Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.618
Filtrar
1.
Health Res Policy Syst ; 20(1): 5, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991591

RESUMO

BACKGROUND: Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. METHODS: Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. RESULTS: The simulation model suggests that Connecticut's GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. CONCLUSIONS: The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Connecticut , Overdose de Drogas/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
2.
Am J Disaster Med ; 16(3): 195-202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34904703

RESUMO

Connecticut was impacted severely and early on by the COVID-19 pandemic due to the state's proximity to New York City. Hartford Healthcare (HHC), one of the largest healthcare systems in New England, became integral in the state's response with a robust emergency management system already in place. In this manuscript, we review HHC's prepandemic emergency operations as well as the response of the system-wide Office of Emergency Management to the initial news of the virus and throughout the evolving pandemic. Additionally, we discuss the unique acquisition of vital critical care resources and personal protective equipment, as well as the hospital personnel distribution in response to the shifting demands of the virus. The public testing and vaccination efforts, with early consideration for at risk populations, are described as well as ethical considerations of scarce resources. To date, the vaccination effort resulted in over 70 percent of the adult population being vaccinated and with 10 percent of the population having been infected, herd immunity is eminent. Finally, the preparation for reestablishing elective procedures while experiencing a second wave of the pandemic is discussed. These descriptions may be useful for other healthcare systems in both preparation and response for future catastrophic emergencies of all types.


Assuntos
COVID-19 , Pandemias , Adulto , Connecticut/epidemiologia , Atenção à Saúde , Humanos , SARS-CoV-2
3.
JAMA Netw Open ; 4(12): e2140602, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34940864

RESUMO

Importance: During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized polymerase chain reaction or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact, and Connecticut colleges and universities used a variety of approaches to reopen campuses to residential students. Objective: To characterize institutional reopening strategies and COVID-19 outcomes in 18 residential college and university campuses across Connecticut. Design, Setting, and Participants: This retrospective cohort study used data on COVID-19 testing and cases and social contact from 18 college and university campuses in Connecticut that had residential students during the 2020-2021 academic year. Exposures: Tests for COVID-19 performed per week per residential student. Main Outcomes and Measures: Cases per week per residential student and mean (95% CI) social contact per week per residential student. Results: Between 235 and 4603 residential students attended the fall semester across each of 18 institutions of higher education in Connecticut, with fewer residential students at most institutions during the spring semester. In census block groups containing residence halls, the fall student move-in resulted in a 475% (95% CI, 373%-606%) increase in mean contact, and the spring move-in resulted in a 561% (95% CI, 441%-713%) increase in mean contact compared with the 7 weeks prior to move-in. The association between test frequency and case rate per residential student was complex; institutions that tested students infrequently detected few cases but failed to blunt transmission, whereas institutions that tested students more frequently detected more cases and prevented further spread. In fall 2020, each additional test per student per week was associated with a decrease of 0.0014 cases per student per week (95% CI, -0.0028 to -0.00001). Conclusions and Relevance: The findings of this cohort study suggest that, in the era of available vaccinations and highly transmissible SARS-CoV-2 variants, colleges and universities should continue to test residential students and use mitigation strategies to control on-campus COVID-19 cases.


Assuntos
Teste para COVID-19/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Universidades , Adolescente , COVID-19/diagnóstico , Connecticut/epidemiologia , Feminino , Habitação , Humanos , Masculino , Programas de Rastreamento/métodos , Estudos Retrospectivos , SARS-CoV-2 , Interação Social , Adulto Jovem
4.
Sci Rep ; 11(1): 20271, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642405

RESUMO

To support public health policymakers in Connecticut, we developed a flexible county-structured compartmental SEIR-type model of SARS-CoV-2 transmission and COVID-19 disease progression. Our goals were to provide projections of infections, hospitalizations, and deaths, and estimates of important features of disease transmission and clinical progression. In this paper, we outline the model design, implementation and calibration, and describe how projections and estimates were used to meet the changing requirements of policymakers and officials in Connecticut from March 2020 to February 2021. The approach takes advantage of our unique access to Connecticut public health surveillance and hospital data and our direct connection to state officials and policymakers. We calibrated this model to data on deaths and hospitalizations and developed a novel measure of close interpersonal contact frequency to capture changes in transmission risk over time and used multiple local data sources to infer dynamics of time-varying model inputs. Estimated epidemiologic features of the COVID-19 epidemic in Connecticut include the effective reproduction number, cumulative incidence of infection, infection hospitalization and fatality ratios, and the case detection ratio. We conclude with a discussion of the limitations inherent in predicting uncertain epidemic trajectories and lessons learned from one year of providing COVID-19 projections in Connecticut.


Assuntos
COVID-19 , Modelos Estatísticos , Pandemias , Vigilância em Saúde Pública/métodos , COVID-19/epidemiologia , COVID-19/transmissão , Connecticut/epidemiologia , Previsões , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos
5.
JAMA Netw Open ; 4(10): e2128575, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34643719

RESUMO

Importance: Black and Latinx communities have faced disproportionate harm from the COVID-19 pandemic. Increasing COVID-19 vaccine acceptance and access has the potential to mitigate mortality and morbidity from COVID-19 for all communities, including those most impacted by the pandemic. Objective: To investigate and understand factors associated with facilitating and obstructing COVID-19 vaccine access and acceptance among Black and Latinx communities. Design, Setting, and Participants: This community-partnered qualitative study conducted semistructured, in-depth focus groups with Black and Latinx participants from March 17 to March 29, 2021, using a secure video conferencing platform. Participants were recruited through emails from local community-based organizations, federally qualified health centers, social service agencies, the New Haven, Connecticut, Health Department, and in-person distribution of study information from community health workers. A total of 8 focus groups were conducted, including 4 in Spanish and 4 in English, with 72 participants from a diverse range of community roles, including teachers, custodial service workers, and health care employees, in New Haven, Connecticut. Data were analyzed from March 17 to July 30, 2021. Main Outcomes and Measures: Interviews were audio-recorded, transcribed, translated, and analyzed using an inductive content analysis approach. Themes and subthemes were identified on the acceptability and accessibility of the COVID-19 vaccine among participants who identified as Black and/or Latinx. Results: Among 72 participants, 36 (50%) identified as Black, 28 (39%) as Latinx, and 8 (11%) as Black and Latinx and 56 (78%) identified as women and 16 (22%) identified as men. Participants described 3 major themes that may represent facilitators and barriers to COVID-19 vaccinations: pervasive mistreatment of Black and Latinx communities and associated distrust; informing trust via trusted messengers and messages, choice, social support, and diversity; and addressing structural barriers to vaccination access. Conclusions and Relevance: The findings of this qualitative study may impact what health care systems, public health officials, policy makers, health care practitioners, and community leaders can do to facilitate equitable uptake of the COVID-19 vaccine. Community-informed insights are imperative to facilitating COVID-19 vaccine access and acceptance among communities hardest hit by the pandemic. Preventing the further widening of inequities and addressing structural barriers to vaccination access are vital to protecting all communities, especially Black and Latinx individuals who have experienced disproportionate death and loss from COVID-19.


Assuntos
Afro-Americanos , Vacinas contra COVID-19 , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Connecticut , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Confiança , Adulto Jovem
7.
Emerg Infect Dis ; 27(10): 2669-2672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34545794

RESUMO

In fall 2020, a coronavirus disease cluster comprising 16 cases occurred in Connecticut, USA. Epidemiologic and genomic evidence supported transmission among persons at a school and fitness center but not a workplace. The multiple transmission chains identified within this cluster highlight the necessity of a combined investigatory approach.


Assuntos
COVID-19 , Academias de Ginástica , Connecticut/epidemiologia , Genômica , Humanos , SARS-CoV-2
8.
Nutrients ; 13(9)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34578817

RESUMO

OBJECTIVE: This pilot study assessed the effectiveness and acceptability of personalized nutrition intervention for mobile food pantry users. METHODS: The 8-week intervention recruited 25 participants in the control (n = 13) and in the treatment (n = 12) groups (60% obese). Personalized nutrition and health reports were generated based on baseline dietary intake and health status. The treatment group received weekly phone counseling and nutrition education, while the control group was only contacted to ensure compliance. The primary outcomes were 8-week changes in weight and diet quality score, assessed by the Healthy Eating Index. RESULTS: The acceptability of the intervention was assessed by the eligibility rate, recruitment rate (62.5%), and drop-out rate (36%). Following the intervention, there was a significant decrease in weight (mean ± standard deviation, -2.3% ± 2.4%) among all participants (p < 0.05). Diet-quality improved (4.54% in treatment vs. 0.18% in control), but was ultimately non-significant (p = 0.284). CONCLUSIONS AND IMPLICATIONS: A personalized nutrition education intervention in mobile food pantry users may be an acceptable and effective intervention to encourage weight loss through dietary improvements.


Assuntos
Aconselhamento/métodos , Dieta/métodos , Assistência Alimentar/estatística & dados numéricos , Educação em Saúde/métodos , Estado Nutricional , Satisfação do Paciente/estatística & dados numéricos , Connecticut , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , População Rural
9.
Accid Anal Prev ; 162: 106399, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34563645

RESUMO

INTRODUCTION: Recent research suggests that COVID-19 associated stay-at-home orders, or shelter-in-place orders, have impacted intra-and-interstate travel as well as motor vehicle crashes (crashes). We sought to further this research and to understand the impact of the stay-at-home order on crashes in the post order period in Connecticut. METHODS: We used a multiple-comparison group, interrupted time-series analysis design to compare crashes per 100 million vehicle miles traveled (VMT) per week in 2020 to the average of 2017-2019 from January 1-August 31. We stratified crash rate by severity and the number of vehicles involved. We modeled two interruption points reflecting the weeks Connecticut implemented (March 23rd, week 12) and rescinded (May 20th, week 20) its stay-at-home order. RESULTS: During the initial week of the stay-at-home order in Connecticut, there was an additional 28 single vehicle crashes compared to previous years (95% confidence interval (CI): [15.8, 36.8]). However, the increase at the order onset was not seen throughout the duration. Rescinding the stay-at-home order by and large did not result in an immediate increase in crash rates. Crash rates steadily returned to previous year averages during the post-stay-at-home period. Fatal crash rates were unaffected by the stay-at-home order and remained similar to previous year rates throughout the study duration. DISCUSSION: The initial onset of the stay-at-home order in Connecticut was associated with a sharp increase in the single vehicle crash rate but that increase was not sustained for the remainder of the stay-at-home order. Likely changes in driver characteristics during and after the order kept fatal crash rates similar to previous years.


Assuntos
Condução de Veículo , COVID-19 , Acidentes de Trânsito , Connecticut/epidemiologia , Humanos , Veículos Automotores , SARS-CoV-2
10.
PLoS One ; 16(9): e0257423, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520505

RESUMO

Health Care Leaders (HCLs) faced unprecedented challenges during the initial phases of the COVID-19 pandemic. Leaders played an important role in shaping the experiences of Health Care Workers (HCWs) during this time. However, research is needed on how HCWs experienced and characterized HCLs' response and support. The aim of our study was to examine HCWs' experiences with leadership and to identify aspects of HCLs' response that were effective in supporting HCWs in their roles during the early phases of the pandemic. This was a qualitative study based on open-ended semi-structured interviews conducted (June 1- July 18, 2020) with frontline HCWs during the first wave of the COVID-19 pandemic in Connecticut, USA. Participants (N = 45) included physicians, nurses, respiratory therapists and patient care assistants who worked in inpatient and outpatient settings in various specialties, roles and 3 health systems across Connecticut, USA during the COVID-19 pandemic. Participants were offered a $25 gift card as an incentive for participation. We used inductive techniques derived from grounded theory to develop themes. We identified 6 main themes related to leadership response and support of HCWs during the pandemic namely: 1) Effective communication and transparency; 2) Prioritizing their health and safety; 3) Employee scheduling considerations: autonomy, assignment support and respite; 4) Appreciation- financial and nonfinancial; 5) Showing up and listening and 6) Stepping up with resources. Our findings can inform leadership responses to future pandemics and other unanticipated crises leading to strengthening of the health care system as a whole.


Assuntos
COVID-19 , Atenção à Saúde , Pessoal de Saúde , Liderança , Pandemias , Comunicação , Connecticut/epidemiologia , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Humanos
11.
PLoS One ; 16(9): e0257608, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535009

RESUMO

BACKGROUND: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION: Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. RESULTS: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION: Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.


Assuntos
COVID-19 , Escores de Disfunção Orgânica , Pandemias , Adolescente , Adulto , COVID-19/etnologia , COVID-19/mortalidade , Connecticut/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Am J Public Health ; 111(10): 1806-1814, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529492

RESUMO

Radical health reform movements of the 1960s inspired two widely adopted alternative health care models in the United States: free clinics and community health centers. These groundbreaking institutions attempted to realize bold ideals but faced financial, bureaucratic, and political obstacles. This article examines the history of Fair Haven Community Health Care (FHCHC) in New Haven, Connecticut, an organization that spanned both models and typified innovative aspects of each while resisting the forces that tempered many of its contemporaries' progressive practices. Motivated by a tradition of independence and struggling to address medical neglect in their neighborhood, FHCHC leaders chose not to affiliate with the local academic hospital, a decision that led many disaffected community members to embrace the clinic. The FHCHC also prioritized grant funding over fee-for-service revenue, thus retaining freedom to implement creative programs. Furthermore, the center functioned in an egalitarian manner, enthusiastically employing nurse practitioners and whole-staff meetings, and was largely able to avoid the conflicts that strained other community-controlled organizations. The FHCHC proved unusual among free clinics and health centers and demonstrated strategies similar institutions might employ to overcome common challenges. (Am J Public Health. 2021;111(10): 1806-1814. https://doi.org/10.2105/AJPH.2021.306417).


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Fortalecimento Institucional/organização & administração , Centros Comunitários de Saúde/organização & administração , Organização do Financiamento/organização & administração , Instituições de Assistência Ambulatorial/economia , Fortalecimento Institucional/economia , Centros Comunitários de Saúde/economia , Connecticut , Organização do Financiamento/economia , Humanos
14.
PLoS One ; 16(9): e0256763, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529684

RESUMO

BACKGROUND: The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes. METHODS: We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics. RESULTS: Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races. CONCLUSION: While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Universitários , Escores de Disfunção Orgânica , Triagem/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/virologia , Connecticut , Feminino , Disparidades em Assistência à Saúde/etnologia , Mortalidade Hospitalar/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2/fisiologia , Triagem/métodos , Adulto Jovem
15.
Creat Nurs ; 27(3): 167-171, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34493636

RESUMO

The high level of gun violence in the United States is unique. Self-harm is the leading reason for death from a gun in the white population, and homicide is the leading reason for death from a gun in the Black population. Because three-quarters of gun owners say they could never see themselves not owning a gun, and half of gun owners say owning a gun is important to their overall identity, the path to reducing deaths and other harm from guns is narrow and must be tread with knowledge and skill. The experience of other countries and that of states like Connecticut and Indiana is evidence that gun safety laws - in particular, universal background checks and extreme risk protection orders - can reduce deaths and injury due to gun violence. Safe storage for firearms, preferably out of the home, also reduces the risk of death and injury from guns. The goal of this article, after briefly describing the intensity and causes of gun violence in the United States, is to give the reader some basic tools to become an effective advocate for gun safety and gun violence reduction.


Assuntos
Armas de Fogo , Connecticut , Humanos , Motivação , Políticas , Estados Unidos
16.
Glob Chang Biol ; 27(21): 5430-5445, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34392584

RESUMO

The effects of climate change on infectious diseases are a topic of considerable interest and discussion. We studied West Nile virus (WNV) in New York (NY) and Connecticut (CT) using a Weather Research and Forecasting (WRF) model climate change scenario, which allows us to examine the effects of climate change and variability on WNV risk at county level. We chose WNV because it is well studied, has caused over 50,000 reported human cases, and over 2200 deaths in the United States. The ecological impacts have been substantial (e.g., millions of avian deaths), and economic impacts include livestock deaths, morbidity, and healthcare-related expenses. We trained two Random Forest models with observational climate data and human cases to predict future levels of WNV based on future weather conditions. The Regional Model used present-day data from NY and CT, whereas the Analog Model was fit for states most closely matching the predicted future conditions in the region. Separately, we predicted changes to mosquito-based WNV risk using a trait-based thermal biology approach (Mosquito Model). The WRF model produced control simulations (present day) and pseudo-global warming simulations (future). The Regional and Analog Models predicted an overall increase in human cases of WNV under future warming. However, the Analog Model did not predict as strong of an increase in the number of human cases as the Regional Model, and predicted a decrease in cases in some counties that currently experience high numbers of WNV cases. The Mosquito Model also predicted a decrease in risk in current high-risk areas, with an overall reduction in the population-weighted relative risk (but an increase in area-weighted risk). The Mosquito Model supports the Analog Model as making more realistic predictions than the Regional Model. All three models predicted a geographic increase in WNV cases across NY and CT.


Assuntos
Culicidae , Febre do Nilo Ocidental , Vírus do Nilo Ocidental , Animais , Mudança Climática , Connecticut/epidemiologia , Humanos , New York/epidemiologia , Estados Unidos , Febre do Nilo Ocidental/epidemiologia
17.
BMC Public Health ; 21(1): 1509, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348695

RESUMO

BACKGROUND: Light at night (LAN) as a circadian disruption factor may affect the human immune system and consequently increase an individual's susceptibility to the severity of infectious diseases, such as COVID-19. COVID-19 infections spread differently in each state in the United States (US). The current analysis aimed to test whether there is an association between LAN and COVID-19 cases in 4 selected US states: Connecticut, New York, California, and Texas. METHODS: We analyzed clustering patterns of COVID-19 cases in ArcMap and performed a multiple linear regression model using data of LAN and COVID-19 incidence with adjustment for confounding variables including population density, percent below poverty, and racial factors. RESULTS: Hotspots of LAN and COVID-19 cases are located in large cities or metro-centers for all 4 states. LAN intensity is associated with cases/1 k for overall and lockdown durations in New York and Connecticut (P < 0.001), but not in Texas and California. The overall case rates are significantly associated with LAN in New York (P < 0.001) and Connecticut (P < 0.001). CONCLUSIONS: We observed a significant positive correlation between LAN intensity and COVID-19 cases-rate/1 k, suggesting that circadian disruption of ambient light may increase the COVID-19 infection rate possibly by affecting an individual's immune functions. Furthermore, differences in the demographic structure and lockdown policies in different states play an important role in COVID-19 infections.


Assuntos
COVID-19 , Ritmo Circadiano , Controle de Doenças Transmissíveis , Connecticut/epidemiologia , Humanos , Incidência , SARS-CoV-2 , Estados Unidos/epidemiologia
18.
Accid Anal Prev ; 160: 106332, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34388614

RESUMO

This study employs the correlated mixed logit models with heterogeneity in means by accounting for temporal instability to estimate both injury severity and vehicle damage. Two years of intersection crash data from Connecticut were analyzed based on driver characteristics, highway and traffic attributes, environmental variables, vehicle and crash types. These elements were used as independent variables to explore the contributing factors to crash outcome. The likelihood ratio test highlights that the temporal instability exists in both injury severity and vehicle damage models. The model estimation results illustrate that the means of some random parameters are different among crashes. The correlation coefficients of random parameters verify that these random parameters are not always independent, and their correlations should be considered and accounted for in crash severity estimation models. The investigation and comparison between injury severity models and vehicle damage models verify that the injury severity and vehicle damage are highly correlated, and the effects of contributing factors on vehicle damage are consistent with the results of injury severity models. This finding demonstrates that vehicle damage can be used as a potential surrogate measure to injury severity when suffering from a low sample of severe injury crashes in crash severity prediction models. It is anticipated that this study can shed light on selecting appropriate statistical models in crash severity estimation, identifying intersection crash contributing factors, and help develop effective countermeasures to improve intersection safety.


Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Connecticut/epidemiologia , Humanos , Funções Verossimilhança , Modelos Logísticos , Modelos Estatísticos , Ferimentos e Lesões/epidemiologia
19.
Nurs Res ; 70(6): 462-468, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34380978

RESUMO

BACKGROUND: The gut microbiome is an important determinant of health and disease in preterm infants. OBJECTIVES: The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants. METHODS: This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks gestational age or weighing <1,500 g and admitted to one of two Level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome; pain sensitivity; and medical, growth, and developmental outcomes at 4, 8-12, and 18-24 months corrected age were measured. DISCUSSION: As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants who do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing necrotizing enterocolitis, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes.


Assuntos
Microbioma Gastrointestinal , Crescimento e Desenvolvimento/genética , Crescimento e Desenvolvimento/fisiologia , Nível de Saúde , Recém-Nascido/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Transtornos do Neurodesenvolvimento/diagnóstico , Fatores Etários , Pré-Escolar , Connecticut , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos
20.
Drug Alcohol Depend ; 227: 108937, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34371235

RESUMO

PURPOSE: To assess post-release outcomes associated with continuation of methadone treatment in correctional centers. METHODS: This case-control study of the post-incarceration impact of pilot methadone programs operating in jails in New Haven and Bridgeport, Connecticut, USA was conducted in 2014-18. The study compared non-fatal overdose, fatal overdose, reincarceration, and resumption of methadone in the community experienced by 1564 eligible men, 660 (42.2 %) of whom continued treatment while incarcerated. RESULTS: Continuation of methadone was associated with a significant decrease in non-fatal overdose (OR:0.55; 95 % CI: 0.36, 0.85) and a greater likelihood of resuming methadone treatment in the community post-release (OR:2.56; 95 % CI: 2.07, 3.16). Time to resumption of methadone was shortened by treatment while time to non-fatal overdose was increased. Treatment while incarcerated resulted in a modest but not significant decrease in fatal overdoses and no difference in reincarceration between those who did and did not receive methadone. However, resumption of methadone after release did significantly reduce fatal overdoses (OR = 0.26, 95 % CI: 0.11, 0.62, p = 0.002). CONCLUSION AND RELEVANCE: Improvements in post-release outcomes of non-fatal overdose and treatment reengagement emphasize the benefits of continuing medication-based treatment for opioid use disorder within the criminal justice system for those receiving it prior to being incarcerated.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Prisioneiros , Analgésicos Opioides/uso terapêutico , Estudos de Casos e Controles , Connecticut/epidemiologia , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Humanos , Prisões Locais , Masculino , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...