = .012) were mildly increased in the high-risk group, as a result of increased minor-not major-medical complication rates (P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group (P = .024). All other outcomes were not statistically different between the cohorts. CONCLUSION: The ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.


Assuntos
Retalhos de Tecido Biológico , Cabeça/cirurgia , Indicadores Básicos de Saúde , Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Arkansas/epidemiologia , Comorbidade , Procedimentos Clínicos/normas , Feminino , Sobrevivência de Enxerto , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
7.
BMJ Open ; 9(2): e023506, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782882

RESUMO

OBJECTIVE: To determine the prevalence and associated factors for personal, work-related and patient/client-related burnout in clinical professionals and biomedical scientists in academic medicine. DESIGN: Prevalence survey using the Copenhagen Burnout Inventory. SETTING: Mid-size academic health centre. PARTICIPANTS: Clinical providers (n=6489) and biomedical scientists (n=248) were invited to complete the survey. 1646 completed responses (response rate 24.4%) were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence estimates and adjusted ORs (AOR) were stratified for gender, age and professional category. RESULTS: Type of burnout varies across professional categories, with significant differences between clinicians and scientists. The prevalence of personal burnout was 52.7% (95%CI 50% to 55%), work-related burnout 47.5% (95%CI 45% to 49%) and patient/client-related burnout 20.3% (95%CI 18% to 22%). The prevalence of personal and work-related burnout was higher among women, while those aged 20-30 had a higher prevalence of all three burnout categories. Overall, clinical professionals had higher personal and work-related burnout, while biomedical scientists had higher client-related burnout. Accounting for the effects of gender and age, a significantly higher risk for personal burnout was found for physicians (AOR 1.64; 95%CI 1.3 to 2.1) and nurses (AOR 1.5; 95%CI 1.03 to 2.2). Significantly higher odds of work-related burnout were found for nurses (AOR 1.5; 95%CI 1.2 to 1.9) and residents (AOR 1.9; 95%CI 1.04 to 3.6). Basic scientists (AOR 10.0; 95%CI 5.7 to 17.6), physicians (AOR 2.8; 95%CI 1.9 to 4.1) and nurses (AOR 2.1; 95%CI 1.3 to 3.5) had higher odds of patient/client-related burnout. CONCLUSIONS: Types of burnout are unevenly distributed in academic medical centres. Physicians have higher risk of personal and patient/client-related burnout, residents have higher risk of work-related burnout, basic scientists are at higher risk of client-related burnout and nurses have higher odds of all three types of burnout. Interventions addressing the problem of burnout in clinical environments may be inadequate to support biomedical scientists.


Assuntos
Esgotamento Profissional/epidemiologia , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Pesquisadores/psicologia , Centros Médicos Acadêmicos , Adulto , Arkansas/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
8.
J Agromedicine ; 24(2): 167-176, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30624156

RESUMO

BACKGROUND: The U.S. logging sector is among the most dangerous industrial sectors, with high fatality and non-fatal injury rates. Limited research has addressed work-related musculoskeletal disorders among logging machine operators (LMOs). The purpose of this study was to estimate the 12-month prevalence of musculoskeletal symptoms and the associated work-related risk factors among LMOs in the Arkansas, Louisiana, and Texas (Ark-La-Tex) logging region. METHODS: A self-administered 93-item questionnaire with six different sections: (1) demographics, (2) lifestyle and medical background, (3) work experience, (4) job training, (5) occupational heat-related stress, and (6) occupational injuries and MSS was administered to LMOs (n = 88) using Qualtrics Mobile Survey Software®. Poisson regression models were used to estimate crude prevalence ratios (PR), adjusted PR [aPR], and corresponding 95% confidence intervals (95% CI). RESULTS: Regarding organizational, ergonomic, and handling equipment occupational factors and 12-month MSS prevalence, the adjusted model controlled for age, BMI, smoking status, and drinking status. For organizational, the most problematic factors for the lower back were performing a task over and over (63.2%) and working very fast, for short periods (60.0%). For ergonomics, the most problematic factor for the lower extremities was awkward or cramped conditions (58.1%) and for the lower back was bending/twisting back awkward (55.9%). Last, for handling equipment, the most problematic for both the lower back and lower extremities was handling or grasping small objects (57.1%). CONCLUSION: Our findings revealed associations between work-related MSS and specific job factors (e.g., organizational, ergonomic, handling equipment, etc.), extreme environmental conditions or environmental, and personal risk factors. In particular, study findings suggest lower back and lower extremities MSS are associated with the a majority of job-related risk factors, lower extremities with extreme environmental conditions, and neck and upper back with personal risk factors.


Assuntos
Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Adulto , Arkansas/epidemiologia , Ergonomia , Fazendeiros/psicologia , Feminino , Agricultura Florestal , Humanos , Louisiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Doenças Profissionais/psicologia , Traumatismos Ocupacionais/psicologia , Fatores de Risco , Inquéritos e Questionários , Texas/epidemiologia , Adulto Jovem
9.
Accid Anal Prev ; 124: 219-229, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30684929

RESUMO

Due to limited visibility and low skid resistance on road surface, single-vehicle crashes under rain conditions, especially those occurred in rural areas, are more likely to result in driver incapacitating injuries and fatalities. A three-year crash dataset including all rural single-vehicle crashes under rain conditions from 2012 to 2014 in four South Central states, i.e., Texas, Arkansas, Oklahoma, and Louisiana, are selected in this paper to analyze the impact factors on driver injury severity. The mixed logit model (MLM) and the latent class model (LCM) are developed on the same dataset. Several parsimony indices, e.g., AIC and BIC, and as well as McFadden pseudo r-squared, are calculated for all the models to evaluate their respective performance. Results show that choosing the uniform distribution as the prior for random parameters could better improve the goodness-of-fit of the MLM than using normal and lognormal distributions. In addition, the two-class LCM also shows superiority when compared to three- and four-class LCMs. Finally, a careful comparison between these two models is conducted, and the results indicate that the LCM has a slightly better performance in analyzing the aforementioned dataset in this study. Model estimation results show that curve, on grade, signal control, multiple lanes, pickup, straight, drug/alcohol impaired, and seat belt not used can significantly increase the probability of incapacitating injuries and fatalities for drivers in the two models. On the other hand, wet, male, semi-trailer, and young can significantly decrease the probability of incapacitating injuries and fatalities for drivers. This study provides an insightful understanding of the effects of these attributes on rural single-vehicle crashes under rain conditions and beneficial references for developing effective countermeasures for severe injury prevention.


Assuntos
Acidentes de Trânsito/mortalidade , Escala de Gravidade do Ferimento , Chuva , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/prevenção & controle , Adulto , Fatores Etários , Idoso , Arkansas/epidemiologia , Feminino , Humanos , Análise de Classes Latentes , Modelos Logísticos , Louisiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Veículos Automotores , Oklahoma/epidemiologia , População Rural/estatística & dados numéricos , Fatores Sexuais , Texas/epidemiologia , Ferimentos e Lesões/prevenção & controle , Adulto Jovem
10.
Ann Vasc Surg ; 54: 48-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30213742

RESUMO

BACKGROUND: The Patient Protection and Affordable Care Act was signed into law in 2010 and enacted in 2013 which improved insurance coverage across America due to increasing Medicaid eligibility as well as changes to individual insurance markets. In Arkansas, this was implemented by a Medicaid expansion waiver which allowed patients to purchase insurance with funds provided by the government to subsidize premiums through the marketplace. The goal of this study was to determine the effects of the Affordable Care Act (ACA) on Arkansas patients with peripheral arterial disease. METHODS: A pre-post research design using the Arkansas Hospital Discharge Dataset was used to study the impact of the ACA on limb amputation, distal bypass, discharge disposition, and total costs for patients diagnosed with peripheral arterial disease/atherosclerosis. The data were obtained for the years 2007 through 2009 (pre-ACA), 2011 through 2013 (post-ACA), and 2014 through 2015 (post-Arkansas expansion). Bivariate analysis, analysis of variance, and regression analyses were performed to analyze the data. RESULTS: A total of 10,923 patients were identified. Uninsured patients ("self-pay") decreased from 7% pre-ACA to 3.4% post-Arkansas expansion (P < 0.0001). There was a decrease in adjusted health-care costs after the Arkansas expansion (P < 0.0001). There was no change in mortality or transfer to rehabilitation facilities, but there was an increase in discharge to skilled nursing facilities along with a decrease in patients being discharged home (P < 0.0001). Regression analysis showed private insurance to be associated with a 49% reduction in the odds of an amputation (P < 0.0001). The Arkansas expansion was associated with a 26% reduction in the odds of an amputation when compared with that before the ACA implementation (P < 0.005). Having private insurance was associated with a 26% increase in the odds of having a bypass when compared with uninsured patients (P < 0.05). CONCLUSIONS: Patients with private insurance have a decreased chance of amputation and increased odds of having a bypass when compared with patients who were of the self-pay category. The increase in private insurance coverage in our patient population could improve the rate of amputation in the vascular population in Arkansas by increasing early interventions for peripheral vascular disease.


Assuntos
Amputação/tendências , Acesso aos Serviços de Saúde/tendências , Patient Protection and Affordable Care Act/tendências , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/tendências , Amputação/legislação & jurisprudência , Arkansas/epidemiologia , Bases de Dados Factuais , Feminino , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/tendências , Salvamento de Membro/legislação & jurisprudência , Salvamento de Membro/tendências , Masculino , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/legislação & jurisprudência , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência
11.
Clin Cardiol ; 42(2): 299-304, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30592068

RESUMO

BACKGROUND: The effects of carvedilol and metoprolol succinate on appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) are not fully understood. HYPOTHESIS: The hypothesis of our study is possible carvedilol superiority over metoprolol in patients with ICD. METHODS: All patients with ICD registered to a single device clinic between 1/2012 and 6/2017 (n = 569) were identified. Patients with systolic heart failure (left ventricular ejection fraction ≤40%) treated with carvedilol vs metoprolol succinate were compared. Primary endpoint was difference in survival free of appropriate device therapy (shock or anti-tachycardia pacing, ATP). Secondary endpoints were freedom from inappropriate therapy (shock or ATP) and all cause death. RESULTS: A total of 225 patients were included in the analysis with median follow up of 57 months (IQR 33.7-90). The 2 groups were comparable in the baseline characteristics. Carvedilol was superior to metoprolol succinate in improving survival free of appropriate ICD therapy (HR 0.42; 95% CI 0.24-0.72, P = 0.01). This difference was driven by reduction in survival free of appropriate shocks (HR 0.30; 95% CI 0.15-0.63, P = -0.01) while there was no significant difference in appropriate ATP (HR 0.55; 95% CI 0.28-1.1, P = 0.12). There was no significant difference in time to inappropriate shocks (HR 1.02; 95% CI 0.19-5.6, P = 0.97), inappropriate ATP (HR 0.93, OR 0.24-3.5, p value 0.9) or all cause death (HR 0.8; 95% CI 0.42-1.5, P = 0.52). CONCLUSIONS: This study suggests that carvedilol use was associated with improved survival free of appropriate ICD therapy compared to metoprolol succinate in patients with HFrEF.


Assuntos
Carvedilol/uso terapêutico , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Metoprolol/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Arkansas/epidemiologia , Causas de Morte/tendências , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
12.
BMC Vet Res ; 14(1): 388, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522490

RESUMO

BACKGROUND: Pigs (Sus scrofa) are the natural hosts of pseudorabies virus (PRV), also known as Aujeszky's disease. Infection in mammals, with the exception of humans, typically causes extreme itching, facial swelling, and excessive salivation, followed by death in non-suid species. The risk to susceptible mammals was assumed to decrease when PRV was eliminated from U.S. commercial swine in 2004, though the virus remains endemic in feral swine. Infected feral swine pose a threat to the disease-free status of the commercial swine industry, and to other animals, including dogs, that come in direct or indirect contact with them. Since dogs are commonly used for hunting feral swine, they are at high risk of exposure. CASE PRESENTATION: The following report describes the progression of pseudorabies infection in dogs in two states after exposure to feral swine. The first case occurred in a dog in Alabama after participation in a competitive wild hog rodeo. The second case occurred in multiple dogs in Arkansas after hunting feral swine, and subsequent consumption of the offal. The antibody prevalence of feral swine in the two states where the dogs were exposed is also examined. CONCLUSIONS: Dogs that are used for hunting feral swine are at high risk of exposure to pseudorabies because the disease is considered endemic in feral swine in the U.S.


Assuntos
Doenças do Cão/patologia , Pseudorraiva/patologia , Pseudorraiva/transmissão , Doenças dos Suínos/patologia , Doenças dos Suínos/transmissão , Alabama/epidemiologia , Animais , Animais Selvagens/virologia , Anticorpos Antivirais/sangue , Arkansas/epidemiologia , Doenças do Cão/diagnóstico , Cães , Evolução Fatal , Feminino , Herpesvirus Suídeo 1/fisiologia , Masculino , Pseudorraiva/diagnóstico , Pseudorraiva/epidemiologia , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/virologia
13.
Arch Psychiatr Nurs ; 32(6): 828-835, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30454624

RESUMO

First responders (FRs) respond to critical incidents as an expectation of their profession, and after years of service, exposure to trauma can accumulate and potentially lead to mental health problems, such as posttraumatic stress disorder (PTSD). A gap persists in the research regarding duty-related risk factors and prevalence of mental health problems among FRs. Guided by existing evidence and in partnerships with the state's FR community, this study assessed the mental health needs of FRs, risk factors that may contribute to these problems, and the associations therein. A convenience sample of firefighters and emergency medical technicians/paramedics (n = 220) were recruited from across Arkansas to complete an online survey. This survey incorporated brief assessment tools to measure various mental health problems, and captured other data regarding possible risk factors. Results found that 14% reported moderate-severe and severe depressive symptoms, 28% reported moderate-severe and severe anxiety symptoms, 26% reported significant symptoms of PTSD, 31% reported harmful/hazardous alcohol use and dependence, 93% reported significant sleep disturbances, and 34% indicated high risk for suicide. Significant group differences were found across measures and gender (female), shift-structure (48 h or more), department setting (rural), relationship status (non-partnered), and having a medical history of hypertension. These findings pose significant implications for mental healthcare providers, as well as other healthcare providers and FR organizations. Findings will guide future research that will address the need for changes in decision-making, funding, and policy regarding FRs' MH and MH services available to them.


Assuntos
Socorristas/psicologia , Transtornos Mentais/psicologia , Transtornos do Sono-Vigília/psicologia , Suicídio/psicologia , Adolescente , Adulto , Arkansas/epidemiologia , Socorristas/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , Adulto Jovem
14.
Psychiatr Serv ; 69(11): 1146-1152, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30152271

RESUMO

OBJECTIVE: Multiple studies have detailed the relationship between Medicaid expansion under the Affordable Care Act and various health and financial outcomes. However, fewer studies have examined Medicaid expansion's effects on individuals with psychiatric diagnoses. This study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression. METHODS: This quasi-experimental study used a random-digit-dial survey of U.S. citizens ages 19-64 with incomes below 138% of the federal poverty level. Surveys were conducted in three southern states (two expansion states, Arkansas and Kentucky, and one nonexpansion state, Texas) between 2013 and 2016. The study sample consisted of those with a positive screen for depression-score of ≥2 on the two-item Patient Health Questionnaire (N=4,853). Survey-weighted difference-in-differences regressions were conducted with insurance status, health care access and utilization, and affordability of care as outcomes of interest. Subgroup analyses stratified the sample on the basis of the respondent's residence in a health professional shortage area (HPSA) in mental health and severity of depression. RESULTS: Medicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance (-23 percentage points, 95% confidence interval=-32 to -14, p<.001). Medicaid expansion was also associated with significant reductions in delaying care and medications because of cost. These changes were similar regardless of residence in a mental health HPSA and severity of depression. CONCLUSIONS: Medicaid expansion was associated with improved access to care and medication among persons with depression, even in areas with relative shortages of mental health professionals.


Assuntos
Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Área Carente de Assistência Médica , Patient Protection and Affordable Care Act/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adulto , Arkansas/epidemiologia , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Texas/epidemiologia , Estados Unidos , Adulto Jovem
15.
Anxiety Stress Coping ; 31(5): 500-513, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29996679

RESUMO

BACKGROUND AND OBJECTIVES: A growing body of work suggests individuals with more severe post-traumatic stress symptoms (PTSS) are at higher risk for developing problematic alcohol use outcomes. Extending work from the adult literature, the present study was the first to examine the extent to which PTSS is related to drinking motives for alcohol use in both clinical and non-clinical samples of adolescents. DESIGN: Hierarchical regression analyses were used to predict coping motives for alcohol use from PTSS, above and beyond demographic variables, alcohol use frequency, and other alcohol use motives. METHODS: Trauma-exposed adolescents before entering treatment (Sample 1 n = 41) and recruited from the local community (Sample 2 n = 55) self-reported on PTSS and alcohol use motives. RESULTS: PTSS positively predicted coping motives for alcohol use after controlling for age, gender, and alcohol use frequency. CONCLUSIONS: The current study highlights the need to consider both PTSS severity, as well as underlying cognitive mechanisms (e.g., motives), to better understand the etiology of problematic alcohol use among trauma-exposed youth. Future work focused on clarifying the trajectory of alcohol use motives and problems as a function of PTSS is needed.


Assuntos
Adaptação Psicológica/fisiologia , Motivação/fisiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Adolescente , Arkansas/epidemiologia , Feminino , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Características de Residência , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
16.
Int J Hyg Environ Health ; 221(6): 958-966, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29886105

RESUMO

Balkan endemic nephropathy (BEN) is an irreversible, lethal kidney disease that occurs in regions of the Balkans where residents drink untreated well water. A key factor contributing to the development of BEN may be consumption of dissolved organic matter leached from low-rank coal called lignite. This hypothesis-known as lignite-water hypothesis-was first posed for areas of the Balkans. It is possible that a BEN-like condition exists in the United States (US) Gulf Coast region in parts of the Mississippi Embayment and the Texas Coastal Uplands aquifers -Arkansas, Louisiana, and Texas, for instance-that rely heavily on groundwater from aquifers that contain lignite. This study utilizes a geographic information system (GIS) to map the distributions of end-stage renal disease (ESRD) in relation to water from lignite-containing aquifers in the tri-state region. Regional patterns emerged from geospatial analysis, suggesting that counties that relied on lignite-containing aquifers for their main water source had higher rates of ESRD in comparison to other populations in the region that rely on other water sources, including surface water and groundwater from aquifers not associated with lignite seams. Statewide rates of ESRD and diabetes associated ESRD (ESRD-DM) showed strong correlations to the percent of families at or below poverty level and the percentage of African Americans. These confounding factors somewhat mitigate the association seen between ESRD and lignite-containing regions at the state level. However, at the larger tri-state view, there is a significant (p = 0.002) increase in incidence rates where groundwater is connected to lignite-containing aquifers when considering both race and poverty. Additionally, no relationship was observed between the rate of public water supply withdrawal from lignite-bearing aquifers and rates of ESRD or ESRD-DM at the state or tri-state regions, supporting the observation that the risk associated with water from lignite-containing aquifers is limited to water from untreated domestic supply.


Assuntos
Carvão Mineral , Diabetes Mellitus/epidemiologia , Água Subterrânea , Falência Renal Crônica/epidemiologia , Poluentes Químicos da Água , Arkansas/epidemiologia , Grupos de Populações Continentais , Humanos , Louisiana/epidemiologia , Pobreza , Texas/epidemiologia , Abastecimento de Água
17.
Int J Tuberc Lung Dis ; 22(6): 628-636, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29862946

RESUMO

SETTING: Arkansas, USA. OBJECTIVE: To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states. DESIGN: We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation. RESULTS: From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation. CONCLUSION: Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Arkansas/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/patologia , Adulto Jovem
18.
J Subst Abuse Treat ; 86: 78-85, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29415855

RESUMO

Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1-2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Arkansas/epidemiologia , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Ohio/epidemiologia , População Rural , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação
19.
Health Promot Pract ; 19(6): 896-904, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29388480

RESUMO

In 2003, Arkansas became the first state to require body mass index (BMI) testing in public schools to raise awareness of the growing obesity epidemic among children and adolescents. Limited information exists regarding the effectiveness of school-based BMI screening programs. The purpose of this study was to determine if BMI health report cards affected parents' knowledge or actions regarding their child's health and to determine the accuracy of parents' perceptions of their child as underweight, normal weight, or overweight according to their child's BMI. A questionnaire was developed with the help of physical educators, pediatricians, and exercise scientists to determine parents' perceptions and behaviors regarding BMI report cards. The questionnaire was distributed to parents/guardians of children who sought medical care at two pediatrician's offices in Arkansas. Based on responses to survey questions, parents are not making changes to their child's diet and exercise habits if their child is classified as "at risk" or "overweight." However, parents did report that BMI health report cards are influencing their knowledge about their child's health. The majority of parents in the study (approximately 66%) did not accurately perceive their child's BMI category.


Assuntos
Índice de Massa Corporal , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Sobrepeso/prevenção & controle , Pais/psicologia , Adolescente , Adulto , Arkansas/epidemiologia , Peso Corporal , Criança , Pré-Escolar , Dieta , Exercício , Feminino , Humanos , Masculino , Relações Pais-Filho , Percepção , Inquéritos e Questionários
20.
J Parasitol ; 104(3): 319-321, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29457936

RESUMO

Adult female guinea worms ( Dracunculus spp.) usually are reported to occur singly in the extremities of their hosts, from which they deliver their larvae into the water through fistulae in the host's skin. We visually examined for the presence of worms in the fascia of the limbs of skinned carcasses of 184 river otters ( Lontra canadensis) harvested in Arkansas and report observations of cysts on wrists and ankles found on 12 otters. Cysts averaged 15.6 × 24.6 mm in diameter, were round to oval, and contained masses of up to 19 adult female Dracunculus sp. (mean 6.7). We speculate that high levels of infection in consumed paratenic hosts might have caused high infection rates, leading to large cyst formation in otters, as larvigerous Dracunculus sp. females accumulated in extremities. No males were discovered during the study, so identification of a sample of worms was based on molecular techniques.


Assuntos
Dracunculíase/veterinária , Dracunculus/fisiologia , Lontras/parasitologia , Animais , Arkansas/epidemiologia , Código de Barras de DNA Taxonômico/veterinária , Dracunculíase/epidemiologia , Dracunculíase/parasitologia , Dracunculus/anatomia & histologia , Dracunculus/genética , Complexo IV da Cadeia de Transporte de Elétrons/genética , Extremidades/parasitologia , Feminino , Masculino , Mitocôndrias/enzimologia , Prevalência
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA