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1.
Artigo em Inglês | MEDLINE | ID: mdl-35409469

RESUMO

We describe patterns of polysubstance use and associations with HIV risk-related behaviors among women engaged in street-based transactional sex, an understudied yet important population and area of research. This sample was restricted to cisgender women who reported drug use (n = 244) in the baseline of the longitudinal SAPPHIRE cohort study. Latent class analysis (LCA) was conducted using drug use measures (route of administration (injection/non-injection); type of drug (specific opioids, stimulants)) and selection based on fit statistics and qualitative interpretation of the classes. Polysubstance use was prevalent (89% ≥ 2), and 68% had injected drugs in the past 3 months. A three-class solution was selected: Class 1 ("heroin/cocaine use", 48.4% of sample), Class 2 ("poly-opioid use", 21.3%), and Class 3 ("poly-route, polysubstance use", 30.3%). Class 3 was significantly younger, and Class 2 was disproportionately non-White. Women reported high levels of housing (63%) and food (55%) insecurity, condomless sex with clients (40%), and client-perpetrated violence (35%), with no significant differences by class. Obtaining syringes from syringe services programs differed significantly by class, despite injection behaviors in all classes. Tailored HIV and overdose prevention programming that considers drug use patterns would strengthen their impact.


Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Baltimore/epidemiologia , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia
2.
AAPS J ; 24(3): 54, 2022 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-35386051

RESUMO

The pharmaceutical industry and regulatory agencies rely on dissolution similarity testing to make critical product decisions as part of drug product life cycle management. Accordingly, the application of mathematical approaches to evaluate dissolution profile similarity is described in regulatory guidance with the emphasis given to the similarity factor f2 with little discussion of alternative methods. In an effort to highlight current practices to assess dissolution profile similarity and to strive toward global harmonization, a workshop entitled "In Vitro Dissolution Similarity Assessment in Support of Drug Product Quality: What, How, When" was held on May 21-22, 2019 at the University of Maryland, Baltimore. This manuscript provides in-depth discussion of the mathematical principles of the model-independent statistical methods for dissolution profile similarity analyses presented in the workshop. Deeper understanding of the testing objective and statistical properties of the available statistical methods is essential to identify methods which are appropriate for application in practice. A decision tree is provided to aid in the selection of an appropriate statistical method based on the underlying characteristics of the drug product. Finally, the design of dissolution profile studies is addressed regarding analytical and statistical recommendations to sufficiently power the study. This includes a detailed discussion on evaluation of dissolution profile data for which several batches per reference and/or test product are available.


Assuntos
Solubilidade , Baltimore
3.
World J Gastroenterol ; 28(5): 570-587, 2022 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-35316959

RESUMO

BACKGROUND: Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood. AIM: We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality. METHODS: This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis. RESULTS: A total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilation. CONCLUSION: Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient's severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.


Assuntos
COVID-19 , Fígado/química , Alanina Transaminase , Fosfatase Alcalina , Aspartato Aminotransferases , Baltimore , Bilirrubina , COVID-19/diagnóstico , COVID-19/terapia , Hospitalização , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
Sleep Health ; 8(2): 249-254, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35151605

RESUMO

STUDY OBJECTIVES: Trauma exposure likely contributes to poor sleep, but relatively few studies have empirically tested this, instead focusing on posttraumatic stress disorder. Moreover, little is known about sex differences in sleep after trauma. The current study used a cross-sectional and retrospective design to test hypotheses that trauma exposure would be associated with subsequent insomnia symptoms, particularly among women, even after accounting for important covariates. METHOD: Data from Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area Study (N = 1920) were used to examine associations between remote (prior to past year) and recent (past year) trauma and current sleep disturbance (insomnia, hypersomnia symptoms) in the total sample (Mage= 55, 63.2% women, 57.7% white), and separately in men and women. Sensitivity analyses were conducted among individuals with no pretrauma sleep disturbance to examine incident sleep disturbance. RESULTS: Among all participants, both remote (odds ratio [OR] = 1.95, 95% confidence interval [CI] [1.34, 2.85]) and recent (OR = 1.94, 95% CI [1.31, 2.87]) trauma exposure were associated with increased odds of insomnia (OR = 2.41, 95% CI [1.54, 3.76]) but not hypersomnia. Associations between trauma and insomnia were particularly strong among women, but null among men. The relationship between trauma exposure and insomnia symptoms persisted among individuals with no pretrauma history of insomnia. CONCLUSION: Results suggest women may be vulnerable to insomnia symptoms as sequelae of trauma. Future research should examine prospective associations between trauma and sleep in larger samples and how assessment and treatment of insomnia among women trauma survivors reduces the public health impact of trauma and poor sleep.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Baltimore/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia
5.
Environ Res ; 209: 112878, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35131327

RESUMO

INTRODUCTION: This study investigates the impact of changes in local industry, urban development, and proximity to suspected emission sources on airborne metal concentration in Baltimore, Maryland between 2001 and 2019 with particular focus on the urban industrial community of Curtis Bay in South Baltimore. METHODS: Integrated PM2.5 and PM10 Harvard Impactors were set up at six locations in the Baltimore City metropolitan area in weeklong sampling sessions from January-July 2019 to assess variation in airborne metal concentration by proximity to suspected metal emission sources. PM2.5 and PM10 were collected on Teflo filters and analyzed for a panel of 12 metals and metalloids (As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sb, and Zn) using inductively coupled plasma mass spectrometry. The findings were compared against airborne metal concentrations reported by the Baltimore Supersite in 2001 and 2003 to assess changes over the 18-year period. RESULTS: PM2.5 concentrations reported from this study ranged from 3.27 µg/m3 to 36.0 µg/m3 and PM10 concentrations ranged from 9.00 µg/m3 to 30.1 µg/m3 across all sampling sites. Metal concentrations ranged from 1.4 times (Cd) to 4.8 times (Cr) higher in PM10 compared to PM2.5. Compared to the study reference site, median PM2.5 concentrations of Co and Fe were roughly 1.8 times and 2.1 times higher, respectively, at near-road sampling sites indicating significant variability in airborne metal concentration by proximity to local traffic emissions. PM2.5 and PM10 Sb concentrations were 3.4 times and 6.7 times higher at a near incinerator site compared to the reference, consistent with existing evidence of Sb sourcing from municipal incinerators in Baltimore City. Decreases in Cr (-40%), Ni (-73%), Pb (-55%), and Zn (-36%) concentrations were observed over the 18-year period while concentrations of Cu, Fe, and Mn were not statistically significantly different. CONCLUSION: Declines in airborne Cr, Ni, Pb, and Zn concentration since 2001 appear to coincide with industrial decline highlighting the success of remediation and redevelopment efforts. Remaining spatial variability is related to vehicular traffic and proximity to a municipal incinerator which should be focal areas for future intervention to reduce metal exposure disparities in Baltimore City.


Assuntos
Poluentes Atmosféricos , Metais Pesados , Poluentes Atmosféricos/análise , Baltimore , Monitoramento Ambiental/métodos , Indústrias , Metais Pesados/análise , Material Particulado/análise
6.
Circ Arrhythm Electrophysiol ; 15(2): e010221, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35089054

RESUMO

BACKGROUND: Exercise is associated with sustained ventricular arrhythmias (VA) in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) but is not included in the ARVC risk calculator (arvcrisk.com). The objective of this study is to quantify the influence of exercise at diagnosis on incident VA risk and evaluate whether the risk calculator needs adjustment for exercise. METHODS: We interviewed ARVC patients without sustained VA at diagnosis about their exercise history. The relationship between exercise dose 3 years preceding diagnosis (average METh/wk) and incident VA during follow-up was analyzed with time-to-event analysis. The incremental prognostic value of exercise to the risk calculator was evaluated by Cox models. RESULTS: We included 176 patients (male, 43.2%; age, 37.6±16.1 years) from 3 ARVC centers, of whom 53 (30.1%) developed sustained VA during 5.4 (2.7-9.7) years of follow-up. Exercise at diagnosis showed a dose-dependent nonlinear relationship with VA, with no significant risk increase <15 to 30 METh/wk. Athlete status, using 3 definitions from literature (>18, >24, and >36 METh/wk), was significantly associated with VA (hazard ratios, 2.53-2.91) but was also correlated with risk factors currently in the risk calculator model. Thus, adding athlete status to the model did not change the C index of 0.77 (0.71-0.84) and showed no significant improvement (Akaike information criterion change, <2). CONCLUSIONS: Exercise at diagnosis was dose dependently associated with risk of sustained VA in ARVC patients but only above 15 to 30 METh/wk. Exercise does not appear to have incremental prognostic value over the risk calculator. The ARVC risk calculator can be used accurately in athletic patients without modification.


Assuntos
Arritmias Cardíacas/diagnóstico , Displasia Arritmogênica Ventricular Direita/diagnóstico , Técnicas de Apoio para a Decisão , Exercício Físico , Adulto , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Displasia Arritmogênica Ventricular Direita/epidemiologia , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Baltimore/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Noruega/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
7.
Asia Pac J Ophthalmol (Phila) ; 11(1): 6-11, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35066521

RESUMO

ABSTRACT: In an effort to address health care disparities in pediatric eye care, school-based vision programs have been established. These programs, while not universally available, have been established at individual schools or across school districts in at least 20 states in the United States (US). They play a critical role for students who are not accessing eye care, especially in disadvantaged communities. In the US, school-based vision programs often provide vision screenings, eye exams, and eyeglasses directly in the school setting. The rationale for involving schools in vision care delivery is the recognition of the inter-relatedness between health and education, including how poor vision can impact learning. Vision for Baltimore is a citywide school-based vision program that provides vision care for all Baltimore City Public Schools elementary and middle school students (age range 4 to 16 years). The goal of this paper is to summarize lessons learned from our work on clinical outcomes from screenings and eye exams, the academic impact of Vision for Baltimore, and qualitative work about consent challenges and stakeholder engagement. While school-based vision programs may vary in operations, we hope the lessons learned through our work may help demonstrate the transformative impact on vision and learning, as well as the importance of addressing stakeholder needs to maximize impact and ensure program sustainability.


Assuntos
Instituições Acadêmicas , Seleção Visual , Adolescente , Baltimore , Criança , Pré-Escolar , Óculos , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos
8.
Environ Sci Technol ; 56(4): 2172-2180, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-35080873

RESUMO

We analyze airborne measurements of atmospheric CO concentration from 70 flights conducted over six years (2015-2020) using an inverse model to quantify the CO emissions from the Washington, DC, and Baltimore metropolitan areas. We found that CO emissions have been declining in the area at a rate of ≈-4.5 % a-1 since 2015 or ≈-3.1 % a-1 since 2016. In addition, we found that CO emissions show a "Sunday" effect, with emissions being lower, on average, than for the rest of the week and that the seasonal cycle is no larger than 16 %. Our results also show that the trend derived from the NEI agrees well with the observed trend, but that NEI daytime-adjusted emissions are ≈50 % larger than our estimated emissions. In 2020, measurements collected during the shutdown in activity related to the COVID-19 pandemic indicate a significant drop in CO emissions of 16 % relative to the expected emissions trend from the previous years, or 23 % relative to the mean of 2016 to February 2020. Our results also indicate a larger reduction in April than in May. Last, we show that this reduction in CO emissions was driven mainly by a reduction in traffic.


Assuntos
Poluentes Atmosféricos , COVID-19 , Poluentes Atmosféricos/análise , Baltimore , Monóxido de Carbono , District of Columbia , Monitoramento Ambiental , Humanos , Pandemias , SARS-CoV-2 , Emissões de Veículos/análise
9.
Biol Psychiatry ; 91(4): 359-369, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-34663503

RESUMO

BACKGROUND: Higher neuroticism and lower conscientiousness are risk factors for Alzheimer's disease and related dementias, but the underlying neuropathological correlates remain unclear. Our aim was to examine whether personality traits are associated with amyloid and tau neuropathology in a new sample and meta-analyses. METHODS: Participants from the BLSA (Baltimore Longitudinal Study of Aging) completed the Revised NEO Personality Inventory and underwent amyloid (11C-labeled Pittsburgh compound B) and tau (18F-flortaucipir) positron emission tomography. RESULTS: Among cognitively normal BLSA participants, neuroticism was associated with higher cortical amyloid burden (odds ratio 1.68, 95% CI 1.20-2.34), and conscientiousness was associated with lower cortical amyloid burden (odds ratio 0.61, 95% CI 0.44-0.86). These associations remained significant after accounting for age, sex, education, depressive symptoms, hippocampal volume, and APOE ε4. Similar associations were found with tau in the entorhinal cortex. Random-effects meta-analyses of 12 studies found that higher neuroticism (N = 3015, r = 0.07, p = .008) and lower conscientiousness (N = 2990, r = -0.11, p < .001) were associated with more amyloid deposition. Meta-analyses of 8 studies found that higher neuroticism (N = 2231, r = 0.15, p < .001) and lower conscientiousness (N = 2206, r = -0.14, p < .001) were associated with more tau pathology. The associations were moderated by cognitive status, with stronger effects in cognitively normal compared with heterogeneous samples, suggesting that the associations between personality and proteopathies are not phenomena that emerge with neuropsychiatric clinical symptoms. CONCLUSIONS: By aggregating results across samples, this study advances knowledge on the association between personality and neuropathology. Neuroticism and conscientiousness may contribute to resistance against amyloid and tau neuropathology.


Assuntos
Doença de Alzheimer , Proteínas tau , Envelhecimento , Doença de Alzheimer/diagnóstico por imagem , Peptídeos beta-Amiloides , Baltimore , Humanos , Estudos Longitudinais , Personalidade , Tomografia por Emissão de Pósitrons
10.
J Gerontol A Biol Sci Med Sci ; 77(2): e98-e106, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-34612486

RESUMO

BACKGROUND: This study examined whether the effects of received and provided social support on blood pressure (BP) would differ by education. METHODS: Data from 602 African American adults (48-95 years) enrolled in the Baltimore Study of Black Aging-Patterns of Cognitive Aging were analyzed using multiple linear regression. RESULTS: We found no main effects of received and provided social support on BP. However, a significant moderation effect was observed for systolic BP, such that greater received social support was positively associated with higher systolic BP among individuals with low levels of education, adjusting for age, sex, chronic health conditions, and depressive symptoms. CONCLUSIONS: The findings demonstrate that social support and education have joint effects on BP, which highlights the importance of considering psychosocial determinants of adverse cardiovascular health outcomes that disproportionately affect African Americans.


Assuntos
Afro-Americanos , Hipertensão , Afro-Americanos/psicologia , Envelhecimento/fisiologia , Baltimore , Pressão Sanguínea/fisiologia , Humanos , Hipertensão/complicações , Apoio Social
11.
Mar Pollut Bull ; 174: 113047, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34871899

RESUMO

Anthropogenic debris has been reported in all studied marine environments, including the deepest parts of the sea. Finding areas of accumulation and methods of transport for debris are important to determine potential impacts on marine life. This study analyzed both sediment cores and Remotely Operated Vehicle video to determine the density and distribution of debris, including both micro- and macroplastics, in Norfolk and Baltimore canyons. The average microplastic density in Norfolk Canyon sediment was 37.30 plastic particles m-2 within the canyon and 21.03 particles m-2 on the adjacent slope, suggesting that microplastics could accumulate within submarine canyons. In video transects from both Norfolk and Baltimore canyons, the largest amounts of macroplastic were recorded near the canyon heads. Our findings contribute to a growing evidence base that canyons and their associated benthic invertebrate communities are important repositories and conduits for debris to the deep sea.


Assuntos
Microplásticos , Plásticos , Animais , Baltimore , Ecossistema , Monitoramento Ambiental , Invertebrados
12.
Am J Emerg Med ; 51: 325-330, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34800905

RESUMO

STUDY HYPOTHESIS: Although Emergency Medicine has recognized Palliative Care (PC) as an important aspect of Emergency Medicine, the importance of integrating palliative care into standard practice is underscored by the data that many patients qualify for PC but are not utilizing this part of medicine. We believe Emergency Medicine should integrate Palliative Care as our responsibility and not rely on our colleagues. To support our statement, we undertook an examination of patients who died while inpatient to identify whether they were appropriately receiving palliative care consults. We hypothesized that palliative care is under-utilized for patients during these admissions. DESIGN, SETTING, AND PARTICIPANT: Retrospective chart review from 2015 to 2018 of inpatient deaths using an Emergency Medicine Palliative Care Screening Tool to determine qualification for Palliative Care. Setting is John Hopkins Hospital. Participants were age 18 and over; who died during their inpatient admission. MAIN OUTCOMES AND MEASURES: Percentage of patients who qualified for palliative care via the screening tool versus percentage of patients who had palliative care involvement. RESULTS: The final study sample included 428 patients who died inpatient in the hospital between January 2015 and December 2018. The analysis used a Palliative Care Screening Tool to determine which patients would have qualified for palliative care. Analysis demonstrates that 66% of patients qualified for palliative care, whereas only 27% received it. CONCLUSION AND RELEVANCE: The data reflects the percentage of patients who qualified for Palliative Care compared to the definite number of patients who received palliative care. The discrepancy in the percentages support our statement Emergency Medicine should take the lead on initiating palliative care for qualifying patients.


Assuntos
Cuidados Paliativos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Baltimore , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
13.
J Public Health Manag Pract ; 28(2): E369-E379, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34016902

RESUMO

CONTEXT: The Good Health & Great Hair program was developed by Kaiser Permanente in partnership with a network of trusted neighborhood barbershops and beauty salons in West Baltimore, Maryland. PROGRAM: The initiative aimed to increase health awareness and knowledge and reduce health disparities by making no-cost health care services available beyond traditional health care settings in predominantly Black, historically redlined neighborhoods in West Baltimore. IMPLEMENTATION: This initiative, established by an integrated health care system, is the first to utilize mobile health clinics into a holistic community health outreach program in partnership with barbershops and beauty salons to provide medical and social services to underserved populations. In addition to the mobile health clinics, key features of this program included lay first responder trainings on topics of physical and behavioral health, on-site medical and social services offered by community partners, and culturally relevant mental health programming. The majority of participants (n = 1823) were male (58%), Black (86%), and between the ages of 45 and 64 years (51%). EVALUATION: Data presented include the number of clinical and social services provided. More than 8000 clinical and social services were provided between September 2016 and March 2020. Blood pressure (n = 2317), diabetes (n = 469), tobacco (n = 448), and cholesterol (n = 443) were the most accessed clinical screening services. The median number of clinical services provided per client was 2. Fitness (n = 1496), job search support (n = 1123), mental health (n = 603), and health insurance (n = 455) were the most accessed social services. DISCUSSION: The initiative delivered critical health and social support services through a partnership with an established integrated health care system, community barbershops and beauty salons, a mobile health team, and social supports. This novel program utilized a mobile health clinic to provide extensive clinical services complemented by on-site social services. Patterns of service utilization and lessons learned could inform the design of similar programs.


Assuntos
Prestação Integrada de Cuidados de Saúde , Equidade em Saúde , Baltimore , Beleza , Feminino , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade
14.
Inj Prev ; 28(1): 61-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33558396

RESUMO

OBJECTIVE: To estimate the long-term impact of Safe Streets Baltimore, which is based on the Cure Violence outreach and violence interruption model, on firearm violence. METHODS: We used synthetic control methods to estimate programme effects on homicides and incidents of non-fatal penetrating firearm injury (non-fatal shootings) in neighbourhoods that had Safe Streets' sites and model-generated counterfactuals. Synthetic control analyses were conducted for each firearm violence outcome in each of the seven areas where Safe Streets was implemented. The study also investigated variation in programme impact over time by generating effect estimates of varying durations for the longest-running programme sites. RESULTS: Synthetic control models reduced prediction error relative to regression analyses. Estimates of Safe Streets' effects on firearm violence varied across intervention sites: some positive, some negative and no effect. Beneficial programme effects on firearm violence reported in prior research were found to have attenuated over time. CONCLUSIONS: For highly targeted interventions, synthetic control methods may provide more valid estimates of programme impact than panel regression with data from all city neighbourhoods. This research offers new understanding about the effectiveness of the Cure Violence intervention over extended periods of time in seven neighbourhoods. Combined with existing Cure Violence evaluation literature, it also raises questions about contextual and implementation factors that might influence programme outcomes.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Baltimore/epidemiologia , Homicídio/prevenção & controle , Humanos , Violência/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controle
15.
J Racial Ethn Health Disparities ; 9(2): 538-545, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33594652

RESUMO

OBJECTIVE: Guideline-directed medical therapy (GDMT) has been shown to improve outcomes for people with cardiovascular disease (CVD). Our goal was to assess racial and socioeconomic differences in GDMT use among a diverse population. METHODS: We examined the cross-sectional association of race and poverty status with GDMT among 441 participants with CVD in a longitudinal cohort of urban-dwelling Black and White adults in Baltimore City, Maryland, using multivariable logistic regression. CVD status and GDMT were self-reported. RESULTS: The participants' mean age was 60.5 (SD 8.5) years, with 61.7% women, 64.4% Black, and 46.9% living below poverty. Of the 126 participants with coronary artery disease (CAD), 37.3%, 54.8%, and 62.7% were on aspirin, antiplatelets, and statins, respectively. Black participants with CAD were less likely to be on aspirin, OR 0.29 (95% CI 0.13-0.67), and on combination GDMT (antiplatelet and statin), OR 0.36 (0.16-0.78) compared to Whites. There were no differences by poverty status in GDMT for CAD. Fully, 222 participants reported atrial fibrillation (AF), but only 10.5% were on anticoagulation with no significant difference by race or poverty status. The use of GDMT for heart failure and stroke was also low overall, but there were no differences by race or poverty status. CONCLUSIONS: Among an urban-dwelling population of adults, the use of secondary prevention of CVD was low, with lower aspirin and combination GDMT for Black participants with CAD. Efforts to improve GDMT use at the patient and provider levels may be needed to improve morbidity and mortality and reduce disparities in CVD.


Assuntos
Doenças Cardiovasculares , Envelhecimento Saudável , Adulto , Aspirina/uso terapêutico , Baltimore/epidemiologia , Estudos Transversais , Feminino , Humanos , Longevidade , Masculino , Pessoa de Meia-Idade , Prevalência
16.
J Int Neuropsychol Soc ; 28(2): 154-165, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33896441

RESUMO

OBJECTIVES: Vision and hearing impairments affect 55% of people aged 60+ years and are associated with lower cognitive test performance; however, tests rely on vision, hearing, or both. We hypothesized that scores on tests that depend on vision or hearing are different among those with vision or hearing impairments, respectively, controlling for underlying cognition. METHODS: Leveraging cross-sectional data from the Baltimore Longitudinal Study of Aging (BLSA) and the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), we used item response theory to test for differential item functioning (DIF) by vision impairment (better eye presenting visual acuity worse than 20/40) and hearing impairment (better ear .5-4 kHz pure-tone average > 25 decibels). RESULTS: We identified DIF by vision impairment for tests whose administrations do not rely on vision [e.g., Delayed Word Recall both in ARIC-NCS: .50 logit difference between impaired and unimpaired (p = .04) and in BLSA: .62 logits (p = .02)] and DIF by hearing impairment for tests whose administrations do not rely on hearing [Digit Symbol Substitution test in BLSA: 1.25 logits (p = .001) and Incidental Learning test in ARIC-NCS: .35 logits (p = .001)]. However, no individuals had differences between unadjusted and DIF-adjusted measures of greater than the standard error of measurement. CONCLUSIONS: DIF by sensory impairment in cognitive tests was independent of administration characteristics, which could indicate that elevated cognitive load among persons with sensory impairment plays a larger role in test performance than previously acknowledged. While these results were unexpected, neither of these samples are nationally representative and each has unique selection factors; thus, replication is critical.


Assuntos
Aterosclerose , Disfunção Cognitiva , Perda Auditiva , Idoso , Envelhecimento , Aterosclerose/complicações , Baltimore , Disfunção Cognitiva/complicações , Disfunção Cognitiva/etiologia , Estudos Transversais , Perda Auditiva/complicações , Perda Auditiva/diagnóstico , Perda Auditiva/psicologia , Humanos , Estudos Longitudinais , Testes Neuropsicológicos
17.
Otolaryngol Head Neck Surg ; 166(1): 93-100, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33784206

RESUMO

OBJECTIVE: The study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on head and neck oncologic care at a tertiary care facility. STUDY DESIGN: This was a cross-sectional study conducted between March 18, 2020, and May 20, 2020. The primary planned outcome was the rate of treatment modifications during the study period. Secondary outcome measures were tumor conference volume, operative volume, and outpatient patient procedure and clinic volumes. SETTING: This single-center study was conducted at a tertiary care academic hospital in a large metropolitan area. METHODS: The study included a consecutive sample of adult subjects who were presented at a head and neck interdepartmental tumor conference during the study period. Patients were compared to historical controls based on review of operative data, outpatient procedures, and clinic volumes. RESULTS: In total, 117 patients were presented during the review period in 2020, compared to 69 in 2019. There was an 8.4% treatment modification rate among cases presented at the tumor conference. There was a 61.3% (347 from 898) reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in procedural volume compared to the prior year. Similarly, the operative volume decreased by 27.0% (224 from 307) compared to the previous year. CONCLUSION: Restrictions related to the COVID-19 pandemic resulted in limited treatment modifications. Transition to virtual tumor board format observed an increase in case presentations. While there were reductions in operative volume, there was a larger proportion of surgical cases for malignancy, reflecting the prioritization of oncologic care during the pandemic.


Assuntos
COVID-19 , Neoplasias de Cabeça e Pescoço/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Baltimore , Protocolos Clínicos , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/tendências , Estudos Prospectivos , Oncologia Cirúrgica/estatística & dados numéricos , Centros de Atenção Terciária , Tempo para o Tratamento
18.
Addiction ; 117(3): 646-655, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34338374

RESUMO

BACKGROUND AND AIMS: During the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV/AIDS, the prescription opioid crisis and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban US city. DESIGN: Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE). SETTING: Baltimore, MD, USA from 1988 to 2018. PARTICIPANTS: A total of 5506 adult PWIDs (median age at baseline 37 years). MEASUREMENTS: Mortality was identified by linkage to National Death Index-Plus (NDI-Plus) and categorized into HIV/infectious disease (HIV/ID) deaths, overdose and violence-related (drug-related) deaths and chronic disease deaths. Person-time at risk accrued from baseline and ended at the earliest of death or study period. All-cause and cause-specific mortality were calculated annually. The Fine & Gray method was used to estimate the subdistribution hazards of cause-specific deaths accounting for competing risks. FINDINGS: Among 5506 participants with 84 226 person-years of follow-up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV/ID deaths, 24.4% drug-related deaths and 33.3% chronic disease deaths. Age-standardized all-cause mortality increased from 23 to 45 per 1000 person-years from 1988 to 1996, declined from 1996 to 2014, then trended upward to 2018. HIV/ID deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic disease deaths increased continuously as the cohort aged. Drug-related deaths declined until 2011, but increased more than fourfold by 2018. HIV/HCV infection and active injecting were independently associated with HIV/ID and drug-related deaths. Female and black participants had a higher risk of dying from HIV/ID deaths and a lower risk of dying from drug-related deaths than male and non-black participants. CONCLUSIONS: Deaths in Baltimore, MD, USA attributable to HIV/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug-related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis.


Assuntos
Usuários de Drogas , Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Adulto , Idoso , Analgésicos Opioides , Baltimore/epidemiologia , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Estudos Prospectivos , Abuso de Substâncias por Via Intravenosa/complicações
19.
AIDS Behav ; 26(2): 537-548, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34338899

RESUMO

Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014-2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15-0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65-1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.


RESUMEN: La adherencia al tratamiento antirretroviral está asociada con la reducción de la morbilidad y mortalidad relacionada con el VIH y su transmisión; sin embargo, no se sabe hasta qué punto esta asociación se modificada por las normas percibidas sobre el tratamiento del VIH. 270 personas que viven con el VIH completaron una encuesta para evaluar las características demográficas, los comportamientos de riesgo, el estigma, la adherencia a los tratamientos antiretrovirales y las normas percibidas sobre el tratamiento del VIH (Baltimore, 2014­2017). Se utilizó una regresión de Poisson modificada para examinar la modificación del efecto por las normas percibidas sobre el tratamiento del VIH. La asociación entre el estigma relacionada con el VIH y la adherencia al tratamiento antirretroviral fue modificada por las normas percibidas de tratamiento del VIH. Entre los individuos que percibían que sus amigos/familiares no se adhirieron al tratamiento antirretroviral de manera óptima, el estigma relacionada con el VIH se asoció negativamente con la adherencia al tratamiento antirretroviral (Razón de riesgo ajustada [RRA] = 0.36; IC 95%:0.15­0.87). Entre los que percibían que sus amigos(as)/familiares se adhirieron al tratamiento del VIH de manera óptima, la asociación entre el estigma relacionada con el VIH y la adherencia al tratamiento antirretroviral no fue estadísticamente significativa (RRA = 1.07; IC 95%:0.65­1.76). Las intervenciones para mejorar la adherencia al tratamiento antirretroviral para aquellos que no se adhieren al tratamiento de manera óptima podrían centrarse en mejorar las normas percibidas sobre la adherencia al tratamiento antirretroviral entre sus amigos(as) y familiares.


Assuntos
Infecções por HIV , Baltimore/epidemiologia , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação , Assunção de Riscos , Estigma Social
20.
Sex Transm Dis ; 49(2): 139-144, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34321450

RESUMO

BACKGROUND: Mycoplasma genitalium (MG) is a prevalent sexually transmitted infection, but little is known about the associated inflammatory signatures in the genital tract of adolescents and young adult women. METHODS: Adolescents and young adult women aged 13 to 24 years were recruited. Demographic information, sexual behavior history, and medical history were collected. Vaginal swab samples were tested for MG, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis, and measurement of 13 cytokines, chemokines, and antimicrobial proteins. Vaginal cytokine concentrations were compared by MG infection status. The strength of associations between multiple factors and MG infection was evaluated. RESULTS: Of 215 participants, 16.7% (95% confidence interval [CI], 12.0%-22.4%) had MG infection. Inflammation was not associated with MG infection (P > 0.05). M. genitalium infection was associated with C. trachomatis infection (adjusted prevalence ratio [aPrR], 3.02; 95% CI, 1.69-5.39), bisexual behavior in the past 3 months (aPrR, 2.07; 95% CI, 1.18-3.64), genitourinary symptoms (aPrR, 2.06; 95% CI, 1.22-3.49), and self-reported Black race (aPrR, 3.53; 95% CI, 1.11-11.18). CONCLUSIONS: Higher levels of genital tract cytokines were not associated with MG infection. C. trachomatis infection, bisexual behavior, self-reported Black race, and genitourinary symptoms were associated with an increased likelihood of MG infection.


Assuntos
Infecções por Chlamydia , Infecções por Mycoplasma , Mycoplasma genitalium , Doenças Sexualmente Transmissíveis , Trichomonas vaginalis , Adolescente , Adulto , Baltimore , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Feminino , Humanos , Inflamação/complicações , Inflamação/epidemiologia , Infecções por Mycoplasma/diagnóstico , Neisseria gonorrhoeae , Prevalência , Doenças Sexualmente Transmissíveis/complicações , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Vagina/microbiologia , Adulto Jovem
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