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1.
Aesthet Surg J ; 41(1): 98-108, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026419

RESUMO

BACKGROUND: A moratorium was placed on nonurgent surgery throughout much of the United States in mid-March 2020 due to surging numbers of COVID-19 cases. Several months later, and with new safety precautions in place, elective surgery gradually resumed. However, no data exist on the safety of plastic surgery during the pandemic. OBJECTIVES: This aim of this survey was to assess the safety of plastic surgery during the pandemic by quantifying: (1) the preoperative prevalence of SARS-CoV-2; (2) the risk of postoperative COVID-19; (3) outcomes and precious resource utilization for such cases; and (4) the risks to office staff. METHODS: Los Angeles plastic surgeons certified by the American Board of Plastic Surgery (ABPS) were sent an online survey in July 2020, during a local COVID-19 surge, querying about the number of procedures performed in the 8- to 10-week period since reopening, testing policies, surgical complications, and cases among staff. RESULTS: In total, 112 surgeons reported 5633 surgeries since resuming elective surgery. Of these, 103 (91.96%) surgeons obtained a preoperative SARS-CoV-2 polymerase chain reaction (PCR) test for every patient. The preoperative PCR test was positive in 41/5881 (0.69%). Positive tests within 2 weeks postoperation occurred in 7/5380 (0.13%) of surgical patients, 3/8506 (0.04%) of injection patients, and 6/2519 (0.24%) of energy therapy patients. Nine offices reported at least 1 staff member who developed COVID-19. All cases were mild, with no hospitalizations or deaths. CONCLUSIONS: These data demonstrate that plastic surgery can be performed safely during a COVID-19 surge by ABPS diplomates. This has profound impact for patients, plastic surgeons, and health policy regulators.


Assuntos
Cirurgia Plástica , Procedimentos Cirúrgicos Eletivos , Humanos , Los Angeles/epidemiologia , Pacientes Ambulatoriais , Cirurgia Plástica/efeitos adversos , Inquéritos e Questionários
3.
Sci Total Environ ; 754: 142089, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33254941

RESUMO

Nitrogen dioxide (NO2) is responsible for aggravating respiratory diseases, particularly asthma. The aim of this study is to investigate the association between NO2 exposure and asthma emergency department (ED) visits during the cold season (November-February) in five populated locations (Sacramento, San Francisco, Fresno, Los Angeles, and San Diego) of California from 2005 to 2015 (1320 Days). Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with a 5 ppb increase in NO2 concentration for the 19,735 ED visits identified. An increase in NO2 exposure increased the odds of having asthma ED visits for the studied population. The potential effect modification by sex (female and male), race (White, Black, Hispanic, and Asian), and age (2-5, 6-18, 19-40, 41-64, and ≥65) was explored. A 5 ppb increase in the concentration of NO2 during lag 0-30 was associated with a 56% increase in the odds of having an asthma ED visit (OR = 1.560, CI: 1.428-1.703). Sex was not found to be a modifier. Asthma ED visits among all the races/ethnicities (except Asians) were associated with NO2 exposure. Whites had the highest OR 75% (OR = 1.750, CI: 1.417-2.160) at lag 0-30 in response to NO2 exposure. The association between NO2 exposure and asthma ED visits was positive among all age groups except for 19 to 40 years old; the OR was higher among 2 to 18 year old (at lag 0-30: age group 2-5 (OR = 1.699, CI: 1.399-2.062), and age group 6-18 (OR = 1.568, CI 1.348-1.825)). For stratification by location, San Diego and Fresno were found to have the highest OR, compared to the other studied locations.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Adolescente , Adulto , Poluentes Atmosféricos/efeitos adversos , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Los Angeles , Masculino , Dióxido de Nitrogênio , São Francisco , Estações do Ano , Adulto Jovem
4.
Health Promot Pract ; 22(1): 9-12, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32830564

RESUMO

The coronavirus (COVID-19) pandemic is having a devastating impact on global health. In the United States and abroad, there is concern for how the novel coronavirus will affect vulnerable populations, including people experiencing homelessness. Individuals who lack stable housing are more likely to have preexisting health conditions and limited access to basic preventative hygiene practices such as handwashing and sanitizing. The situation has become critical in Los Angeles' Skid Row neighborhood, where nearly 5,000 unhoused residents (13% of the city's homeless population) reside on any given night. Community members' concerns have mounted as social and health services in the area have decreased, and early efforts to prevent the transmission of coronavirus did not adequately address the lack of access to handwashing stations and hand sanitizing products. This Practice Note details an academic-community partnership that uses grassroots organizing to provide "do-it-yourself" handwashing stations to the Skid Row neighborhood. We describe how an academic-community partnership was mobilized to establish innovative practices in response to the coronavirus, offering lessons and recommendations for others hoping to do similar work.


Assuntos
/prevenção & controle , Desinfecção das Mãos , Pessoas em Situação de Rua , /epidemiologia , Pesquisa Participativa Baseada na Comunidade , Humanos , Los Angeles/epidemiologia , Pandemias/prevenção & controle , Universidades , Populações Vulneráveis
5.
J Adolesc Health ; 67(6): 763-768, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33071164

RESUMO

PURPOSE: The aim of the study was to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in a university student population. METHODS: This was a cross-sectional survey study based on the World Health Organization population-based seroepidemiological investigational protocol for SARS-CoV-2 conducted between April 29, 2020, and May 8, 2020, examining SARS-CoV-2 antibody prevalence among 790 university students in Los Angeles, CA. Participants completed a questionnaire on potential risk factors before blood sampling. Samples were analyzed using the EUROIMMUN Anti-SARS-CoV-2 ELISA (IgG) for the qualitative detection of IgG class antibodies to SARS-CoV-2 in human serum or plasma. RESULTS: The estimated prevalence of SARS-CoV-2 antibody was 4.0% (3.0%, 5.1%). Factors associated with having a positive test included history of anosmia and/or loss of taste (95% CI: 1.4-9.6). A history of respiratory symptoms, with or without fever, was not associated with a positive antibody test. CONCLUSIONS: Prevalence of SARS-CoV-2 antibodies in the undergraduate and graduate student university population was similar to community prevalence.


Assuntos
/epidemiologia , Imunoglobulina G/sangue , Estudos Soroepidemiológicos , Estudantes/estatística & dados numéricos , Universidades , Adulto , Estudos Transversais , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Prevalência , Inquéritos e Questionários , Adulto Jovem
6.
JAMA Netw Open ; 3(10): e2024191, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026453

RESUMO

Importance: In late December 2019, an outbreak of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. Data on the routes of transmission to Los Angeles, California, the US West Coast epicenter for coronavirus disease 2019 (COVID-19), and subsequent community spread are limited. Objective: To determine the transmission routes of SARS-CoV-2 to Southern California and elucidate local community spread within the Los Angeles metropolitan area. Design, Setting, and Participants: This case series included 192 consecutive patients with reverse transcription-polymerase chain reaction (RT-PCR) test results positive for SARS-CoV-2 who were evaluated at Cedars-Sinai Medical Center in Los Angeles, California, from March 22 to April 15, 2020. Data analysis was performed from April to May 2020. Main Outcomes and Measures: SARS-CoV-2 viral genomes were sequenced. Los Angeles isolates were compared with genomes from global subsampling and from New York, New York; Washington state; and China to determine potential sources of viral dissemination. Demographic data and outcomes were collected. Results: The cohort included 192 patients (median [interquartile range] age, 59.5 [43-75] years; 110 [57.3%] men). The genetic characterization of SARS-CoV-2 isolates in the Los Angeles population pinpointed community transmission of 13 patients within a 3.81 km2 radius. Variation landscapes of this case series also revealed a cluster of 10 patients that contained 5 residents at a skilled nursing facility, 1 resident of a nearby skilled nursing facility, 3 health care workers, and a family member of a resident of one of the skilled nursing facilities. Person-to-person transmission was detected in a cluster of 5 patients who shared the same single-nucleotide variation in their SARS-CoV-2 genomes. High viral genomic diversity was identified: 20 Los Angeles isolates (15.0%) resembled SARS-CoV-2 genomes from Asia, while 109 Los Angeles isolates (82.0%) were similar to isolates originating from Europe. Analysis of other common respiratory viral pathogens did not reveal coinfection in the cohort. Conclusions and Relevance: These findings highlight the precision of detecting person-to-person transmission and accurate contact tracing directly through SARS-CoV-2 genome isolation and sequencing. Development and application of phylogenetic analyses from the Los Angeles population established connections between COVID-19 clusters locally and throughout the US.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Genoma Viral/genética , Pneumonia Viral/transmissão , Adulto , Idoso , Ásia , California/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Europa (Continente) , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Pandemias , Filogenia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Análise de Sequência de RNA , Proteínas não Estruturais Virais/genética , Washington
7.
Am Surg ; 86(10): 1407-1410, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33103463

RESUMO

Surgeons are often unfamiliar with the costs of surgical instrumentation and supplies. We hypothesized that surgeon cost feedback would be associated with a reduction in cost. A multidisciplinary team evaluated surgical supply costs for laparoscopic appendectomies of 7 surgeons (surgeons A-G) at a single-center academic institution. In the intervention, each surgeon was debriefed with their average supply cost per case, their partner's average supply cost per case, the cost of each surgical instrument/supply, and the cost of alternatives. In addition, the laparoscopic appendectomy tray was standardized to remove extraneous instruments. Pre-intervention (March 2017-February 2018) and post-intervention (March 2018-October 2018) costs were compared. Pre-intervention, the surgeons' average supply cost per case ranged from $754-$1189; when ranked from most to least expensive, surgeon A > B > C > D > E > F > G. Post-intervention, the surgeons' average supply cost per case ranged from $676 to $846, and ranked from surgeon G > D > F > C > E > B > A. Overall, the average cost per case was lower in the post-intervention group ($854.35 vs. $731.11, P < .001). This resulted in savings per case of $123.24 (14.4%), to a total annualized savings of $29 151.


Assuntos
Apendicectomia/economia , Conscientização , Equipamentos e Provisões/economia , Laparoscopia/economia , Cirurgiões , Controle de Custos , Humanos , Los Angeles
8.
Arterioscler Thromb Vasc Biol ; 40(12): 3015-3021, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33028098

RESUMO

OBJECTIVE: Women with symptoms or signs of myocardial ischemia but no obstructive coronary artery disease (INOCA) often have coronary vascular dysfunction and elevated risk for adverse cardiovascular events. We hypothesized that u-hscTnI (ultra-high-sensitivity cardiac troponin I), a sensitive indicator of ischemic cardiomyocyte injury, is associated with coronary vascular dysfunction in women with INOCA. Approach and Results: Women (N=263) with INOCA enrolled in the WISE-CVD study (Women's Ischemic Syndrome Evaluation-Coronary Vascular Dysfunction) underwent invasive coronary vascular function testing and u-hscTnI measurements (Simoa HD-1 Analyzer; Quanterix Corporation, Lexington, MA). Logistic regression models, adjusted for traditional cardiovascular risk factors were used to evaluate associations between u-hscTnI and coronary vascular function. Women with coronary vascular dysfunction (microvascular constriction and limited coronary epicardial dilation) had higher plasma u-hscTnI levels (both P=0.001). u-hscTnI levels were associated with microvascular constriction (odds ratio, 1.38 per doubling of u-hscTnI [95% CI, 1.03-1.84]; P=0.033) and limited coronary epicardial dilation (odds ratio, 1.37 per doubling of u-hscTnI [95% CI, 1.04-1.81]; P=0.026). u-hscTnI levels were not associated with microvascular dilation or coronary epicardial constriction. CONCLUSIONS: Our findings indicate that higher u-hscTnI is associated with coronary vascular dysfunction in women with INOCA. This suggests that ischemic cardiomyocyte injury in the setting of coronary vascular dysfunction has the potential to contribute to adverse cardiovascular outcomes observed in these women. Additional studies are needed to confirm and investigate mechanisms underlying these findings in INOCA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00832702.


Assuntos
Circulação Coronária , Vasos Coronários/fisiopatologia , Hemodinâmica , Isquemia Miocárdica/diagnóstico , Miócitos Cardíacos/metabolismo , Troponina I/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Florida , Humanos , Los Angeles , Microcirculação , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/patologia , Prognóstico , Estudos Prospectivos , Medição de Risco , Vasoconstrição , Vasodilatação
9.
Proc Natl Acad Sci U S A ; 117(43): 26681-26687, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33046637

RESUMO

Measurements of Δ14C and CO2 can cleanly separate biogenic and fossil contributions to CO2 enhancements above background. Our measurements of these tracers in air around Los Angeles in 2015 reveal high values of fossil CO2 and a significant and seasonally varying contribution of CO2 from the urban biosphere. The biogenic CO2 is composed of sources such as biofuel combustion and human metabolism and an urban biospheric component likely originating from urban vegetation, including turf and trees. The urban biospheric component is a source in winter and a sink in summer, with an estimated amplitude of 4.3 parts per million (ppm), equivalent to 33% of the observed annual mean fossil fuel contribution of 13 ppm. While the timing of the net carbon sink is out of phase with wintertime rainfall and the sink seasonality of Southern California Mediterranean ecosystems (which show maximum uptake in spring), it is in phase with the seasonal cycle of urban water usage, suggesting that irrigated urban vegetation drives the biospheric signal we observe. Although 2015 was very dry, the biospheric seasonality we observe is similar to the 2006-2015 mean derived from an independent Δ14C record in the Los Angeles area, indicating that 2015 biospheric exchange was not highly anomalous. The presence of a large and seasonally varying biospheric signal even in the relatively dry climate of Los Angeles implies that atmospheric estimates of fossil fuel-CO2 emissions in other, potentially wetter, urban areas will be biased in the absence of reliable methods to separate fossil and biogenic CO2.


Assuntos
Dióxido de Carbono/análise , Isótopos de Carbono/análise , Monitoramento Ambiental/métodos , Ciclo do Carbono , Combustíveis Fósseis , Humanos , Los Angeles , Estações do Ano , Emissões de Veículos
10.
Cardiovasc Ther ; 2020: 1494506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072188

RESUMO

Background: Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the effect of early initiation of high-dose intravenous magnesium sulfate on cardiac adverse events in stroke patients. Methods: This is a secondary analysis of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized phase-3 clinical trial, conducted from 2005-2013. Consecutive patients with suspected acute stroke and a serum magnesium level within 72 hours of enrollment were selected. Twenty grams of magnesium sulfate or placebo was administered in the ambulance starting with a 15-minute loading dose intravenous infusion followed by a 24-hour maintenance infusion in the hospital. Results: Among 1126 patients included in the analysis of this study, 809 (71.8%) patients had ischemic stroke, 277 (24.6%) had hemorrhagic stroke, and 39 (3.5%) with stroke mimics. The mean age was 69.5 (SD13.4) and 42% were female. 565 (50.2%) received magnesium treatment, and 561 (49.8%) received placebo. 254 (22.6%) patients achieved the target, and 872 (77.4%) did not achieve the target, regardless of their treatment group. Among 1126 patients, 159 (14.1%) had at least one CAE. Treatment with magnesium was not associated with fewer cardiac adverse events. A multivariate binary logistic regression for predictors of CAEs showed a positive association of older age and frequency of CAEs (R = 1.04, 95% CI 1.03-1.06, p < 0.0001). Measures of early and 90-day outcomes did not differ significantly between the magnesium and placebo groups among patients who had CAEs. Conclusion: Treatment of acute stroke patients with magnesium did not result in a reduction in the number or severity of cardiac serious adverse events.


Assuntos
Cardiopatias/prevenção & controle , Hospitalização , Sulfato de Magnésio/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Esquema de Medicação , Feminino , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Incidência , Los Angeles/epidemiologia , Sulfato de Magnésio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
11.
J Stroke Cerebrovasc Dis ; 29(12): 105323, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002791

RESUMO

OBJECTIVES: Although healthy lifestyle practices mitigate recurrent stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a occupational therapy-based lifestyle management intervention, Healthy Eating And Lifestyle after Stroke (HEALS), to improve stroke survivors' self-management skills relating to diet and physical activity and evaluated it in a diverse safety-net population. MATERIALS AND METHODS: One hundred English- or Spanish-speaking participants with stroke or transient ischemic attack were randomized to a 6-week occupational therapist-led group lifestyle intervention vs. usual care. Each of the six 2-h group sessions included didactic presentations on diet and physical activity, peer exchange, personal exploration with goal setting, and direct experience through participation in a relevant activity. Primary outcomes at 6 months were change in body mass index, fruit/vegetable intake, and physical activity. Secondary outcomes included change in waist circumference, smoking, blood pressure, high-density lipoprotein, low-density lipoprotein, triglyceride, total cholesterol, glycosylated hemoglobin levels, quality of care, and perceptions of care. Effect sizes were determined in preparation for a larger randomized controlled trial powered to detect a difference in primary outcomes. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and intervention adherence. RESULTS: There were no significant changes in primary or secondary outcomes at 6 months. Effect sizes for all outcomes were small (< 0.2). Focus group participants recommended extending the intervention program duration with more sessions, additional information on stroke and vascular risk factors, an interdisciplinary approach, additional family involvement, and incentives. Providers recommended longer program duration, more training, fidelity checks to ensure standardized program delivery, and additional incentives for participants. CONCLUSIONS: The HEALS intervention was feasible in a safety-net setting, but effect sizes were small. A longer-duration intervention, with intervener fidelity checks may be warranted. TRIAL REGISTRATION: NCT01550822.


Assuntos
Dieta Saudável , Terapia por Exercício , Ataque Isquêmico Transitório/reabilitação , Comportamento de Redução do Risco , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Comportamento Alimentar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Ataque Isquêmico Transitório/psicologia , Los Angeles , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Projetos Piloto , Provedores de Redes de Segurança , Autocuidado , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
Cancer Causes Control ; 31(12): 1093-1103, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32964365

RESUMO

PURPOSE: While cancer mortality has declined by 27% between 1991 and 2016 in the United States, there are large disparities in cancer mortality by racial/ethnic groups, socioeconomic status and access to care. The purpose of this analysis is to compare trends in cancer mortality among regions (Service Planning Areas, SPAs) in Los Angeles (LA) County that vary with respect to racial/ethnic distribution and social determinants of health, including poverty, education and access to care. METHODS: We estimated age- and race/ethnicity-standardized mortality for lung, colorectal (CRC) and breast cancer for eight SPAs from 1999 to 2013. We calculated three recommended measures of disparities that reflect absolute, relative and between-group disparities. RESULTS: In all of LA County, statistically significant declines in age- and race/ethnicity-standardized mortality ranged from 30% for lung cancer to 20% for CRC to 15% for breast cancer. Despite some of the largest declines in the most under-resourced SPAs (South LA, East LA, South Bay), disparities between the lowest and highest mortality by SPA did not significantly change from 1999 to 2013. CONCLUSIONS: Despite significant declines in cancer mortality in LA County from 1999 to 2013, and in racial/ethnic groups, there was little progress toward reducing disparities among SPAs. Highest mortalities for the three cancers were observed in Antelope Valley, San Fernando Valley, San Gabriel Valley, South LA and East LA. Findings demonstrate the importance of examining regional differences in cancer mortality to identify areas with highest needs for interventions and policies to reduce cancer disparities.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias Colorretais/mortalidade , Neoplasias Pulmonares/mortalidade , Adulto , Neoplasias da Mama/etnologia , Neoplasias Colorretais/etnologia , Feminino , Recursos em Saúde , Disparidades nos Níveis de Saúde , Humanos , Los Angeles/epidemiologia , Los Angeles/etnologia , Neoplasias Pulmonares/etnologia , Masculino , Classe Social
14.
PLoS One ; 15(9): e0239474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960917

RESUMO

Worldwide, testing capacity for SARS-CoV-2 is limited and bottlenecks in the scale up of polymerase chain reaction (PCR-based testing exist. Our aim was to develop and evaluate a machine learning algorithm to diagnose COVID-19 in the inpatient setting. The algorithm was based on basic demographic and laboratory features to serve as a screening tool at hospitals where testing is scarce or unavailable. We used retrospectively collected data from the UCLA Health System in Los Angeles, California. We included all emergency room or inpatient cases receiving SARS-CoV-2 PCR testing who also had a set of ancillary laboratory features (n = 1,455) between 1 March 2020 and 24 May 2020. We tested seven machine learning models and used a combination of those models for the final diagnostic classification. In the test set (n = 392), our combined model had an area under the receiver operator curve of 0.91 (95% confidence interval 0.87-0.96). The model achieved a sensitivity of 0.93 (95% CI 0.85-0.98), specificity of 0.64 (95% CI 0.58-0.69). We found that our machine learning algorithm had excellent diagnostic metrics compared to SARS-CoV-2 PCR. This ensemble machine learning algorithm to diagnose COVID-19 has the potential to be used as a screening tool in hospital settings where PCR testing is scarce or unavailable.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pacientes Internados , Aprendizado de Máquina , Pneumonia Viral/diagnóstico , Adulto , Idoso , Área Sob a Curva , Técnicas de Laboratório Clínico/normas , Humanos , Los Angeles , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Pandemias , Reação em Cadeia da Polimerase , Estudos Retrospectivos
15.
PLoS One ; 15(9): e0238713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966318

RESUMO

Air pollution is a serious concern to people who want to engage in physical activities to improve and maintain their health. However, air quality data collected at the nearest monitoring site may not be the best source of information because the data may be incomplete (e.g., some pollutants are not monitored) or not representative. This paper puts forward a method that uses air quality data from a large area to derive a diurnal profile of air quality variation for that area and identify the time window in which the air quality is typically the best during a day. If people exercise in that time window then they can minimize their exposure to air pollution. Three years' worth of air quality data in five California counties were analyzed to identify the general pattern of diurnal variation of air quality. The analysis shows the pattern of air quality variation is very similar among those five counties which represent diverse geographical and meteorological conditions. The analysis further reveals that in California air quality is generally the best in early mornings; as such, people should exercise in the early morning if their daily schedule allows it. A similar analysis can be performed for other areas to help people choose the best time window to exercise.


Assuntos
Exercício Físico/fisiologia , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Ritmo Circadiano/fisiologia , Humanos , Los Angeles
16.
PLoS One ; 15(9): e0238507, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881915

RESUMO

OBJECTIVE: In this exploratory longitudinal study we assessed cognitive development in a community sample of infants born into predominantly low-income families from two different urban sites, to identify family and community factors that may associate with outcomes by 1 year of age. METHOD: Infant-mother dyads (n = 109) were recruited in Boston and Los Angeles community pediatric practices. Infant cognition was measured using the Mullen Scales of Early Learning when the infant was aged 2, 6, 9, and 12 months. Longitudinal linear mixed effects modeling and linear regression models explored potential predictors of cognitive outcomes. RESULTS: Cognitive scores were lower than the reference population mean at both 6 and 12 months. There were site differences in demographics and cognitive performance. Maternal education predicted expressive language in Boston, and speaking Spanish and lower rates of community poverty were associated with greater increases in overall cognition in Los Angeles. CONCLUSION: This exploratory study identified a number of drivers of child development that are both shared across cohorts and unique to specific community samples. Factors influencing heterogeneity within and across populations both may be important contributors to prevention and intervention in supporting healthy development among children.


Assuntos
Desenvolvimento Infantil , Cognição , Pobreza , Boston , Feminino , Humanos , Lactente , Estudos Longitudinais , Los Angeles , Mães/psicologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32911772

RESUMO

Background: For African American middle-aged and older adults with hypertension, poor adherence to medication and lifestyle recommendations is a source of disparity in hypertension outcomes including higher rates of stroke in this population relative to whites. Aims: To study demographic, social, behavioral, cognitive, and medical predictors of adherence to medication and lifestyle recommendations among underserved African American middle-aged and older adults with hypertension. Methods: This was a community-based cross-sectional survey in South Los Angeles with 338 African American middle-aged and older adults with hypertension who were 55 years or older. Age, gender, continuity of care, comorbidity, financial difficulty, self-rated health, depression, educational attainment, adherence knowledge, and adherence worries were the independent variables. Data was analyzed using linear regression with two outcomes, namely, adherence to medication (measured by the first 9 items of the Blood Pressure Self-Care Scale) and adherence to lifestyle recommendations (measured by the second 9 items of the Blood Pressure Self-Care Scale). Results: There were about twice more females than males, with a total mean age of 70 years (range 55-90 years). Various demographic, social, behavioral, and medical factors predicted adherence to medication but not adherence to lifestyle recommendations. Females with hypertension with higher continuity of care, less financial strain, higher knowledge, less negative general beliefs, and concerns about antihypertensive medications had higher adherence to antihypertensive medications. The presence of depressive symptoms, reduced knowledge, and disease management worries were associated with a reduced adherence to lifestyle recommendations. Conclusions: There seem to be fewer demographic, social, behavioral, cognitive, and medical factors that explain adherence to lifestyle recommendations than adherence to medication in economically disadvantaged underserved African American middle-aged and older adults with hypertension. More research is needed on factors that impact adherence to lifestyle recommendations of African American middle-aged and older adults with hypertension.


Assuntos
Afro-Americanos , Hipertensão , Adesão à Medicação , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Estilo de Vida , Los Angeles , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade
18.
Am J Sports Med ; 48(13): 3322-3327, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32976717

RESUMO

BACKGROUND: There is no research on incomplete footprint coverage with single-row repair related to bone marrow stimulation (BMS) in large to massive rotator cuff tears (RCTs). PURPOSE/HYPOTHESIS: The purpose was to compare the clinical results and structural integrity between BMS and non-BMS groups that underwent arthroscopic repair of large to massive rotator cuff tears with <50% footprint coverage. It was hypothesized that both groups would exhibit improved clinical outcomes at 2 years after surgery but the BMS group would have significantly better clinical outcomes and structural integrity. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 98 patients who underwent arthroscopic repair with <50% footprint coverage for large to massive RCTs with (BMS group; n = 56) or without (non-BMS group; n = 42) BMS. Functional outcomes at the 2-year follow-up were assessed using the visual analog scale for pain score, subjective shoulder value; American Shoulder and Elbow Surgeons score; University of California, Los Angeles, shoulder score; and active range of motion. Structural integrity was evaluated using magnetic resonance arthrography or computed tomography arthrography results at 6 months postoperatively. RESULTS: At the 2-year follow-up, all functional outcomes significantly improved in both groups compared with preoperative values (P < .001). However, there were no significant postoperative differences between groups. On follow-up magnetic resonance arthrography or computed tomography arthrography, the overall retear rate was not significantly different between the BMS group (30.3%; 17/56) and the non-BMS group (35.7%; 15/42). CONCLUSION: While both groups exhibited functional improvement after single-row repair with <50% footprint coverage for large to massive RCTs, BMS did not produce better clinical outcomes or structural integrity.


Assuntos
Medula Óssea , Lesões do Manguito Rotador , Artroscopia , Medula Óssea/cirurgia , Estudos de Coortes , Humanos , Los Angeles , Imagem por Ressonância Magnética , Células-Tronco Mesenquimais/fisiologia , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
19.
Int J Infect Dis ; 100: 298-301, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32835787

RESUMO

OBJECTIVE: To determine the diagnostic yield of repeat testing for SARS-CoV-2. METHODS: A retrospective analysis was performed of all SARS-CoV-2 test results within the UCLA Health System between March 9th and April 29th, 2020. All patients with repeat test results were identified and those with discordant results were reviewed. RESULTS: Between March 9th and April 29th there were 10,165 SARS-CoV-2 test results, of which 630 (6.2%) were positive. Among the 904 patients with repeat test results, 808 (89.4%) were initially negative and 96 (10.6%) were initially positive. Among the 808 patients with an initial negative test, 15 (1.9%) subsequently tested positive. Eleven cases with an initial negative SARS-CoV-2 test and without a known prior positive SARS-CoV-2 test were reviewed; 6 were employed as healthcare workers and 10 were positive on the second test. CONCLUSIONS: We found a low diagnostic yield of repeat testing for SARS-CoV-2 in our health system. Repeat testing might prove useful in certain clinical scenarios, such as in healthcare workers, when symptoms develop after a negative test, and in hospitalized patients with a high clinical suspicion for COVID-19.


Assuntos
/diagnóstico , Pessoal de Saúde , Humanos , Los Angeles , Pandemias , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
PLoS One ; 15(8): e0237241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764800

RESUMO

BACKGROUND: Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California. METHODS: We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C. RESULTS: The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race. CONCLUSION: Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.


Assuntos
Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido Pequeno para a Idade Gestacional , Los Angeles/epidemiologia , Masculino , Gravidez , Pontuação de Propensão , Características de Residência , Estudos Retrospectivos , São Francisco/epidemiologia , Segregação Social , Fatores Socioeconômicos , Adulto Jovem
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