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1.
N Engl J Med ; 382(11): 1009-1017, 2020 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-32160662

RESUMO

BACKGROUND: Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS: We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS: A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS: Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.


Assuntos
Vacina contra Sarampo-Caxumba-Rubéola , Sarampo , Vacinação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Recursos em Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Anamnese , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Índice de Gravidade de Doença , Vacinação/estatística & dados numéricos , Adulto Jovem
4.
J Environ Manage ; 258: 110023, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31929063

RESUMO

River water quality and habitats are degraded by thermal pollution from urban areas caused by warm surface runoff, lack of riparian forests, and impervious channels that transfer heat and block cool subsurface flows. This study updates the i-Tree Cool River model to simulate restoration of these processes to reverse the urban river syndrome, while using the HEC-RAS model water surface profiles needed for flood hazard analysis in restoration planning. The new model was tested in a mountain river within the New York City drinking water supply area (Sawmill, SM, Creek), and then used for base case and restoration scenarios on the 17.5 km reach of the Los Angeles (LA) River where a multi-million dollar riverine restoration project is planned. The model simulated the LA River average temperature in the base case decreased from 29.5 °C by 0.3 °C when warm surface inflows were converted to cooler groundwater inflows by terrestrial green infrastructure; by 0.7 °C when subsurface hyporheic exchange was increased by removal of armoring and installation of riffle-pool bedforms; by 3.6 °C when riparian forests shaded the river; and by 6.4 °C when floodplain forests were added to riparian forests to cool surface reservoirs and local air temperatures. Applying all four restoration treatments lowered river temperature by 7.2 °C. The simulated decreases in river temperature lead to increased saturated dissolved oxygen levels, reaching 8.7 mg/L, up from the 7.6 mg/L in the base case scenario, providing improved fish habitat and reducing eutrophication and hypoxic zones. This study evaluating the performance of environmental management scenarios could help managers control the thermal pollution in rivers.


Assuntos
Ecossistema , Rios , Animais , Florestas , Los Angeles , Cidade de Nova Iorque
5.
J Environ Manage ; 256: 109977, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31989967

RESUMO

Food waste measurement and policy often seek to differentiate between edible food and associated inedible parts, acknowledging different underlying causes for discard and different preferred solutions for waste management. Given the varying views of edibility within and across cultures, there is no widely agreed upon or universal categorization. To understand how edibility influences the outcome of food waste quantification, we applied four different categorizations to 489 household kitchen diaries from Denver, CO and New York City, NY. We also compared them to how respondents self-characterized edibility. We found that the percentage of total food discarded considered edible ranged from 52% to 71% and that the top ten lists of most discarded edible foods changed based on the categorization used. We found that edibility does matter when studying household food waste in terms of defining the extent of the problem, identifying hot spots for intervention, and tracking progress over time. Additionally, we found that respondents' perceptions of edibility varied and were not aligned with any of the four categorizations. Our findings suggest that how edibility is defined should be rigorously and transparently considered and that the varied perceptions of edibility may influence what and how interventions to reduce wasted food are designed, targeted, and evaluated.


Assuntos
Brassica , Eliminação de Resíduos , Gerenciamento de Resíduos , Alimentos , Cidade de Nova Iorque
6.
Sports Health ; 12(1): 74-79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31642726

RESUMO

BACKGROUND: Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. HYPOTHESIS: A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. STUDY DESIGN: Randomized trial. LEVEL OF EVIDENCE: Level 2. METHODS: Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. RESULTS: A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). CONCLUSION: There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. CLINICAL RELEVANCE: Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.


Assuntos
Transtornos Traumáticos Cumulativos/prevenção & controle , Extremidade Inferior/lesões , Força Muscular/fisiologia , Resistência Física/fisiologia , Treinamento de Resistência , Corrida/lesões , Adulto , Transtornos Traumáticos Cumulativos/epidemiologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Humanos , Cidade de Nova Iorque/epidemiologia , Fatores de Risco , Corrida/fisiologia
7.
Endocr Pract ; 26(1): 6-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31461357

RESUMO

Objective: Transgender and gender-nonbinary individuals (TGNB) are disproportionately impacted by obesity. In addition to the associated health impact, obesity represents a significant barrier to accessing gender-confirmation surgery (GCS). The purpose of this study was to determine the prevalence of obesity among TGNB surgical candidates at an urban academic medical center and evaluate the efficacy of self-monitored weight management. Methods: The study was conducted at the Center for Transgender Medicine and Surgery at Mount Sinai in New York City. Data abstraction from a quality improvement database was completed for patients with a documented body mass index (BMI) and a GCS consult from October 2015 through February 2019. A total of 1,457 TGNB patients with a documented BMI and a GCS consult in the historical period of review were included in analysis. Data were abstracted to determine the prevalence of obesity among GCS candidates and evaluate the current default pre-operative self-monitored weight management protocol. Results: Of 1,457 TGNB patients, 382 (26%) were obese (BMI ≥30 kg/m2) at initial surgical consult. In addition, 369 (27%) were obese at a subsequent follow-up, suggesting no statistically significant change in the rate of obesity among evaluated TGNB despite self-monitored weight management (P = .5272). Conclusion: Obesity is a significant barrier to gender affirming surgery for transgender individuals. Self-monitored weight management is an unsuccessful strategy for improvement even among individuals who would be predicted to be motivated. Abbreviations: BMI = body mass index; CTMS = Center for Transgender Medicine and Surgery (at Mount Sinai); GCS = gender confirmation surgery; TGNB = transgender and gender-nonbinary.


Assuntos
Cirurgia de Readequação Sexual , Pessoas Transgênero , Transexualismo , Índice de Massa Corporal , Humanos , Cidade de Nova Iorque
8.
Sci Total Environ ; 704: 135322, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-31787288

RESUMO

BACKGROUND: Tobacco remains the leading cause of preventable death in the United States, with 41,000 deaths attributable to secondhand smoke (SHS) exposure. On July 30, 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. OBJECTIVES: Prior to SFH policy implementation, we measured self-reported and objective SHS incursions in a purposeful sample of 21 high-rise buildings (>15 floors) in New York City (NYC): 10 public housing and 11 private sector buildings where most residents receive federal housing subsidies (herein 'Section 8' buildings). METHODS: We conducted a baseline telephone survey targeting all residents living on the 3rd floor or higher of selected buildings: NYC Housing Authority (NYCHA) residents were surveyed in April-July 2018 (n = 559), and residents in 'Section 8' buildings in August-November 2018 (n = 471). We invited non-smoking household participants to enroll into a longitudinal air monitoring study to track SHS exposure using: (1) nicotine concentration from passive, bisulfate-coated nicotine filters and (2) particulate matter (PM2.5) from low-cost particle monitors. SHS was measured for 7-days in non-smoking households (NYCHA n = 157, Section 8 n = 118 households) and in building common areas (n = 91 hallways and stairwells). RESULTS: Smoking prevalence among residents in the 21 buildings was 15.5%. Two-thirds of residents reported seeing people smoke in common areas in the past year (67%) and 60% reported smelling smoke in their apartments coming from elsewhere. Most stairwells (88%) and hallways (74%) had detectable nicotine levels, but nicotine was detected in only 9.9% of non-smoking apartments. Substantial variation in nicotine and PM2.5 was observed between and within buildings; on average nicotine concentrations were higher in NYCHA apartments and hallways than in Section 8 buildings (p < 0.05), and NYCHA residents reported seeing smokers in common areas more frequently. CONCLUSIONS: SFH policies may help in successfully reducing SHS exposure in public housing, but widespread pre-policy incursions suggest achieving SFH will be challenging.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Características da Família , Feminino , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Habitação Popular , Política Antifumo , Adulto Jovem
9.
Water Res ; 170: 115350, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31830651

RESUMO

To better control and manage harbor water quality is an important mission for coastal cities such as New York City (NYC). To achieve this, managers and governors need keep track of key quality indicators, such as temperature, pH, and dissolved oxygen. Among these, the Biochemical Oxygen Demand (BOD) over five days is a critical indicator that requires much time and effort to detect, causing great inconvenience in both academia and industry. Existing experimental and statistical methods cannot effectively solve the detection time problem or provide limited accuracy. Also, due to various human-made mistakes or facility issues, the data used for BOD detection and prediction contain many missing values, resulting in a sparse matrix. Few studies have addressed the sparse matrix problem while developing statistical detection methods. To address these gaps, we propose a deep learning based model that combines Deep Matrix Factorization (DMF) and Deep Neural Network (DNN). The model was able to solve the sparse matrix problem more intelligently and predict the BOD value more accurately. To test its effectiveness, we conducted a case study on the NYC harbor water, based on 32,323 water samples. The results showed that the proposed method achieved 11.54%-17.23% lower RMSE than conventional matrix completion methods, and 19.20%-25.16% lower RMSE than traditional machine learning algorithms.


Assuntos
Aprendizado Profundo , Água , Cidades , Humanos , Aprendizado de Máquina , Cidade de Nova Iorque
11.
Ann Vasc Surg ; 62: 183-190.e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30710629

RESUMO

BACKGROUND: There is varying evidence regarding the effects of body mass index (BMI) on outcomes of endovascular aneurysm repair (EVAR). This study investigates the effects of BMI on an index of perioperative and postoperative outcomes after EVAR. METHODS: Four hundred ninety-two patients who underwent elective EVAR at Mount Sinai Hospital were included in this study. Patients were classified as either normal weight (BMI = 18.5-25), overweight (BMI = 25-30), or obese (BMI>30). Chi-squared tests were used to determine significant differences between weight classes across an index of outcomes. The following outcomes were collected: intraoperative complications (e.g., conversion to open), perioperative complications (e.g., hematoma, bowel ischemia, and so forth), and postoperative outcomes (endoleak, sac enlargement, sac shrinkage, access site infection, prolonged postoperative length of stay, reintervention, stroke, claudication/lower extremity ischemia, deep vein thrombosis, limb occlusion, renal complications, abdominal aortic aneurysm (AAA) rupture, AAA-related mortality, and all-cause mortality). Kaplan-Meier survival analysis and a log-rank test were used to determine meaningful differences in all-cause mortality following EVAR between the respective weight classes. Subsequently, multivariate Cox proportional hazards were performed for selection of outcomes, with weight classes as predictors. Finally, a multivariate logistic regression was performed for postoperative hospital stay. Subgroup multivariate analysis was also performed examining only class I obese patients, rather than all obese patients. RESULTS: Overweight patients were significantly less likely to experience all-cause mortality up to 9 years after EVAR than normal-weight patients in both Kaplan-Meier and multivariable Cox proportional hazards models. Obese patients similarly had a lower risk of mortality in Kaplan-Meier analysis, but this did not persist in the multivariate analysis. Overweight patients were also significantly less likely to require a postoperative hospital stay longer than 1 day when compared with normal-weight patients. Finally, obese patients were less likely to have a sac shrinkage greater than 5 mm after EVAR, but were also less likely to have an endoleak. CONCLUSIONS: This study adds to the debate on the effects of BMI on outcomes of EVAR. Obesity was not a risk factor for negative perioperative or postoperative outcomes after EVAR with the exception of decreased sac shrinkage. Obese patients were less likely to have an endoleak, and overweight patients were protected against all-cause mortality and longer postoperative hospital stays.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Índice de Massa Corporal , Procedimentos Endovasculares , Obesidade/complicações , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Obesidade/diagnóstico , Obesidade/mortalidade , Valor Preditivo dos Testes , Fatores de Proteção , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
BMC Public Health ; 19(1): 1730, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870351

RESUMO

BACKGROUND: Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users. METHODS: We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC3 project. RESULTS: Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity. CONCLUSIONS: SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.


Assuntos
Exercício , Observação , Parques Recreativos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Reprodutibilidade dos Testes , Estações do Ano , Adulto Jovem
14.
J Stroke Cerebrovasc Dis ; 28(12): 104449, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31668582

RESUMO

BACKGROUND: Visceral infarctions appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. METHODS: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 to 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory's upper limit of normal (.04 ng/ mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients' other characteristics. Multivariable logistic regression was used to evaluate the association between elevated troponin and visceral infarction. RESULTS: Among 2116 patients registered in CAESAR from 2011 to 2016, 153 patients had both a troponin assay and a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarction. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% confidence interval [CI], 16%-49%) than among patients without an elevated troponin (10%; 95% CI, 5%-17%) (P = .003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarction (odds ratio, 3.9; 95% CI, 1.5-10.4). CONCLUSIONS: Among patients with acute ischemic stroke, elevated troponin was associated with visceral infarction. Our results demonstrate that poststroke troponin elevation may indicate the presence of underlying embolic sources.


Assuntos
Isquemia Encefálica/sangue , Embolia/sangue , Infarto/sangue , Rim/irrigação sanguínea , Baço/irrigação sanguínea , Acidente Vascular Cerebral/sangue , Troponina/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Embolia/diagnóstico , Embolia/epidemiologia , Feminino , Humanos , Infarto/diagnóstico , Infarto/epidemiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Regulação para Cima
15.
BMC Health Serv Res ; 19(1): 818, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703682

RESUMO

BACKGROUND: While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York. CASE PRESENTATION: A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient's treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines. CONCLUSIONS: We employ this patient's narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.


Assuntos
Tempestades Ciclônicas , Assistência à Saúde/normas , Desastres , Medicare/normas , Múltiplas Afecções Crônicas/terapia , Hispano-Americanos , Humanos , Seguro Saúde , Masculino , Turismo Médico , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/etnologia , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde , Porto Rico/etnologia , Refugiados , Diálise Renal , Estados Unidos
16.
Med Care ; 57(12): 960-967, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31730568

RESUMO

OBJECTIVES: Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. METHODS: We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. RESULTS: Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). CONCLUSIONS: We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.


Assuntos
Grupos de Populações Continentais/psicologia , Acesso aos Serviços de Saúde , Nível de Saúde , Saúde Mental/etnologia , Estigma Social , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Depressão/etnologia , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Socioeconômicos , Adulto Jovem
17.
BMC Public Health ; 19(1): 1479, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31744491

RESUMO

BACKGROUND: To determine if outdoor advertising density for non-alcoholic drinks, food, tobacco products, and alcohol, is associated with neighborhood poverty or other Census-level characteristics in New York City (NYC). METHODS: From June - July of 2015, photographs were taken of all street-level, stationary outdoor advertising (posters, stickers, decals, etc.) for consumable products in a sample of 953 NYC retail-dense street segments. Density of product images was analyzed by neighborhood poverty level and other characteristics using multivariate negative-binomial regression. RESULTS: A total of 16,305 discrete advertisements displaying 50,673 product images were photographed. Total product image prevalence relative to retail density was not significantly higher in high- vs. low-poverty neighborhoods, as hypothesized (OR: 1.31; 95% CI: 0.98, 1.77). However, total product image prevalence was higher in neighborhoods with a higher percentage of Black residents (OR: 1.08; 95% CI: 1.04, 1.12), and for sugary drinks in areas with a higher percentage of adults with

Assuntos
/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Bebidas Alcoólicas , Bebidas , Censos , Feminino , Alimentos , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Produtos do Tabaco
18.
Public Health Rep ; 134(6): 695-702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31647883

RESUMO

OBJECTIVES: Chronic hepatitis B virus (HBV) infection is a lifelong infection that can cause serious liver damage and liver cancer. The last surveillance-based prevalence estimate of chronic HBV infection in New York City was 1.2% in 2008; however, it did not account for persons with undiagnosed infection. The objective of this study was to calculate the prevalence of chronic HBV infection, including undiagnosed infection, for 2016 by using surveillance data and literature-based information. METHODS: We calculated the number of persons with diagnosed chronic HBV infection (2000-2016) who were alive and living in New York City in 2016 by using routine surveillance data. We estimated the percentage of persons with undiagnosed chronic HBV infection by using birth region-specific percentages from the literature, weighted by the proportion of the New York City population with diagnosed chronic HBV infection from the same birth region. We identified minimum, maximum, and most likely values for the percentage with undiagnosed chronic HBV infection to generate 95% certainty limits (CLs) of the prevalence estimate. RESULTS: The prevalence of chronic HBV infection in 2016, including undiagnosed infection, in New York City was 2.7% (95% CL, 2.2%-3.6%), representing approximately 230 000 persons. The prevalence of diagnosed chronic HBV infection was 1.5%. The estimated prevalence among non-US-born residents was 6.9% (95% CL, 5.4%-8.9%). CONCLUSIONS: The current burden of chronic HBV infection in New York City, especially for non-US-born residents, is substantial. A renewed focus and dedication of resources is required to increase the number of new diagnoses and improve provider capacity to care for the large number of persons with chronic HBV infection.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Hepatite B Crônica/epidemiologia , Vigilância da População , Adulto , África/etnologia , Ásia/etnologia , Feminino , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/diagnóstico , Humanos , Masculino , Modelos Estatísticos , Cidade de Nova Iorque/epidemiologia , Prevalência , Fatores de Risco
19.
Epidemiol Health ; 41: e2019041, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31623424

RESUMO

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits. METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model. RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate. CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Renda/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Adulto Jovem
20.
Environ Sci Technol ; 53(21): 12594-12601, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31601103

RESUMO

The TROPOspheric Monitoring Instrument (TROPOMI) is used to derive top-down NOX emissions for two large power plants and three megacities in North America. We first re-process the vertical column NO2 with an improved air mass factor to correct for a known systematic low bias in the operational retrieval near urban centers. For the two power plants, top-down NOX emissions agree to within 10% of the emissions reported by the power plants. We then derive top-down NOX emissions rates for New York City, Chicago, and Toronto, and compare them to projected bottom-up emissions inventories. In this analysis of 2018 NOX emissions, we find a +22% overestimate for New York City, a -21% underestimate in Toronto, and good agreement in Chicago in the projected bottom-up inventories when compared to the top-down emissions. Top-down NOX emissions also capture intraseasonal variability, such as the weekday versus weekend effect (emissions are +45% larger on weekdays versus weekends in Chicago). Finally, we demonstrate the enhanced capabilities of TROPOMI, which allow us to derive a NOX emissions rate for Chicago using a single overpass on July 7, 2018. The large signal-to-noise ratio of TROPOMI is well-suited for estimating NOX emissions from relatively small sources and for sub-seasonal timeframes.


Assuntos
Poluentes Atmosféricos , Chicago , Cidades , Monitoramento Ambiental , Cidade de Nova Iorque , América do Norte , Centrais Elétricas , Estados Unidos
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