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1.
Public Health Rep ; 135(2): 262-269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040923

RESUMO

OBJECTIVES: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. METHODS: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). RESULTS: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. CONCLUSIONS: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Heroína/envenenamento , Adolescente , Adulto , Criança , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Classificação Internacional de Doenças , Kentucky , Masculino , Naloxona/administração & dosagem
2.
South Med J ; 113(1): 29-36, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31897496

RESUMO

OBJECTIVES: Uterine cancer is the nation's most common gynecologic malignancy, but it is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). Our aim was to assess the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP) KY. METHODS: This population-based cohort study used Surveillance, Epidemiology, and End Results data and the Kentucky Cancer Registry to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looked at the incidence between diagnoses in AP and NAP. The evaluation criteria included tumor histology (type I, type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance status, and county of residence at diagnosis. RESULTS: The overall age-adjusted incidence rate and survival are similar for US and KY populations; however, histologic types and distribution differ. Compared with the United States, the incidence of corpus cancers in KY is higher for type I (P = 0.03), but lower for type II (P = 0.003), sarcoma (P = 0.006), and mixed (P < 0.001). AP KY has a higher incidence of type I (P < 0.0001) and mixed malignancy (P = 0.04), younger age at diagnosis (P < 0.0001), larger non-Hispanic white population (P < 0.0001), fewer smokers (P = 0.002), and more uninsured and Medicaid recipients (P < 0.0001) compared with NAP KY. The hazard ratio for death is similar in AP and NAP KY (0.896; 95% confidence interval 0.795-1.009). CONCLUSIONS: Type I and mixed uterine corpus cancers have a higher age-adjusted incidence and a younger age at diagnosis in AP compared with NAP KY.


Assuntos
Disparidades nos Níveis de Saúde , Neoplasias Uterinas/epidemiologia , Adulto , Idoso , Região dos Apalaches/epidemiologia , Feminino , Humanos , Incidência , Kentucky/epidemiologia , Pessoa de Meia-Idade , Programa de SEER , Taxa de Sobrevida , Estados Unidos/epidemiologia
3.
Plant Dis ; 104(3): 634-648, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31967505

RESUMO

The main techniques for minimizing Fusarium head blight (FHB, or scab) and deoxynivalenol in wheat and barley are well established and generally available: planting of moderately FHB-resistant cultivars, risk monitoring, and timely use of the most effective fungicides. Yet the adoption of these techniques remains uneven across the FHB-prone portions of the U.S. cereal production area. A national survey was undertaken by the U.S. Wheat and Barley Scab Initiative in 17 states where six market classes of wheat and barley are grown. In 2014, 5,107 usable responses were obtained. The highest percentages reporting losses attributable to FHB in the previous 5 years were in North Dakota, Maryland, Kentucky, and states bordering the Great Lakes but across all states, ≥75% of respondents reported no FHB-related losses in the previous 5 years. Adoption of cultivar resistance was uneven by state and market class and was low except among hard red spring wheat growers. In 13 states, a majority of respondents had not applied an FHB-targeted fungicide in the previous 5 years. Although the primary FHB information source varied by state, crop consultants were considered to be an important source or their primary source of information on risk or management of FHB by the largest percentage of respondents. Use of an FHB risk forecasting website was about twice as high in North Dakota as the 17-state average of 6%. The most frequently cited barriers to adopting FHB management practices were weather or logistics preventing timely fungicide application, difficulty in determining flowering timing for fungicide applications, and the impracticality of FHB-reducing rotations. The results highlight the challenges of managing an episodically damaging crop disease and point to specific areas for improvement.


Assuntos
Fusarium , Hordeum , Kentucky , Maryland , North Dakota , Doenças das Plantas , Inquéritos e Questionários , Triticum
4.
Ground Water ; 58(1): 70-78, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30982960

RESUMO

Lack of filtration and rapid transport of groundwater and particulate matter make karst aquifers susceptible to bacterial contamination. This study utilized quantitative polymerase chain reaction (qPCR) to examine the transport and attenuation of two nonvirulent isolates of Escherichia coli (E. coli) in relation to traditional groundwater tracers (rhodamine WT dye and 1-µm diameter latex microspheres) in a karst-conduit aquifer in central Kentucky. Bacterial isolates were labeled with stable isotopes (15 N and 13 C). All tracers were detected more than 6 km downstream from the injection site and demonstrated overlapping breakthrough curves, with differential transport observed between the two bacterial strains. The E. coli isolate containing the kps gene (low attachment) arrived at sampling sites 1.25 to 36 h prior to the bacterial isolate containing the iha gene (high attachment) and was detected in samples collected following storm events in which the iha isolate was not detected. The storage potential of contaminants within karst systems was demonstrated by the remobilization of all tracers during storm events more than 1 month after injection. Bacteria-sized microspheres were more easily remobilized during periods of increased discharge compared to other tracers. The study demonstrated that molecular biology techniques such as qPCR can be utilized as a sensitive analysis of bacterial tracers in karst aquifers and may prove to be a more sensitive analytical technique than stable isotope analysis for field-scale traces.


Assuntos
Água Subterrânea , Bactérias , Escherichia coli , Kentucky
6.
Sci Total Environ ; 698: 134233, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31514023

RESUMO

Soil carbon (C) sequestration plays an important role in mitigating global climate change, and certain land utilization strategies can exert a pronounced effect on carbon storage. Land use practices, such as planting previously cropped lands into perennial grasslands, can increase soil C sequestration; however, the temporal response of soil C pools to such changes in land use are likely complex and not well quantified. In the current study, a space-for-time approach was used to assess the response of soil C sequestration and microbial community composition during a five-year grazed pasture rotation following three years of vegetable production on a central Kentucky farm. After 5 years in pasture, soil organic C and N in the top 15 cm increased 20.6% and 20.1%, respectively, from year 1 levels, and particulate organic matter C (POM C) increased 53.5%. A carbon mineralization (CM) assay indicated that the potential release of CO2 also increased with time in pasture rotation. When compared to permanent pasture (not previously used for vegetable production), soil microbial community composition differed in rotation years 1-3 but became similar in years 4 and 5. Multi-response permutation procedure (MRPP) analysis showed that CM and POM were key factors affecting microbial community composition. Soil microbial community composition also varied with time of year (season), but to a lesser degree than with pasture duration. Overall, incorporation of perennial pasture into cropping systems can have profound effects on microbial community composition and function, increasing soil organic C, and consequently enhancing the potential for C sequestration; however, whether these increases in C storage persist throughout the full cropping sequence (i.e., once the pasture has been returned to vegetables) and/or how these changes influence subsequent vegetable production remains to be evaluated.


Assuntos
Agricultura/métodos , Sequestro de Carbono , Ecossistema , Microbiologia do Solo , Mudança Climática , Kentucky , Microbiota
7.
South Med J ; 112(11): 553-559, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31682734

RESUMO

OBJECTIVES: This study assessed providers' present practices and perceived needs in Appalachian Kentucky to identify the standard of care and implementation of expert recommendations for managing pediatric obesity. METHODS: Questionnaire data were gathered from 28 providers at a pediatric obesity continuing medical education workshop in eastern Kentucky. We assessed current practices, perceived barriers to treatment, and needed resources for managing pediatric obesity. RESULTS: Respondents reported mixed adherence to expert recommendations, with providers less frequently addressing family-reported barriers to change and assessing a family's readiness to change behaviors related to pediatric obesity. Respondents also reported service barriers related to patient motivation, lack of time with patients, and a lack of referral options. Finally, providers reported needing multiple community resources to better address pediatric obesity, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. CONCLUSIONS: There remains a significant need for education and guidance regarding the implementation of expert recommendations for addressing pediatric obesity in Appalachian Kentucky. Providers reported needing multiple community resources, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. We discuss the implications for disseminating and implementing expert recommendations in rural eastern Kentucky, with an emphasis on the roles of behavioral health experts.


Assuntos
Obesidade Pediátrica/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde , Região dos Apalaches , Aconselhamento , Feminino , Fidelidade a Diretrizes , Comportamentos Relacionados com a Saúde , Humanos , Kentucky , Masculino , Determinação de Necessidades de Cuidados de Saúde , Guias de Prática Clínica como Assunto , Serviços de Saúde Rural , População Rural , Inquéritos e Questionários
9.
Zootaxa ; 4646(2): zootaxa.4646.2.11, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31717022

RESUMO

Species composition and distribution of hindgut ciliates were investigated in the feces of 20 thoroughbred mares in Kentucky, USA. Thirty-three species and six morphotypes belonging to 21 genera were identified. The average density of hindgut ciliates in mares was 13.5 ± 13.7 × 104 cells ml-1, whereas mean number of ciliate species per host was 14.4 ± 5.3. Bundleia nana, B. elongata, B. piriformis, Blepharoconus hemiciliatus, Holophryoides ovalis, H. macrotricha, Blepharoprosthium polytrichum, Prorodonopsis coli, Paraisotrichopsis composita, Blepharocorys microcorys, and Ochoterenaia appendiculata were the first identified species in horses inhabited in USA. Scanning electron microscopic images of Holophryoides macrotricha, Paraisotrichopsis composita, Cycloposthium dentiferum m. corrugatum, C. edentatum m. edentatum, C. edentatum m. scutigerum, Tetratoxum parvum m. parvum, T. parvum m. sulcatum, T. excavatum m. excavatum, Allantosoma intestinale, and Arcosoma brevicorniger were studied. Binary fission in Polymorphella ampulla was also studied.


Assuntos
Cilióforos , Abdome , Animais , Fezes , Feminino , Cavalos , Kentucky , Microscopia Eletrônica de Varredura
10.
Am Surg ; 85(11): 1205-1208, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775959

RESUMO

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.


Assuntos
Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Emergências , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/cirurgia , Humanos , Kentucky/epidemiologia , Pulmão/cirurgia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Toracostomia/métodos , Toracotomia/estatística & dados numéricos , Toracotomia/tendências , Fatores de Tempo , Tempo para o Tratamento , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
11.
Am J Law Med ; 45(2-3): 202-223, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722629

RESUMO

In the 21st century the opportunity for the public to comment to an administrative agency typically means an invitation to go to a website, type words into a box, and hit send. Many advocacy groups provide templates for people to submit a statement in support or opposition to specific proposals. However, standardized comments do not capture the voice of Medicaid. They do not share people's personal experiences and insights. This article describes how consumer advocates in Kentucky devised a strategy, their Secret Sauce, to help consumers participate in the public comment process that is now required for Section 1115 Medicaid demonstration waiver applications. It shows how advocates can help real people's voices be heard in the public comment process, not through templates but through a process that assists people to tell their own stories in their own words. This is Medicaid's voice, the stories of real people who rely on Medicaid. Medicaid's voice can help policy makers understand the real-life impact of policy choices they make. It can also provide relevant evidence for courts reviewing the Secretary's grant of a Section 1115 waiver. Medicaid's voice can also help build political momentum, bringing those who rely on Medicaid to the polls and into the political conversation about the future of Medicaid.


Assuntos
Participação da Comunidade , Defesa do Consumidor , Medicaid/legislação & jurisprudência , Narrativas Pessoais como Assunto , Humanos , Cobertura do Seguro/legislação & jurisprudência , Kentucky , Patient Protection and Affordable Care Act , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31614429

RESUMO

Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, unexplained variation remains, and community-engaged research approaches are warranted to identify contributing factors. The Mountain Air Project's community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and we undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. While photovoice has been employed for other youth-focused health studies in Appalachia, to our knowledge, this work represents the region's first environmental study using photovoice among youth. Over eight weeks, ten participants (age 12-18) represented their perspectives through photographs and accompanying narratives. A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.


Assuntos
Conscientização , Saúde Ambiental , Conhecimentos, Atitudes e Prática em Saúde , Inteligência , Infecções Respiratórias/epidemiologia , Fumar/efeitos adversos , Fumar/psicologia , Adolescente , Criança , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Kentucky/epidemiologia , Masculino
14.
Am J Health Syst Pharm ; 76(16): 1211-1217, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369116

RESUMO

PURPOSE: Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin-tazobactam and vancomycin are reported. METHODS: A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science's Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded. RESULTS: A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28-1.66]). CONCLUSION: Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin-tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.


Assuntos
Lesão Renal Aguda/epidemiologia , Antibacterianos/efeitos adversos , Obesidade/epidemiologia , Combinação Piperacilina e Tazobactam/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Medicine (Baltimore) ; 98(33): e16874, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415427

RESUMO

To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2-3 modalities received) versus low (0-1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0-1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Segunda Neoplasia Primária/terapia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia/estatística & dados numéricos , Feminino , Humanos , Kentucky , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Virginia , Adulto Jovem
16.
Vet Microbiol ; 235: 243-247, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383308

RESUMO

The combination of a macrolide and rifampicin has been the mainstay of therapy in foals with Rhodococcus equi pneumonia for decades. Recent studies suggest that mass antimicrobial treatment of subclinically affected foals over time has selected for antimicrobial resistance. Our objective was to estimate the prevalence of R. equi strains resistant to macrolides and rifampicin at horse breeding farms in Kentucky. A hundred breeding farms in Kentucky were surveyed and R. equi were cultured from soil samples. Data were analyzed with logistic regression and generalized linear modeling (P < 0.05). Seventy-six percent (76%) of farms yielded resistant R. equi, and resistance to macrolides and rifampicin was associated with their use at farms. The present study is the first to report the prevalence and distribution of resistant isolates in the environment of farms in Kentucky, USA. Collectively, previous reports and the data presented herein provide irrefutable evidence of emerging antimicrobial resistance in R. equi with alarming prevalence. Widespread dissemination and maintenance of resistance genes in the environment where many other pathogenic bacteria exist is a concern for both animal and human health.


Assuntos
Infecções por Actinomycetales/veterinária , Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Macrolídeos/farmacologia , Rhodococcus equi/efeitos dos fármacos , Rifampina/farmacologia , Animais , Cruzamento , Fazendas , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/microbiologia , Cavalos , Kentucky/epidemiologia , Prevalência , Rhodococcus equi/genética , Fatores de Risco
17.
Cancer Causes Control ; 30(10): 1087-1100, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31435875

RESUMO

PURPOSE: This study examined targeted genomic variants of transforming growth factor beta (TGFB) signaling in Appalachian women. Appalachian women with cervical cancer were compared to healthy Appalachian counterparts to determine whether these polymorphic alleles were over-represented within this high-risk cancer population, and whether lifestyle or environmental factors modified the aggregate genetic risk in these Appalachian women. METHODS: Appalachian women's survey data and blood samples from the Community Awareness, Resources, and Education (CARE) CARE I and CARE II studies (n = 163 invasive cervical cancer cases, 842 controls) were used to assess gene-environment interactions and cancer risk. Polymorphic allele frequencies and socio-behavioral demographic measurements were compared using t tests and χ2 tests. Multivariable logistic regression was used to evaluate interaction effects between genomic variance and demographic, behavioral, and environmental characteristics. RESULTS: Several alleles demonstrated significant interaction with smoking (TP53 rs1042522, TGFB1 rs1800469), alcohol consumption (NQO1 rs1800566), and sexual intercourse before the age of 18 (TGFBR1 rs11466445, TGFBR1 rs7034462, TGFBR1 rs11568785). Interestingly, we noted a significant interaction between "Appalachian self-identity" variables and NQO1 rs1800566. Multivariable logistic regression of cancer status in an over-dominant TGFB1 rs1800469/TGFBR1 rs11568785 model demonstrated a 3.03-fold reduction in cervical cancer odds. Similar decreased odds (2.78-fold) were observed in an over-dominant TGFB1 rs1800469/TGFBR1 rs7034462 model in subjects who had no sexual intercourse before age 18. CONCLUSIONS: This study reports novel associations between common low-penetrance alleles in the TGFB signaling cascade and modified risk of cervical cancer in Appalachian women. Furthermore, our unexpected findings associating Appalachian identity and NQO1 rs1800566 suggests that the complex environmental exposures that contribute to Appalachian self-identity in Appalachian cervical cancer patients represent an emerging avenue of scientific exploration.


Assuntos
Fator de Crescimento Transformador beta1/genética , Neoplasias do Colo do Útero/genética , Adulto , Idoso , Alelos , Feminino , Interação Gene-Ambiente , Humanos , Kentucky/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , NAD(P)H Desidrogenase (Quinona)/genética , Ohio/epidemiologia , Receptor do Fator de Crescimento Transformador beta Tipo I/genética , Fatores de Risco , Transdução de Sinais , Neoplasias do Colo do Útero/epidemiologia , West Virginia/epidemiologia , Adulto Jovem
18.
Am Surg ; 85(6): 572-578, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267896

RESUMO

Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.


Assuntos
Mortalidade Hospitalar , Sistema de Registros , Comportamento Autodestrutivo/psicologia , Centros de Traumatologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Kentucky , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Taxa de Sobrevida , Resultado do Tratamento , Ferimentos Perfurantes/prevenção & controle , Adulto Jovem
19.
South Med J ; 112(7): 369-375, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31282965

RESUMO

OBJECTIVES: Many local communities in Kentucky, a state with one of the highest smoking prevalence rates in the United States, have enacted smoke-free ordinances that prohibit smoking in workplaces and enclosed buildings open to the public. Research has shown that such ordinances are clearly beneficial for public health, but their influence on smoking prevalence in the populations they cover remains unclear. This study explores the effect of local smoke-free ordinances on smoking prevalence in Kentucky. METHODS: We used a database of smoke-free ordinances maintained by the Kentucky Center for Smoke-Free Policy, Kentucky Behavioral Risk Factor Surveillance System survey data, and US Census data. We estimated the proportion of Kentucky adults living in counties with smoke-free ordinances of varying strength; examined bivariate associations between smoke-free ordinances and smoking prevalence; and fit regression models that adjusted for various county-level demographic, socioeconomic, and geographic factors. RESULTS: Smoking prevalence was approximately 5% lower in counties with smoke-free ordinances, even after adjusting for other relevant factors, including a trend in decreasing prevalence throughout the study region. There was a slight dose-response effect related to the strength of smoke-free ordinances after adjustment for these covariates. Smoke-free ordinances appear to have a modest effect on smoking prevalence across the span of several years. CONCLUSIONS: Findings demonstrate that although smoking prevalence fell throughout the state during the study period, counties with smoke-free ordinances experienced a greater decline. Future research should examine the strength of smoke-free ordinances in greater detail to better understand their influence on smoking prevalence.


Assuntos
Política Antifumo/legislação & jurisprudência , Fumar/epidemiologia , Adulto , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Prevalência , Inquéritos e Questionários
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