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1.
Lancet Public Health ; 7(9): e744-e753, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36057273

RESUMO

BACKGROUND: During the first year of the COVID-19 pandemic, workers in essential sectors had higher rates of SARS-CoV-2 infection and COVID-19 mortality than those in non-essential sectors. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur during the periods of SARS-CoV-2 variants and vaccine availability. METHODS: In this longitudinal cohort study, we obtained data from the California Department of Public Health on all deaths occurring in the state of California, USA, from Jan 1, 2016, to Dec 31, 2021. We restricted our analysis to residents of California who were aged 18-65 years at time of death and died of natural causes. We classified the occupational sector into nine essential sectors; non-essential; or unemployed or without an occupation provided on the death certificate. We calculated the number of COVID-19 deaths in total and per capita that occurred in each occupational sector. Separately, using autoregressive integrated moving average models, we estimated total, per-capita, and relative excess natural-cause mortality by week between March 1, 2020, and Nov 30, 2021, stratifying by occupational sector. We additionally stratified analyses of occupational risk into counties with high versus low vaccine uptake, categorising high-uptake regions as counties where at least 50% of the population were fully vaccinated according to US guidelines by Aug 1, 2021. FINDINGS: From March 1, 2020, to Nov 30, 2021, 24 799 COVID-19 deaths were reported in residents of California aged 18-65 years and an estimated 28 751 (95% prediction interval 27 853-29 653) excess deaths. People working in essential sectors were associated with higher COVID-19 deaths and excess deaths than were those working in non-essential sectors, with the highest per-capita COVID-19 mortality in the agriculture (131·8 per 100 000 people), transportation or logistics (107·1 per 100 000), manufacturing (103·3 per 100 000), facilities (101·1 per 100 000), and emergency (87·8 per 100 000) sectors. Disparities were wider during periods of increased infections, including during the Nov 29, 2020, to Feb 27, 2021, surge in infections, which was driven by the delta variant (B.1.617.2) and occurred during vaccine uptake. During the June 27 to Nov 27, 2021 surge, emergency workers had higher COVID-19 mortality (113·7 per 100 000) than workers from any other sector. Workers in essential sectors had the highest COVID-19 mortality in counties with low vaccination uptake, a difference that was more pronounced during the period of the delta infection surge during Nov 29, 2020, to Feb 27, 2021. INTERPRETATION: Workers in essential sectors have continued to bear the brunt of high COVID-19 and excess mortality throughout the pandemic, particularly in the agriculture, emergency, manufacturing, facilities, and transportation or logistics sectors. This high death toll has continued during periods of vaccine availability and the delta surge. In an ongoing pandemic without widespread vaccine coverage and with anticipated threats of new variants, the USA must actively adopt policies to more adequately protect workers in essential sectors. FUNDING: US National Institute on Aging, Swiss National Science Foundation, and US National Institute on Drug Abuse.


Assuntos
COVID-19 , Vacinas , California/epidemiologia , Estudos de Coortes , Humanos , Estudos Longitudinais , Pandemias , SARS-CoV-2
2.
Health Aff (Millwood) ; 41(9): 1316-1323, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36067431

RESUMO

Surprise billing laws that allow dispute arbitration relying on provider charges may incentivize out-of-network providers to increase their charges to increase upcoming or future out-of-network payments. Although the federal No Surprises Act forbids arbitrators from considering charges during payment disputes over surprise bills covered by the act, states with existing laws can continue to use the specified state laws, which may allow the consideration of charges. This analysis examined provider charges in two such states, using claims data to compare trends in billed charges for out-of-network care during surprise bill scenarios involving nonemergency inpatient hospitalizations. The analysis considered New York, where state law uses arbitration tied to charges; California, where state law uses a payment standard rather than charges; and a comparison group of states without a law regarding surprise billing. We estimated that provider out-of-network charges for the nonemergency out-of-network bills we studied increased by $1,157 (24 percent) in New York after the passage of New York's surprise billing law and decreased by $752 (25 percent) in California compared to states without surprise billing laws. Assistant surgeons and surgical assistants had a large increase in charges in New York from before to after the law's passage, which may have driven the overall increase in charges.


Assuntos
Honorários e Preços , Negociação , California , Humanos , New York , Estados Unidos
3.
J Am Coll Surg ; 235(4): 581-591, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36102546

RESUMO

BACKGROUND: Timely receipt of surgery should be available for all patients. Few studies have examined differences in the treatment of symptomatic cholelithiasis (SC), a common surgical problem, based on race/ethnicity or insurance status. This study aimed to identify differences in repeat emergency department (ED) use and wait time to cholecystectomy for SC. STUDY DESIGN: Patients discharged from the ED with SC between July 1, 2016, and December 31, 2017, were identified from California administrative databases and followed for 1 year. Repeat ED use and wait time to elective and nonelective cholecystectomy after ED discharge were examined using logistic and negative binomial regression models. RESULTS: The final cohort analyzed 13,596 patients who underwent cholecystectomy within 1 year from index ED visit for SC. In adjusted analysis, non-Hispanic Black patients had higher odds for repeat ED use for biliary-related conditions before elective surgery and experienced longer waits for cholecystectomy (across several measures of wait times) compared with non-Hispanic White patients. Similar findings were seen for Medicaid and self-pay compared with privately insured patients. For example, self-pay patients had more than double the odds of experiencing repeat ED use while waiting for elective cholecystectomy compared with privately insured patients (adjusted odds ratio 2.49, 95% CI 1.88-3.31). CONCLUSION: Patients with SC receiving cholecystectomy within 1 year from index ED visit were more likely to have repeat ED use and longer waits to surgery based on their race/ethnicity and insurance status, even after adjusting for other measures of access. We identify a vulnerable population at risk for differences in treatment for a common surgical pathology.


Assuntos
Colelitíase , Alta do Paciente , California , Colelitíase/cirurgia , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Estados Unidos
4.
Front Public Health ; 10: 876769, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36091515

RESUMO

Adverse Childhood Experiences (ACEs) are defined as traumatic events occurring before age 18, such as maltreatment, life-threatening accidents, harsh migration experiences, or violence. Screening for ACEs includes asking questions about an individual's early exposure to these types of events. ACEs screenings have potential value in identifying children exposed to chronic and significant stress that produces elevated cortisol levels (i.e., toxic stress), and its associated physical and mental health conditions, such as heart disease, diabetes, depression, asthma, ADHD, anxiety, and substance dependence. However, ACEs screenings are seldom used in primary care settings. The Surgeon General of California has addressed this care gap by introducing ACEs Aware, an ACEs screening fee-for-service healthcare policy signed into law by Gov. Gavin Newsom. Since January 2020, Medi-Cal, California's Medicaid health care program, has reimbursed primary care providers for using the Pediatric ACEs and Related Life-events Screener (PEARLS) tool to screen children and adults for ACEs during wellness visits. To achieve the goals set by the ACEs Aware state policy, it is essential to develop and test implementation strategies that are informed by the values, priorities, and resources of clinical settings, healthcare professionals, and end-users. To address this need, we partnered with a system of federally qualified health centers in Southern California on a pilot study to facilitate the implementation of ACEs screenings in five community-based clinics. The health centers had broad ideas for an implementation strategy, as well as best practices to improve adoption of screenings, such as focusing on staff training to improve clinic workflow. This knowledge was incorporated into the development of an implementation strategy template, used at the outset of this study. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to guide the study and inform a participatory planning process called Implementation Mapping. In this paper, we describe how Implementation Mapping was used to engage diverse stakeholders and guide them through a systematic process that resulted in the development of the implementation strategy. We also detail how the EPIS framework informed each Implementation Mapping Task and provide recommendations for developing implementation strategies using EPIS and Implementation Mapping in health-care settings.


Assuntos
Experiências Adversas da Infância , Adolescente , Adulto , California , Criança , Política de Saúde , Humanos , Programas de Rastreamento/métodos , Projetos Piloto , Estados Unidos
5.
Science ; 377(6611): 1136-1137, 2022 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-36074849

RESUMO

Move to phase out gas-powered cars will force progress toward faster charging batteries.


Assuntos
Fontes de Energia Elétrica , California
6.
Zootaxa ; 5174(3): 294-300, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-36095395

RESUMO

A new species of Aleurocybotus Quaintance Baker, 1914 found on grasses in the Mojave Desert in California, U.S.A., is described, figured, and diagnosed from its congeners. It can be easily recognized from A. occiduus Russell, 1964, the only other species of this genus present in California, by the copious white woolly wax secretions of its puparia and corresponding dorsal submarginal glandular band, and from A. cereus Martin, 2005, the only other Aleurocybotus species that produces large amounts of white wax, by its narrower glandular band, shape of vasiform orifice and operculum, and several other cuticular characters. A key to identify puparia of all described species of Aleurocybotus is provided.


Assuntos
Produtos Biológicos , Hemípteros , Animais , California , Poaceae
7.
Artigo em Inglês | MEDLINE | ID: mdl-36078318

RESUMO

The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.


Assuntos
COVID-19 , Assistência Alimentar , California , Criança , Feminino , Frutas , Humanos , Lactente , Estudos Longitudinais , Estados Unidos , Verduras
8.
J Safety Res ; 82: 102-111, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36031237

RESUMO

OBJECTIVE: Since 2012, 19 states and the District of Columbia have legalized the recreational use of marijuana for adults ages 21 and older. Marijuana use at any level can impair driving performance. Prior research on enforcement of the minimum legal marijuana use age of 21 (MLMU-21) laws is limited. The objective of the current study was to assess the ease of access to marijuana by underage patrons at recreational marijuana outlets in California, where recreational marijuana was legalized in 2016. METHOD: Pseudo-underage patrons were sent to 50 randomly selected licensed recreational marijuana outlets in the state to see if they could enter the outlet without showing a valid identification of their age. RESULTS: Pseudo-underage patrons were required to show age identification to enter in 100% of the licensed recreational marijuana outlets visited. CONCLUSIONS: It appears that licensed California recreational marijuana outlets avoid selling marijuana to underage customers. One reason could be a strong incentive for recreational marijuana outlet owners and managers to avoid being shut down for an illegal activity. PRACTICAL APPLICATION: Underage youth are not obtaining marijuana at licensed recreational outlets. Future studies and cannabis enforcement agencies should investigate whether underage patrons attempt to use fake IDs at licensed marijuana outlets and whether youth are obtaining marijuana from illicit dispensaries or from social sources.


Assuntos
Cannabis , Fumar Maconha , Adolescente , Adulto , California , Comércio , District of Columbia , Humanos , Adulto Jovem
9.
J Safety Res ; 82: 144-150, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36031241

RESUMO

INTRODUCTION: A 2018 change to the California building code mandates that new residential construction in the state include rooftop solar photovoltaic power systems beginning in 2020. As residential construction (especially work on rooftops) is among the more dangerous occupations in the United States, this paper seeks to quantify the increased risks to workers as a result of this mandate. METHOD: An analysis of the trends by occupation of nonfatal safety incident rates in the United States combined with a Monte Carlo simulation provide an estimate of the uncertain impact of this new mandate. RESULTS: Recordable safety incidents are anticipated to increase by a total of 16.6 incidents (standard deviation = 1.0 incidents) over the 2020-2029 time period as a result of this policy change. However, lessons from Germany and other industries offer potential avenues to reduce the negative social impact of this mandate. CONCLUSIONS: While it is not possible to increase employment in any sector without increasing the expected number of occupational injuries to some degree, these results indicate that risks could be considerably reduced by making solar PV system design decisions that increase worker productivity and reduce roof exposure time. PRACTICAL APPLICATIONS: Changes such as eliminating work on roofs could decrease the expected number of recordable injuries over the 10-year period by 0.30 incidents per year (a reduction of 18%).


Assuntos
Saúde do Trabalhador , Traumatismos Ocupacionais , California , Alemanha , Humanos , Ocupações , Estados Unidos
10.
Environ Pollut ; 310: 119888, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35940487

RESUMO

In this short communication, we estimate that California's wildfire carbon dioxide equivalent (CO2e) emissions from 2020 are approximately two times higher than California's total greenhouse gas (GHG) emission reductions since 2003. Without considering future vegetation regrowth, CO2e emissions from the 2020 wildfires could be the second most important source in the state above either industry or electrical power generation. Regrowth may partly of fully occur over a long period, but due to exigencies of the climate crisis most of the regrowth will not occur quickly enough to avert greater than 1.5 degrees of warming. Global monetized damages caused by CO2e from in 2020 wildfire emissions amount to some $7.1 billion USD. Our analysis suggests that significant societal benefits could accrue from larger investments in improved forest management and stricter controls on new development in fire-prone areas at the wildland-urban interface.


Assuntos
Gases de Efeito Estufa , Incêndios Florestais , California , Dióxido de Carbono , Florestas , Efeito Estufa
11.
J Dairy Sci ; 105(9): 7750-7763, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35931482

RESUMO

Bovine respiratory disease (BRD) is a multifactorial disease which causes short- and long-term negative effects. Early detection is crucial for a prompt response to therapy, as well as to decrease mortality risk. Clinical scoring systems have been developed mostly in North America for screening calves at risk or suspected of having BRD, and these tools have also been applied in subtropical and tropical countries. However, it has been unknown whether these scoring systems had the same accuracy in tropical environmental conditions. Therefore, this study evaluated the accuracy of 4 different field techniques, as well as serum haptoglobin (HAP), to diagnose BRD in Holstein dairy calves in subtropical conditions. The tests used to diagnose BRD were thoracic ultrasound (TUS; positive if consolidation depth ≥1 cm), thoracic auscultation (AUSC; positive if crackles, wheezes, or silent areas were present), Wisconsin score (WISC; ≥2 categories with scores of ≥2), and California score (CALIF; positive if total score ≥5). Also, HAP was measured and classified as positive if ≥15 mg/dL. Heifers between 30 d of age and weaning (n = 482), residing on 17 commercial dairies in São Paulo state, were enrolled in this study. Bayesian latent class models were used with informative priors to evaluate the accuracy of TUS, AUSC, and HAP, and noninformative priors for the accuracy of WISC and CALIF. The percentage of calves positive for each test on each farm ranged from 0 to 56% for WISC, 11-51% for CALIF, 0-72% for TUS, 0-32% for AUSC, and 0-100% for HAP. The sensitivity (Se; 95% credible interval) and specificity (Sp) for WISC were 77.9% (64.8-90.2) and 81.9% (76.3-88.2). For CALIF, the Se was 67.1% (53.6-80.1) and Sp 79.1% (73.9-84.6). For TUS Se was 59.8% (46.5-73.1) and Sp was 84.8% (80.0-89.5), and for AUSC, Se was 58.8% (41.3-79.8) and Sp was 98.6% (95.7-99.9). The Se and Sp of HAP was 67.6% (55.3-78.8) and 46.7% (41.4-52.2), respectively. The performance of the scoring systems was similar to, or better than, the performance found in North American studies, despite the fact that calves were in a tropical environment.


Assuntos
Complexo Respiratório Bovino , Doenças dos Bovinos , Doenças Respiratórias , Animais , Teorema de Bayes , Complexo Respiratório Bovino/diagnóstico , Brasil , California , Bovinos , Feminino , Doenças Respiratórias/veterinária , Wisconsin
12.
Inquiry ; 59: 469580221103925, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35975746

RESUMO

The California Medical Supervision Program is designed to protect agricultural workers from overexposure to Toxicity Category I and II organophosphate (OP) and carbamate (CB) pesticides by routinely monitoring their blood cholinesterase (ChE) activity levels. ChE testing is conducted at State-approved laboratories and electronically reported to the Department of Pesticide Regulation (DPR) and the Office of Environmental Health Hazard Assessment (OEHHA) for review. In 2015, OEHHA and DPR evaluated the effectiveness of the Program by analyzing ChE data from pesticide handlers performed between 2011 and 2013, which revealed issues with the data quality that hindered the evaluation process. Several interventions have been implemented since then to improve data quality and the overall function of the Program. A new evaluation was conducted in 2020 to 2021 using data from 2014 to 2019 to determine the effectiveness of the Program, Program compliance, and efficacy of the interventions. The analysis revealed similar data quality issues identified in the last evaluation, however, an improvement in data quality was observed. The number of individuals with ChE depression below the action level threshold have decreased in recent years, corresponding to the implementation of certain interventions, indicating that the effectiveness of the Program has improved. Spatial and temporal analysis showed the proportion of pre-exposure baseline tests inversely correlated with pesticide use data while routine follow-up ChE test results showed a positive correlation, indicating a high degree of Program compliance across the state. Major improvements in the data cleaning and analysis since the last evaluation have also improved the evaluation: pesticide handlers under the Program were able to be identified with more certainty and ChE depressions were able to be calculated with increased accuracy. However, further improvements to the data collection process could enhance future evaluations of the Program.


Assuntos
Inseticidas , Exposição Ocupacional , Praguicidas , California , Colinesterases , Eletrônica , Humanos , Inseticidas/análise , Inseticidas/toxicidade , Exposição Ocupacional/análise , Praguicidas/análise , Praguicidas/toxicidade
13.
Emerg Infect Dis ; 28(9): 1842-1846, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35997543

RESUMO

We conducted a retrospective cohort study that tested 2,000 US military personnel for Coccidioides antibodies in a disease-endemic region. The overall incidence of seroconversion was 0.5 cases/100 person-years; 12.5% of persons who seroconverted had illnesses requiring medical care. No significant association was found between demographic characteristics and seroconversion or disease.


Assuntos
Coccidioidomicose , Militares , California , Coccidioides , Coccidioidomicose/epidemiologia , Coccidioidomicose/etiologia , Humanos , Incidência , Estudos Retrospectivos
14.
Artigo em Inglês | MEDLINE | ID: mdl-36011454

RESUMO

Latino construction workers in the U.S. have faced a disproportionate risk for COVID-19 infection in the workplace. Prior studies have focused on quantifying workplace risk for COVID-19 infection; few have captured workers' experiences and perspectives. This study describes COVID-19-related workplace risks from the perspectives of Latino construction workers. We conducted a qualitative study using semi-structured phone interviews with Latino construction workers from the Fruitvale District of Oakland, California. Twenty individuals were interviewed from December 2020 to March 2021. Nearly all participants (19/20) were Spanish-speaking men; mean age 42.6 years. The majority were low-income and over one-third did not have health insurance. Participants worked in varied construction-related jobs ranging from demolition to office work; additionally, four were day laborers, and three belonged to a labor union. We identified four major themes with public health policy and workplace safety implications: (1) Major concern about the risk of SARS-CoV-2 infection for family health and economic wellbeing; (2) Clarity about mask use and social distancing but not disclosure; (3) Variability in access to additional resources provided by employers; and (4) Uncertainty around structural support for SARS-CoV-2 quarantine/isolation. Our findings provide further evidence from workers' own perspectives of the major gaps experienced during the pandemic in workplace protections and resources.


Assuntos
COVID-19 , Adulto , COVID-19/epidemiologia , California/epidemiologia , Hispânico ou Latino , Humanos , Masculino , Pandemias/prevenção & controle , SARS-CoV-2 , Local de Trabalho
15.
Environ Health Perspect ; 130(8): 85001, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35920661

RESUMO

BACKGROUND: Many pesticide products are mixtures of multiple chemicals. These include active ingredients intended to kill pests, and so-called inert ingredients intended to improve the physical characteristics of the product. In addition, shortly before applying a pesticide product, applicators often mix adjuvants into the sprayer tank. Adjuvants are products designed to improve the performance or physical properties of a pesticide spray mixture. Manufacturers may use a particular chemical compound both as an inert ingredient within pesticide products and as a component of adjuvant products. Nonetheless, regulations dictate that data on use are publicly available only for the portion used in adjuvants. Adjuvants are exempt from federal registration, but are defined as pesticides in California. Based on that definition, California has identified α-(p-nonylphenyl)-ω-hydroxypoly(oxyethylene) (APNOHO) as the most widely used pesticide in the state, applied to more than 10 million acres annually. That quantified use includes only agricultural acres treated with adjuvants containing APNOHO. Total APNOHO use is likely higher because manufacturers also use the chemical as an inert ingredient within pesticide products, although data on such use are shielded by regulation. OBJECTIVES: We use APNOHO as a case study to demonstrate that the use of adjuvants and inert ingredients is difficult to track because relevant information is not publicly available. We synthesize information that suggests widespread agricultural use of alkylphenol ethoxylates, such as APNOHO, may pose significant human and environmental health risks. We then make recommendations for future research and policy. METHODS: We used information from California's pesticide use reporting system and the U.S. Environmental Protection Agency (EPA) to estimate use of APNOHO. We used U.S. EPA and European databases, as well as published research, to identify human and environmental health hazards of APNOHO. We focused on research showing that APNOHO is an endocrine-disrupting chemical. DISCUSSION: Within California, APNOHO is applied in more than 150 adjuvant products. Nationwide, it is used as an inert ingredient in at least 650 pesticide products. Exposure to APNOHO is associated with endocrine disruption, birth defects, and aquatic toxicity. We suggest that the case of APNOHO illustrates the larger problem of a lack of publicly available data on use and toxicity of many adjuvants and pesticide inert ingredients. We recommend that researchers and regulators include adjuvants and inert ingredients when evaluating pesticide hazards, including endocrine disruption. We also recommend regulatory requirements to identify all ingredients on product labels. https://doi.org/10.1289/EHP10634.


Assuntos
Praguicidas , Agricultura , California , Saúde Ambiental , Humanos , Praguicidas/toxicidade , Estados Unidos , United States Environmental Protection Agency
16.
BMC Womens Health ; 22(1): 336, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941639

RESUMO

BACKGROUND: Awareness about hereditary breast cancer and the preventative steps to minimize disease risk is lower in Hispanic/Latina individuals than non-Hispanic White women in the United States. For this reason, we developed a promotor-based hereditary breast cancer education and risk identification program for self-identified Hispanic/Latina women, which included training promotores in basic genetics and hereditary breast cancer. This study explored promotores' experiences receiving training and participating in virtual practice sessions as well as changes in knowledge about hereditary breast cancer. METHODS: A total of ten promotores underwent a two-week basic training led by the promotores organization and an eight-hour in person hereditary breast cancer training workshop. Demographic information along with pre- and post-training surveys were completed by ten promotores who participated in the training workshop. Surveys were given to determine changes in knowledge of hereditary breast cancer and genetics. Of the ten promotores, two were selected to lead community education sessions and participated in 6 semi-structured interviews. All interviews and practice sessions were conducted using a virtual platform. RESULTS: The data revealed that after the 8-h workshop and practice sessions, promotores felt confident about their ability to conduct virtual education sessions with the community. Interviews identified key facilitators to success such as a supportive environment, practice presentations, and personal motivation. Learning the online platform was considered the biggest challenge by the promotores, as opposed to learning complex genetics topics. CONCLUSIONS: These results provide further evidence supporting promotores' willingness and ability to provide health education on relatively complex topics. It also offers insight into the challenges of presenting information to vulnerable populations using an online platform and the additional support that is required to ensure a positive outcome.


Assuntos
Neoplasias da Mama , Agentes Comunitários de Saúde , Neoplasias da Mama/genética , California , Feminino , Educação em Saúde/métodos , Hispânico ou Latino , Humanos , América Latina
17.
Transfusion ; 62(9): 1743-1751, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35920049

RESUMO

BACKGROUND: To examine the extent of hospital-level variation in risk-adjusted rates of postpartum hemorrhage (PPH). STUDY DESIGN AND METHODS: We performed a cross-sectional study examining live births in 257 California hospitals between 2011 and 2015 using linked birth certificate and maternal discharge data. PPH was measured using International Classification of Diseases Codes version 9. Mixed-effects logistic regression models were used to examine the presence and extent of hospital-level variation in PPH before and after adjustment for patient-level risk factors and select hospital characteristics (teaching status and annual delivery volume). Risk-adjusted rates of PPH were estimated for each hospital. The extent of hospital variation was evaluated using the median odds ratio (MOR) and intraclass correlation coefficient (ICC). RESULTS: Our study cohort comprised 1,904,479 women who had a live birth delivery hospitalization at 247 hospitals. The median, lowest, and highest hospital-specific rates of PPH were 3.48%, 0.54%, and 12.0%, respectively. Similar rates were observed after adjustment for patient and hospital factors (3.44%, 0.60%, and 11.48%). After adjustment, the proportion of the total variation in PPH rates attributable to the hospital was low, with a MOR of 2.02 (95% confidence interval [CI]: 1.89-2.15) and ICC of 14.3% (95% CI: 11.9%-16.3%). DISCUSSION: Wide variability exists in the rate of PPH across hospitals in California, not attributable to patient factors, hospital teaching status, and hospital annual delivery volume. Determining whether differences in hospital quality of care explain the unaccounted-for variation in hospital-level PPH rates should be a public health priority.


Assuntos
Hemorragia Pós-Parto , California/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Hospitais de Ensino , Humanos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Fatores de Risco
18.
J Bus Contin Emer Plan ; 16(1): 86-92, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35996305

RESUMO

Wildfires in California have been progressively increasing in duration, intensity and frequency. In response, a number of best practices have been developed for mitigating and responding to fires within the state. This paper describes the lessons learned within core capabilities and describes current practices. Reflections are offered as a consideration and should not be interpreted as standards of practice.


Assuntos
Planejamento em Desastres , Incêndios , Incêndios Florestais , California , Estações do Ano
19.
BMC Public Health ; 22(1): 1558, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35974358

RESUMO

BACKGROUND: Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. METHODS: This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. RESULTS: Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). CONCLUSIONS: Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.


Assuntos
Teste para COVID-19 , COVID-19 , Emigrantes e Imigrantes , Acesso aos Serviços de Saúde , Imigrantes Indocumentados , COVID-19/diagnóstico , COVID-19/epidemiologia , California/epidemiologia , Estudos Transversais , Diagnóstico Tardio , Emigração e Imigração , Disparidades em Assistência à Saúde , Humanos , Adulto Jovem
20.
MMWR Morb Mortal Wkly Rep ; 71(33): 1052-1056, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35980867

RESUMO

Work-related factors can contribute to risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, and subsequent COVID-19-attributable outcomes, including death. Comparing COVID-19 metrics across industries can help identify workers at highest risk. Elevated COVID-19 mortality rates have been reported among all transportation workers, as well as specifically in public transportation industries (1-3). The California Department of Public Health (CDPH) calculated public transportation industry-specific COVID-19 outbreak incidence during January 2020-May 2022 and analyzed all laboratory-confirmed COVID-19 deaths among working-age adults in California to calculate public transportation industry-specific mortality rates during the same period. Overall, 340 confirmed COVID-19 outbreaks, 5,641 outbreak-associated cases, and 537 COVID-19-associated deaths were identified among California public transportation industries. Outbreak incidence was 5.2 times as high (129.1 outbreaks per 1,000 establishments) in the bus and urban transit industry and 3.6 times as high in the air transportation industry (87.7) as in all California industries combined (24.7). Mortality rates were 2.1 times as high (237.4 deaths per 100,000 workers) in transportation support services and 1.8 times as high (211.5) in the bus and urban transit industry as in all industries combined (114.4). Workers in public transportation industries are at higher risk for COVID-19 workplace outbreaks and mortality than the general worker population in California and should be prioritized for COVID-19 prevention strategies, including vaccination and enhanced workplace protection measures.


Assuntos
COVID-19 , Adulto , California/epidemiologia , Surtos de Doenças/prevenção & controle , Humanos , Indústrias , SARS-CoV-2
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