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1.
Sci Rep ; 11(1): 18285, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521900

RESUMO

Serological assays intended for diagnosis, sero-epidemiologic assessment, and measurement of protective antibody titers upon infection or vaccination are essential for managing the SARS-CoV-2 pandemic. Serological assays measuring the antibody responses against SARS-CoV-2 antigens are readily available. However, some lack appropriate characteristics to accurately measure SARS-CoV-2 antibodies titers and neutralization. We developed an Enzyme-linked Immunosorbent Assay (ELISA) methods for measuring IgG, IgA, and IgM responses to SARS-CoV-2, Spike (S), receptor binding domain (RBD), and nucleocapsid (N) proteins. Performance characteristics of sensitivity and specificity have been defined. ELISA results show positive correlation with microneutralization and Plaque Reduction Neutralization assays with infectious SARS-CoV-2. Our ELISA was used to screen healthcare workers in Louisville, KY during the first wave of the local pandemic in the months of May and July 2020. We found a seropositive rate of approximately 1.4% and 2.3%, respectively. Our analyses demonstrate a broad immune response among individuals and suggest some non-RBD specific S IgG and IgA antibodies neutralize SARS-CoV-2.


Assuntos
Anticorpos Antivirais/sangue , COVID-19/epidemiologia , SARS-CoV-2/imunologia , Área Sob a Curva , COVID-19/sangue , COVID-19/virologia , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Kentucky/epidemiologia , Pandemias , Fosfoproteínas/imunologia , Curva ROC , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/metabolismo , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/imunologia
2.
Viruses ; 13(7)2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372536

RESUMO

Equine rotavirus group A (ERVA) is one of the most common causes of foal diarrhea. Starting in February 2021, there was an increase in the frequency of severe watery to hemorrhagic diarrhea cases in neonatal foals in Central Kentucky. Diagnostic investigation of fecal samples failed to detect evidence of diarrhea-causing pathogens including ERVA. Based on Illumina-based metagenomic sequencing, we identified a novel equine rotavirus group B (ERVB) in fecal specimens from the affected foals in the absence of any other known enteric pathogens. Interestingly, the protein sequence of all 11 segments had greater than 96% identity with group B rotaviruses previously found in ruminants. Furthermore, phylogenetic analysis demonstrated clustering of the ERVB with group B rotaviruses of caprine and bovine strains from the USA. Subsequent analysis of 33 foal diarrheic samples by RT-qPCR identified 23 rotavirus B-positive cases (69.69%). These observations suggest that the ERVB originated from ruminants and was associated with outbreaks of neonatal foal diarrhea in the 2021 foaling season in Kentucky. Emergence of the ruminant-like group B rotavirus in foals clearly warrants further investigation due to the significant impact of the disease in neonatal foals and its economic impact on the equine industry.


Assuntos
Doenças dos Cavalos/virologia , Cavalos/virologia , Rotavirus/patogenicidade , Animais , Proteínas do Capsídeo/genética , Diarreia/etiologia , Diarreia/virologia , Surtos de Doenças/veterinária , Fezes/virologia , Kentucky , Filogenia , RNA Viral/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Rotavirus/classificação , Infecções por Rotavirus/veterinária
3.
MMWR Morb Mortal Wkly Rep ; 70(32): 1081-1083, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34383732

RESUMO

Although laboratory evidence suggests that antibody responses following COVID-19 vaccination provide better neutralization of some circulating variants than does natural infection (1,2), few real-world epidemiologic studies exist to support the benefit of vaccination for previously infected persons. This report details the findings of a case-control evaluation of the association between vaccination and SARS-CoV-2 reinfection in Kentucky during May-June 2021 among persons previously infected with SARS-CoV-2 in 2020. Kentucky residents who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.58-3.47). These findings suggest that among persons with previous SARS-CoV-2 infection, full vaccination provides additional protection against reinfection. To reduce their risk of infection, all eligible persons should be offered vaccination, even if they have been previously infected with SARS-CoV-2.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Reinfecção/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Reinfecção/epidemiologia , Medição de Risco , Adulto Jovem
4.
Res Nurs Health ; 44(5): 767-775, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34227136

RESUMO

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.


Assuntos
COVID-19/prevenção & controle , Protestantismo/psicologia , População Rural/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , COVID-19/etnologia , COVID-19/psicologia , Estudos Transversais , Feminino , Humanos , Kentucky , Masculino , Pessoa de Meia-Idade , População Rural/tendências , Inquéritos e Questionários
5.
PLoS One ; 16(7): e0248324, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34319978

RESUMO

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14-20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.


Assuntos
COVID-19/prevenção & controle , Máscaras/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , Kentucky/epidemiologia , Pandemias , Prevalência , Logradouros Públicos , Saúde Pública/métodos , SARS-CoV-2/isolamento & purificação
6.
BMJ Open ; 11(7): e047340, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34272219

RESUMO

INTRODUCTION: HIV prevalence among criminal justice (CJ)-involved adults is five times higher than the general population. Following incarceration, CJ-involved individuals experience multilevel barriers to HIV prevention. Pre-exposure prophylaxis (PrEP) is a widely available, daily medication efficacious in preventing HIV. Little is known about PrEP knowledge, acceptability, initiation and sustained use among CJ-involved persons or about how these outcomes vary by multilevel factors. The Southern Pre-Exposure Prophylaxis Study (SPECS) will investigate barriers and facilitators for PrEP initiation and sustained use among CJ-involved adults, building a foundation for PrEP interventions for this underserved population. METHODS AND ANALYSIS: SPECS uses a mixed-methods sequential design, including a multisite, prospective cohort study in three southern states-North Carolina, Florida and Kentucky-and subsequent qualitative interviews. HIV-negative adults clinically indicated for PrEP with CJ-involvement in the past year (n=660; 220 per site)-will be recruited for four quantitative interviews separated by 6 months, with 18 months of follow-up. Interviews will measure CJ involvement, substance use, sexual behaviours, PrEP acceptability and use, healthcare access and utilisation, support systems and psychological and emotional well-being. We will estimate probabilities of PrEP acceptability and use in a CJ-involved population using descriptive and multivariable analyses. After the follow-up, a subsample that never initiated PrEP, initiated but did not sustain PrEP or sustained PrEP will be asked to participate in a qualitative interview to contextualise their experiences and decisions around PrEP. An inductive approach will guide qualitative analyses. ETHICS AND DISSEMINATION: PrEP initiation and sustained use rates are unknown among CJ-involved adults. This research will identify individual, social and structural factors that predict PrEP initiation and use. Data generated from the study have the potential to guide research and the development and tailoring of PrEP interventions to CJ-involved populations and provide context to HIV-related outcomes for those with CJ experiences.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Direito Penal , Florida , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Kentucky , North Carolina , Estudos Prospectivos , Estados Unidos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34300097

RESUMO

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five focus groups with elected community leaders, community residents, members, and key stakeholders to assess perspectives on physical activity barriers and resources within the county. The cohort survey sample (N = 152) reported a median of 6 barriers (range 0-13) to participating in at least 30 min of physical activity daily. The qualitative analysis yielded three overarching themes related to physical activity participation: lack of motivation, physical environment, and cultural barriers. This mixed-methods study revealed the challenges and perceptions among rural residents across the socioecological model when assessing physical inactivity. Findings can be used to tailor future interventions focused on expanding social support, designing infrastructure, and creating policies that promote physical activity.


Assuntos
Exercício Físico , População Rural , Adulto , Região dos Apalaches , Grupos Focais , Humanos , Kentucky
8.
BMJ Open ; 11(7): e041490, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226208

RESUMO

OBJECTIVES: The overall goal of the Kentucky Viral Hepatitis Treatment Study (KeY Treat) is to eliminate hepatitis C transmission from a county in Appalachian Kentucky by removing the barriers to accessing hepatitis C virus (HCV) treatment. METHODS/ANALYSIS: KeY Treat is a phase IV, open-label, single-arm clinical trial of sofosbuvir/velpatasvir (SOF/VEL) for the treatment of viraemic HCV infections. Those eligible for KeY Treat are at least 18 years of age, viraemic and are residents of the target county. Pregnant women are not eligible. Rapid HCV RNA screening is used to determine eligibility, and those with a quantifiable viral load (VL) consenting to participate initiate SOF/VEL on the same day. All pharmacologic treatment and related medical care is provided free of charge using a non-specialist provider model. Follow-up visits occur at 2, 6 and 12 weeks during treatment to assess medication adherence (measured via VL and self-report), side effects and engagement in risk behaviours. Post-treatment visits occur at 12 weeks (sustained virologic response (SVR12) visit), 6 months and 12 months post-treatment completion to assess re-infection. A control county has also been identified, and prevalence and incidence of chronic HCV infections will be compared with the target community longitudinally. The primary outcome to assess elimination is SVR12. However, several outcomes will be measured to assess the effectiveness of removing the barriers to HCV treatment, including treatment entry, completion and re-infection. Analyses will be conducted via a generalised linear model framework that can incorporate flexible covariate adjustment and multiple outcome types with a compatible link function. Mathematical modelling will be completed assessing the impact and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION: KeY Treat has been approved by the Institutional Review Board at the University of Kentucky. Results from KeY Treat will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03949764.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Carbamatos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis , Humanos , Kentucky/epidemiologia , Gravidez , Sofosbuvir/uso terapêutico , Resultado do Tratamento
9.
PLoS One ; 16(7): e0250152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197461

RESUMO

Early in the pandemic, slowing the spread of novel coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions. All U.S. states adopted social-distancing restrictions in March and April of 2020, though policies varied both in timing and scope. Compared to states with Democratic governors, those with Republican governors often adopted measures for shorter durations and with greater resistance from their residents. In Kentucky, an extremely close gubernatorial election immediately prior to the discovery of SARS-CoV-2 replaced a Republican incumbent with a Democrat, despite Republicans easily winning all other statewide races. This chance election result offers a unique opportunity to examine the impact of early social distancing policies in a relatively conservative, rural, white-working-class state. Our study begins by estimating an event-study model to link adoption of several common social distancing measures-public school closures, bans on large gatherings, closures of entertainment-related businesses such as restaurants, and shelter-in-place orders (SIPOs)-to the growth rate of cases across counties in the Midwest and South in the early stages of the pandemic. These policies combined to slow the daily growth rate of COVID-19 cases by 9 percentage points after 16 days, with SIPOs and entertainment establishment closures accounting for the entire effect. In order to obtain results with more direct applicability to Kentucky, we then estimate a model that interacts the policy variables with a "white working class" index characterized by political conservatism, rurality, and high percentages of white, evangelical Christian residents without college degrees. We find that the effectiveness of early social distancing measures decreased with higher values of this index. The results imply that the restrictions combined to slow the spread of COVID-19 by 12 percentage points per day in Kentucky's two largest urban counties but had no statistically detectable effect across the rest of the state.


Assuntos
COVID-19/epidemiologia , Distanciamento Físico , COVID-19/prevenção & controle , Política de Saúde , Humanos , Kentucky/epidemiologia , Modelos Econométricos , SARS-CoV-2/isolamento & purificação , Estados Unidos
10.
Nutrients ; 13(7)2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34206825

RESUMO

Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items.


Assuntos
Alimentos , Marketing , Obesidade , População Rural , Região dos Apalaches , Bebidas , Comportamento de Escolha , Comércio , Preferências Alimentares , Abastecimento de Alimentos , Humanos , Kentucky , Lanches
11.
J Health Care Poor Underserved ; 32(2): 664-670, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120967

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is prevalent in Kentucky, and treatment in primary care clinics is being implemented through collaborations such as the Kentucky Hepatitis Academic Mentorship Program (KHAMP) to meet Medicaid requirements. METHODS: We completed a retrospective review of 375 HCV patients seen from 2018-2019, comparing outcomes pre- and post- KHAMP implementation. RESULTS: Post-KHAMP implementation in 2019, 191 patients were diagnosed with HCV. Compared with pre-KHAMP, these patients were less likely to be referred to a specialist (difference in percentage points: -16.1%, 95% CI (6.7-25.1), p=.0008), with no change in loss to follow-up (difference in percentage points: 4.8%, 95% CI (-4.6-14.1), p=.32). Of 127 eligible patients, 52 (41%) were treated via KHAMP during the study period.


Assuntos
Hepatite C , Mentores , Hepacivirus , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Kentucky/epidemiologia , Estudos Retrospectivos , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-34065363

RESUMO

The objectives of this study were to assess the state of Kentucky's workplace health promotion and occupational safety and health programs, to ensure the ability to comprehend any possible trends over the past six years in the state's progress in offering workplace health promotion and health protection programs, to compare the results of this survey with the 2013 Kentucky state-wide assessment, and to identify gaps in Kentucky's workplace health promotion and occupational safety and health based on Total Worker Health® (TWH) concepts. Using Qualtrics research software, the Workplace Health in America assessment was sent to companies located in Kentucky and having 10 or more employees. Participants were identified using Dun and Bradstreet's Hoover's database. The results showed that, as with the 2013 survey, larger workplaces significantly were more likely to offer workplace health promotion programs than smaller companies (X2 = 24.30; p < 0.001). However, more companies (78%) reported offering programs compared to the 2013 assessment (49%). Given the results of the current study as compared to the statewide assessment conducted in 2013, Kentucky's WHP is moving in a positive direction; yet, there is still much to be done. There remains a strong need to provide cost-effective and accessible resources for all elements of TWH to small workplaces.


Assuntos
Saúde do Trabalhador , Local de Trabalho , Promoção da Saúde , Humanos , Kentucky , Inquéritos e Questionários
13.
Poult Sci ; 100(7): 101209, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34089933

RESUMO

Salmonella is a foodborne pathogen and an emerging zoonotic bacterial threat in the food industry. The aim of this study was to evaluate the biofilm formation by a cocktail culture of 3 wild isolates of Salmonella enterica serotype Kentucky on plastic (PLA), silicon rubber (SR), and chicken skin surfaces under various temperatures (4, 10, 25, 37, and 42°C) and pH values (4.0, 5.0, 6.0, 7.0, and 8.0). Then, at the optimum temperature and pH, the effects of supplementation with glucose (0, 0.025, 0.05, and 0.4% w/v) on biofilm formation were assessed on each of the surfaces. The results indicated that higher temperatures (25 to 42°C) and pH values (7.0 and 8.0) led to more robust biofilm formation than lower temperatures (4 and 10°C) and lower pH levels (4.0 to 6.0). Moreover, biofilm formation was induced by 0.025% glucose during incubation at the optimum temperature (37°C) and pH (7.0) but inhibited by 0.4% glucose. Consistent with this finding, virulence related gene (rpoS, rpoH, hilA, and avrA) expression was increased at 0.025% glucose and significantly reduced at 0.4% glucose. This results also confirmed by field emission scanning electron microscope, confocal laser scanning microscopy, and autoinducer-2 determination. This study concluded that optimum environmental conditions (temperature 37°C, pH 7.0, and 0.25% glucose) exhibited strong biofilm formation on food and food contract surfaces as well as increased the virulence gene expression levels, indicating that these environmental conditions might be threating conditions for food safety.


Assuntos
Salmonella enterica , Animais , Biofilmes , Galinhas , Expressão Gênica , Glucose , Concentração de Íons de Hidrogênio , Kentucky , Sorogrupo , Temperatura , Virulência
14.
Lupus Sci Med ; 8(1)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952624

RESUMO

OBJECTIVES: Cardiovascular complications became a notable cause of morbidity and mortality in patients with lupus as therapeutic advancements became more efficient at managing other complications. The Appalachian community in Kentucky has a higher prevalence of traditional cardiovascular risk factors, predisposing them to cardiovascular events. Namely, the mean body mass index of the members of the Kentucky Appalachian community was reported at 33 kg/m2 and 94.3% of male members of this community use tobacco. We sought to identify risk factors that predispose patients with lupus to cardiovascular morbidities and examine the effect of immunomodulatory drugs. METHODS: We identified 20 UKHS patients having both a lupus diagnosis and experienced at least one cardiovascular event. We chose three controls matched for birth-year ±5 years to each case. In a case-control design, we analysed lupus manifestations, cardiovascular risk factors and immunosuppressive therapies. We collected Systemic Lupus Erythematosus Disease Activity Index 2000 disease activity index during the cardiovascular event. RESULTS: We identified 308 patients with lupus from among all University of Kentucky Health System patients. 20 (6.5%) of such patients with lupus were confirmed to cardiovascular complication. Of those 20, 7 (35%) had experienced myocardial infarction, 10 (50%) had experienced stroke and 4 (20%) had peripheral ischaemia. Tobacco use and male gender were the only traditional cardiovascular risk factors higher in the cases group. Hydroxychloroquine and steroids were less utilised in the cases than in the controls (70% vs 100% in hydroxychloroquine, 30% vs 82% in steroids). Venous thrombosis was found to be significantly higher in the cases. On multivariate analysis, venous thrombosis remained significant. CONCLUSION: Despite tobacco use partially explaining the increased risk of cardiovascular disease among the cases group, the higher prevalence of venous thrombosis in the cases group suggests lupus as a potential additional risk factor of cardiovascular morbidity among patients with lupus in this Appalachian community.


Assuntos
Doenças Cardiovasculares , Lúpus Eritematoso Sistêmico , Região dos Apalaches , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Hidroxicloroquina , Kentucky/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Fatores de Risco
16.
J Equine Vet Sci ; 101: 103421, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33993929

RESUMO

Ethanol-soluble carbohydrates (ESCs) of cool-season grasses include mono- and disaccharides and sometimes short-chain fructans, which may exacerbate the risk of pasture-associated laminitis. A calibration for prediction of ESC concentrations by near-infrared reflectance spectroscopy (NIRS) was developed from 323 samples of four cool-season grass species (orchardgrass, Kentucky bluegrass, tall fescue, and perennial ryegrass) across 10 cultivars collected in central Kentucky in the morning and afternoon over two growing seasons. The calibration, which had accuracy above 95%, was used to predict ESC concentrations of 1,532 samples from the second growing season. ESC concentrations increased in the afternoon compared to the morning across all cultivars. In the majority of samples, ESC concentrations were not affected by nitrogen application to plots. Use of NIRS has the potential to evaluate management and cultivar effects on ESC concentrations in cool-season grass pastures.


Assuntos
Carboidratos , Etanol , Animais , Kentucky , Estações do Ano , Espectroscopia de Luz Próxima ao Infravermelho/veterinária
17.
J Surg Res ; 264: 186-193, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33838402

RESUMO

BACKGROUND: The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS: For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS: ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS: In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Opiáceos/epidemiologia , Epidemia de Opioides/estatística & dados numéricos , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Analgésicos Opioides/envenenamento , Prescrições de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Heroína/efeitos adversos , Heroína/envenenamento , Humanos , Kentucky/epidemiologia , Overdose de Opiáceos/prevenção & controle , Epidemia de Opioides/prevenção & controle , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/prevenção & controle
18.
PLoS One ; 16(4): e0249653, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33857198

RESUMO

BACKGROUND: Inappropriate antimicrobial use (AMU) is a global concern. Opinions of veterinarians regarding AMU and its role in the development of antimicrobial resistance (AMR) may influence their prescription practices. It is important to understand these opinions, prescription practices and their potential impact on the development of AMR in order to guide efforts to curb the problem. Therefore, the objective of this study was to investigate the antimicrobial prescription practices and opinions of veterinarians in Kentucky regarding AMU and AMR. METHODS: This cross-sectional study used a 30-question survey questionnaire administered to veterinarians who were members of the Kentucky Veterinary Medical Association. Survey responses from 101 participants were included in the study. Descriptive statistics were computed and associations between categorical variables assessed using Chi-square or Fisher's exact tests. Firth logistic models were used to investigate predictors of "Compliance with prescription policies" and "Cost of antimicrobial affects prescription decisions". RESULTS: Almost all (93%) respondents indicated that improper AMU contributed to selection for AMR. A total of 52% of the respondents believed that antimicrobials were appropriately prescribed, while the remaining 48% believed that antimicrobials were inappropriately prescribed. Significant predictors of compliance with prescription policies were availability of prescription policy at the veterinary facility (Odds Ratio (OR) = 4.2; p<0.001) and over-prescription (OR = 0.35; p = 0.025). Similarly, significant predictors of cost of antimicrobials affecting prescription decisions were lack of post-graduate training (OR = 8.3; p = 0.008) and practice type, with large animal practices having significantly lower odds of the outcome (OR = 0.09; p = 0.004) than small animal practices. CONCLUSION: Most veterinarians indicated that improper AMU contributed to selection for AMR. Since the odds of compliance with prescription policies were 4-times higher among veterinarians working at facilities that had prescription policies compared to those at facilities that didn't, more veterinary facilities should be encouraged to adopt prescription policies to help improve compliance and reduce AMR. Veterinarians would also benefit from continued professional education to help improve prescription practices, antimicrobial stewardship and curb AMR.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Médicos Veterinários/estatística & dados numéricos , Animais , Antibacterianos/efeitos adversos , Atitude , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Humanos , Kentucky , Masculino , Inquéritos e Questionários
19.
Am J Health Promot ; 35(7): 1015-1027, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33906415

RESUMO

OBJECTIVE: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. DATA SOURCE: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. STUDY INCLUSION AND EXCLUSION CRITERIA: Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. DATA EXTRACTION: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. DATA SYNTHESIS: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. RESULTS: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. CONCLUSIONS: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.


Assuntos
Mortalidade Prematura , Saúde da Mulher , Região dos Apalaches/epidemiologia , Feminino , Serviços de Saúde , Humanos , Kentucky , Pessoa de Meia-Idade , Gravidez
20.
Am J Public Health ; 111(7): 1284-1291, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33856885

RESUMO

Objectives. To determine the magnitude of increases in monthly drug-related overdose mortality during the COVID-19 pandemic in the United States. Methods. We leveraged provisional records from the Centers for Disease Control and Prevention provided as rolling 12-month sums, which are helpful for smoothing, yet may mask pandemic-related spikes in overdose mortality. We cross-referenced these rolling aggregates with previous monthly data to estimate monthly drug-related overdose mortality for January through July 2020. We quantified historical errors stemming from reporting delays and estimated empirically derived 95% prediction intervals (PIs). Results. We found that 9192 (95% PI = 8988, 9397) people died from drug overdose in May 2020-making it the deadliest month on record-representing a 57.7% (95% PI = 54.2%, 61.2%) increase over May 2019. Most states saw large-magnitude increases, with the highest in West Virginia, Kentucky, and Tennessee. We observed low concordance between rolling 12-month aggregates and monthly pandemic-related shocks. Conclusions. Unprecedented increases in overdose mortality occurred during the pandemic, highlighting the value of presenting monthly values alongside smoothed aggregates for detecting shocks. Public Health Implications. Drastic exacerbations of the US overdose crisis warrant renewed investments in overdose surveillance and prevention during the pandemic response and postpandemic recovery efforts.


Assuntos
COVID-19/epidemiologia , Overdose de Drogas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Comorbidade , Humanos , Kentucky , Transtornos Relacionados ao Uso de Opioides/epidemiologia , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Tennessee , Estados Unidos , West Virginia
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