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1.
Environ Pollut ; 292(Pt A): 118356, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34653582

RESUMO

The inorganic components of particulate matter (PM), especially transition metals, have been shown to contribute to PM toxicity. In this study, the spatial distribution of PM elements and their potential sources in the Greater Los Angeles area were studied. The mass concentration and detailed elemental composition of fine (PM2.5) and coarse (PM2.5-10) particles were assessed at 46 locations, including urban traffic, urban community, urban background, and desert locations. Crustal enrichment factors (EFs), roadside enrichments (REs), and bivariate correlation analysis revealed that Ba, Cr, Cu, Mo, Pd, Sb, Zn, and Zr were associated with traffic emissions in both PM2.5 and PM2.5-10, while Fe, Li, Mn, and Ti were affected by traffic emissions mostly in PM2.5. The concentrations of Ba, Cu, Mo, Sb, Zr (brake wear tracers), Pd (tailpipe tracer), and Zn (associated with tire wear) were higher at urban traffic sites than urban background locations by factors of 2.6-4.6. Both PM2.5 and PM2.5-10 elements showed large spatial variations, indicating the presence of diverse emission sources across sampling locations. Principal component analysis extracted four source factors that explained 88% of the variance in the PM2.5 elemental concentrations, and three sources that explained 86% of the variance in the PM2.5-10 elemental concentrations. Based on multiple linear regression analysis, the contribution of traffic emissions (27%) to PM2.5 was found to be higher than mineral dust (23%), marine aerosol (18%), and industrial emissions (8%). On the other hand, mineral dust was the dominant source of PM2.5-10 with 45% contribution, followed by marine aerosol (22%), and traffic emissions (19%). This study provides novel insight into the spatial variation of traffic-related elements in a large metropolitan area.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Los Angeles , Material Particulado/análise , Emissões de Veículos/análise
2.
Zootaxa ; 5027(3): 417-428, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34811162

RESUMO

A new species of Myxia Bahder Bartlett (Cixiidae: Cixiinae: Oecleini) is established as Myxia hernandezi sp. n. collected from native palms in cloud forest habitat in Costa Rica. Placement in the genus Myxia is supported by molecular analysis of the cytochrome c oxidase subunit I (COI) and 18S loci as well as morphological characters.


Assuntos
Hemípteros , Animais , Cocos , Costa Rica , Florestas , Los Angeles
3.
Int J Public Health ; 66: 603810, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744569

RESUMO

Objectives: This study aimed to estimate the long-term trends of breast cancer incidence in Shanghai, Hong Kong, and Los Angeles (LA). Methods: Data were obtained from Cancer Incidence in Five Continents (CI5plus) database. The average annual percent change (AAPC) was conducted by joinpoint regression analysis, and the age, period and cohort effects were estimated by age-period-cohort (APC) analysis. Results: The age-standardized incidence rates (ASIRs) in LA were higher than Shanghai and Hong Kong. During 1988-2012, the ASIRs significantly decreased in white women in LA (AAPC = -0.6%, 95% CI: -0.9% to -0.4%) while increased in Shanghai (2.5%: 2.1%-2.9%) and Hong Kong (2.2%: 2.0%-2.5%). The APC analysis revealed significantly increased effects of age and period, and decreased effect of birth cohort. Conclusion: Although age and cohort effects were relatively strong, the period effect may be the key factor affecting trends of incidence, which may be caused by increasing exposures to carcinogens and risk factors. Therefore, more effective measures should be carried out promptly to protect high-risk populations such as elder women, to avoid exposures to risk factors of breast cancer.


Assuntos
Neoplasias da Mama , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/história , China/epidemiologia , Estudos de Coortes , Feminino , História do Século XX , História do Século XXI , Hong Kong/epidemiologia , Humanos , Incidência , Los Angeles/epidemiologia , Fatores de Risco
5.
Artigo em Inglês | MEDLINE | ID: mdl-34639411

RESUMO

Acetaminophen is the most common over-the-counter pain and fever medication used by pregnant women. While European studies suggest acetaminophen exposure in pregnancy could affect childhood asthma development, findings are less consistent in other populations. We evaluated whether maternal prenatal acetaminophen use is associated with childhood asthmatic symptoms (asthma diagnosis, wheeze, dry cough) in a Los Angeles cohort of 1201 singleton births. We estimated risk ratio (RR) and 95% confidence interval (CI) for childhood asthmatic outcomes according to prenatal acetaminophen exposure. Effect modification by maternal race/ethnicity and psychosocial stress during pregnancy was evaluated. The risks for asthma diagnosis (RR = 1.39, 95% CI 0.96, 2.00), wheezing (RR = 1.25, 95% CI 1.01, 1.54) and dry cough (RR =1.35, 95% CI 1.06, 1.73) were higher in children born to mothers who ever used acetaminophen during pregnancy compared with non-users. Black/African American and Asian/Pacific Islander children showed a greater than two-fold risk for asthma diagnosis and wheezing associated with the exposure. High maternal psychosocial stress also modified the exposure-outcome relationships. Acetaminophen exposure during pregnancy was associated with childhood asthmatic symptoms among vulnerable subgroups in this cohort. A larger study that assessed prenatal acetaminophen exposure with other social/environmental stressors and clinically confirmed outcomes is needed.


Assuntos
Asma , Efeitos Tardios da Exposição Pré-Natal , Acetaminofen/efeitos adversos , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Feminino , Humanos , Los Angeles/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Sons Respiratórios
6.
Sci Total Environ ; 7772021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602658

RESUMO

Over the past decade, sensor networks have been proven valuable to assess air quality on highly localized scales. Here we leverage innovative sensors to characterize gaseous pollutants in a complex urban environment and evaluate differences in air quality in three different Los Angeles neighborhoods where oil and gas activity is present. We deployed monitors across urban neighborhoods in South Los Angles adjacent to oil and gas facilities with varying levels of production. Using low-cost sensors built in-house, we measured methane, total non-methane hydrocarbons (TNMHCs), carbon monoxide, and carbon dioxide during three deployment campaigns over four years. The multi-sensor linear regression calibration model developed to quantify methane and TNMHCs offers up to 16% improvement in coefficient of determination and up to a 22% reduction in root mean square error for the most recent dataset as compared to previous models. The deployment results demonstrate that airborne methane concentrations are higher within a 500 m radius of three urban oil and gas facilities, as well as near a natural gas distribution pipeline, likely a result of proximity to sources. While there are numerous additional sources of TNMHCs in complex urban environments, some sites appear to be larger emitters than others. Significant methane emissions were also measured at an idle site, suggesting that fugitive emissions may still occur even if production is ceased. Episodic spikes of both compounds suggested an association with oil and gas activities, demonstrating how sensor networks can be used to elucidate community-scale sources and differences in air quality moving forward.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Hidrocarbonetos , Los Angeles , Metano/análise
7.
Drug Alcohol Depend ; 228: 109028, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34500239

RESUMO

BACKGROUND: Opioid-related morbidity and mortality has increased during the COVID-19 pandemic, yet specific information about the communities most affected remains unknown. Our objective is to evaluate decedent-level associations with an opioid-related death following the implementation of stay-at-home orders in Los Angeles County. METHODS: This retrospective cohort study used data from the L.A. County Medical Examiner-Coroner to identify opioid-related deaths in 2019 and 2020. We used logistic regression to analyze the change in opioid-related deaths following a 30-day washout period after the start of stay-at-home orders. Independent variables included decedent age, gender, race and ethnicity, heroin or fentanyl present at the time of death, census tract-level education, and a scheduled drug prescription in the year before death. RESULTS: Opioid-related deaths in L.A. County are most common in census tracts where a small percentage of the population has a Bachelor's degree. Following stay-at-home orders, Non-Hispanic Caucasian individuals had significantly more opioid-related deaths than Hispanic individuals (risk ratio (RR): 1.82 [95 % CI, 1.10-3.02]; P < 0.05) after adjusting for age, gender, and heroin or fentanyl use. Racial and ethnic differences in mortality were not explained by census tract-level education or recent scheduled drug prescriptions. DISCUSSION: There has been an alarming rise in opioid-related deaths in L.A. County during 2020. The increase in opioid-related overdose deaths following the onset of COVID-19 and related policies occurred most often among Non-Hispanic Caucasian individuals. Further research on this trend's underlying cause is needed to inform policy recommendations during these simultaneous public health crises.


Assuntos
COVID-19 , Overdose de Drogas , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Humanos , Los Angeles/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2
8.
JAMA Netw Open ; 4(9): e2127582, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34591103

RESUMO

Importance: The COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19-related disparities. Objective: To examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making. Design, Setting, and Participants: This qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis. Main Outcomes and Measures: Themes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization's Vaccine Hesitancy Matrix categories. Results: A total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation). Conclusions and Relevance: In this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Confiança/psicologia , COVID-19/psicologia , Grupos Étnicos/psicologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Los Angeles , Masculino , Grupos Minoritários/psicologia , Motivação , Participação do Paciente/psicologia
9.
Environ Sci Technol ; 55(18): 12191-12201, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34495669

RESUMO

Assessing the role of volatile organic compounds (VOCs) in production of ozone and secondary organic aerosol (SOA) is especially important in light of ongoing policy goals. Here, we estimated the ozone formation potential (OFP) and SOA formation potential (SOAP) of anthropogenic and biogenic VOC emissions to evaluate (1) anthropogenic VOCs and associated sectors that dominate OFP and SOAP and (2) the potential impacts of enhanced biogenic VOCs from urban greening programs on air quality in Los Angeles county. In the present-day scenario, ethylene had the largest OFP followed by m & p-xylene, toluene, propylene, and formaldehyde. The top five contributors to SOAP were toluene, mineral spirits, benzene, heptadecane, and hexadecane. Mobile and solvent sources were the dominant VOC sources for both OFP and SOAP. The potential increases in biogenic VOC emissions due to future urban greening had significant effects on urban air quality that offset the benefits of reducing anthropogenic VOC emissions. This study demonstrates that urban greening programs in Los Angeles county, and likely other cities as well, need to account for both anthropogenic and biogenic VOC contributions to secondary pollution, and greening cities should consider using vegetation types with low VOC emissions to avoid further degradation to urban air quality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Compostos Orgânicos Voláteis , Poluentes Atmosféricos/análise , China , Monitoramento Ambiental , Los Angeles , Ozônio/análise , Compostos Orgânicos Voláteis/análise
10.
MMWR Morb Mortal Wkly Rep ; 70(35): 1220-1222, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34473679

RESUMO

In-person instruction during the COVID-19 pandemic concerns educators, unions, parents, students, and public health officials as they plan to create a safe and supportive learning environment for children and adolescents (1). Los Angeles County (LAC), the nation's largest county, has an estimated population of 10 million, including 1.7 million children and adolescents aged 5-17 years (2). LAC school districts moved to remote learning for some or all students in transitional kindergarten* through grade 12 (TK-12) schools during the 2020-21 school year (3). Schools that provided in-person instruction were required by LAC Health Officer orders to implement prevention measures such as symptom screening, masking, physical distancing, cohorting, and contact tracing (4). This analysis compares COVID-19 case rates in TK-12 schools among students and staff members who attended school in person with LAC case rates during September 2020-March 2021.


Assuntos
COVID-19/epidemiologia , Características de Residência/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-34574791

RESUMO

To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between 'neighborhood risks and resources' and 'sense of community' factors for each dietary outcome of interest. While high perceived neighborhood violence (p < 0.001) and perceived community-level collective efficacy (p < 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p < 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p < 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.


Assuntos
Frutas , Verduras , Adulto , Dieta , Humanos , Los Angeles , População Urbana
12.
Front Public Health ; 9: 660289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34497790

RESUMO

The COVID-19 pandemic has disproportionately affected Latino adults aged 50 and older in California. Among adults aged 50-64, Latinos constitute approximately one-third (32%) of the population, but over half (52%) of COVID-19 cases, and more than two-thirds (64%) of COVID-related deaths as of June 2, 2021. These health disparities are also prevalent among Latinos 65 years and older who constitute 22% of the population, but 40% of confirmed COVID-19 cases and 50% of COVID-related deaths. Emergency medical services (EMS) are an essential component of the United States healthcare system and a vital sector in COVID-19 response efforts. Using data from the California Emergency Medical Services Information System (CEMSIS), this study examines racial and ethnic differences in respiratory distress related EMS calls among adults aged 50 and older in all counties except Los Angeles. This study compares the early pandemic period, January to June 2020, to the same time period in 2019. Between January and June 2019, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks, Asians, and Whites. During the early pandemic period, January to June 2020, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks but slightly higher odds compared to Whites. Differences by race/ethnicity and region were statistically significant. Understanding EMS health disparities is crucial to inform policies that create a more equitable prehospital care system for the heterogeneous population of middle aged and older adults.


Assuntos
COVID-19 , Serviços Médicos de Emergência , Hispano-Americanos , Humanos , Los Angeles/epidemiologia , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Estados Unidos
13.
J Am Pharm Assoc (2003) ; 61(6): e32-e41, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34366287

RESUMO

BACKGROUND: Despite the importance of pharmacies in ensuring medications and health care needs are met, there is limited up-to-date information regarding access to pharmacies or their services in the United States. OBJECTIVES: To evaluate trends and disparities in access to pharmacies in 4 largest cities in the United States, New York City, Los Angeles, Houston, and Chicago, by neighborhood racial and ethnic composition from 2015 to 2020. METHODS: Data from the National Council for Prescription Drug Programs (2015-2020) and the American Community Survey (2015-2019) were used. We examined neighborhoods (i.e., census tracts) and evaluated disparities in "pharmacy deserts" (low-income neighborhoods (1) whose average distance to the nearest pharmacy was at least 1 mile or (2) whose average distance to the nearest pharmacy was at least 0.5 mile and at least 100 households had no vehicle access). We also evaluated the differences in pharmacy closures and the availability of pharmacy services. RESULTS: From 2015 to 2020, the percent of neighborhoods with pharmacy deserts declined in New York City (from 1.6% to 0.9% of neighborhoods, P < 0.01), remained stable in Los Angeles (13.7% to 13.4%, P = 0.58) and Houston (27.0% to 28.5%, P = 0.18), and increased in Chicago (15.0% to 19.9%, P < 0.01). Pharmacy deserts were persistently more common in Black and Latino neighborhoods in all 4 cities. As of 2020, pharmacies in Black and Latino neighborhoods were also more likely to close and less likely to offer immunization, 24-hour, and drive-through services than pharmacies in other neighborhoods. CONCLUSION: To reduce disparities in access to medications and health care services, including those in response to the coronavirus disease 2019 pandemic (e.g., testing and vaccinations), policies that improve pharmacy access and expand the provision of pharmacy services in minority neighborhoods are critical.


Assuntos
COVID-19 , Assistência Farmacêutica , Farmácias , Chicago , Acesso aos Serviços de Saúde , Humanos , Los Angeles , Cidade de Nova Iorque , SARS-CoV-2 , Estados Unidos
14.
MMWR Morb Mortal Wkly Rep ; 70(34): 1170-1176, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34437525

RESUMO

COVID-19 vaccines fully approved or currently authorized for use through Emergency Use Authorization from the Food and Drug Administration are critical tools for controlling the COVID-19 pandemic; however, even with highly effective vaccines, a proportion of fully vaccinated persons will become infected with SARS-CoV-2, the virus that causes COVID-19 (1). To characterize postvaccination infections, the Los Angeles County Department of Public Health (LACDPH) used COVID-19 surveillance and California Immunization Registry 2 (CAIR2) data to describe age-adjusted infection and hospitalization rates during May 1-July 25, 2021, by vaccination status. Whole genome sequencing (WGS)-based SARS-CoV-2 lineages and cycle threshold (Ct) values from qualitative reverse transcription-polymerase chain reaction (RT-PCR) for two SARS-CoV-2 gene targets, including the nucleocapsid (N) protein gene region and the open reading frame 1 ab (ORF1ab) polyprotein gene region,* were reported for a convenience sample of specimens. Among 43,127 reported SARS-CoV-2 infections in Los Angeles County residents aged ≥16 years, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. Much lower percentages of fully vaccinated persons infected with SARS-CoV-2 were hospitalized (3.2%), were admitted to an intensive care unit (0.5%), and required mechanical ventilation (0.2%) compared with partially vaccinated persons (6.2%, 1.0%, and 0.3%, respectively) and unvaccinated persons (7.6%, 1.5%, and 0.5%, respectively) (p<0.001 for all comparisons). On July 25, the SARS-CoV-2 infection rate among unvaccinated persons was 4.9 times and the hospitalization rate was 29.2 times the rates among fully vaccinated persons. During May 1-July 25, the percentages of B.1.617.2 (Delta) variant infections estimated from 6,752 samples with lineage data increased among fully vaccinated persons (from 8.6% to 91.2%), partially vaccinated persons (from 0% to 88.1%), and unvaccinated persons (from 8.2% to 87.1%). In May, there were differences in median Ct values by vaccination status; however, by July, no differences were detected among specimens from fully vaccinated, partially vaccinated, and unvaccinated persons by gene targets. These infection and hospitalization rate data indicate that authorized vaccines were protective against SARS-CoV-2 infection and severe COVID-19 during a period when transmission of the Delta variant was increasing. Efforts to increase COVID-19 vaccination, in coordination with other prevention strategies, are critical to preventing COVID-19-related hospitalizations and deaths.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/diagnóstico , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Adulto Jovem
15.
Pediatr Infect Dis J ; 40(10): e379-e381, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34387617

RESUMO

This brief report presents transmission rates from a prospective study of 15 households with pediatric index cases of severe acute respiratory coronavirus-2 in Los Angeles County from December 2020 to February 2021. Our findings support ongoing evidence that transmission from pediatric index cases to household contacts is frequent but can be mitigated with practicing well-documented control measures at home, including isolation, masking and good hand hygiene.


Assuntos
COVID-19/transmissão , Infecções Respiratórias/transmissão , Adolescente , Criança , Pré-Escolar , Características da Família , Feminino , Higiene das Mãos/métodos , Humanos , Los Angeles , Masculino , Máscaras , Estudos Prospectivos , SARS-CoV-2/patogenicidade , Isolamento Social
17.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34400572

RESUMO

BACKGROUND: Adolescent nonmedical prescription opioid use is associated with overdose and other adverse outcomes, but its risk factors are poorly understood. METHODS: Data were drawn from a prospective cohort study of Los Angeles, California, high school students. At baseline (mean age = 14.6 years), students completed self-report screening measures of problem alcohol, cannabis, and drug use and 6 mental health problems (major depression, generalized anxiety, panic disorder, social phobia, obsessive-compulsive disorder, and hypomania or mania). Past 6-month nonmedical prescription opioid use (yes or no) was assessed across 7 semiannual follow-ups. RESULTS: Among baseline never users of nonmedical prescription opioids (N = 3204), average past 6-month prevalence of new nonmedical prescription opioid use across the 42-month follow-up was 4.4% (range 3.5%-6.1%). In a multivariable model co-adjusting for 9 baseline behavioral problems and other factors, major depression, hypomania or mania, cannabis, alcohol, and other drug use problems were associated with increased odds of nonmedical prescription opioid use over follow-ups. Cumulative indices of behavioral health comorbidity showed successively greater odds of subsequent nonmedical prescription opioid use for students with 1 (odds ratio [OR]: 3.74; 95% confidence interval [CI]: 2.79-5.01), 2 (OR: 8.79; 95% CI: 5.95-12.99), or 3 (OR: 9.69; 95% CI: 5.63-16.68) vs 0 baseline substance use problems, and similar increases were associated with increasing number of mental health problems (1 [OR: 1.60; 95% CI: 1.03-2.88] to all 6 [OR: 3.98; 95% CI: 1.09-14.82] vs 0). CONCLUSIONS: Behavioral health problems may be associated with increased risk of subsequent nonmedical prescription opioid use during mid to late adolescence, with successively greater risk for those with greater behavioral health comorbidity. In pediatric clinical practice or school-based prevention, behavioral health screeners may be useful for identifying youth at high risk for nonmedical prescription opioid use.


Assuntos
Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Humanos , Los Angeles , Masculino , Uso Indevido de Medicamentos sob Prescrição/psicologia , Prescrições , Prevalência , Estudos Prospectivos , Fatores de Risco , Estudantes/psicologia
18.
Environ Sci Technol ; 55(17): 12116-12125, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34383475

RESUMO

Contaminated sediments can negatively affect aquatic organisms and beneficial uses of coastal regions. Monitoring programs typically collect many indicators of sediment toxicity, yet multivariate approaches that comprehensively evaluate data across heterogeneous spatial environments are frequently not performed. In this paper, we explore a multivariate approach to show that a list of suspected drivers of sediment toxicity to native Mytilus galloprovincialis (mussel) and Eohaustorius estuarius (a marine amphipod) population can be narrowed down without excluding samples, and that redundancies in sampling sites can be identified and isolated. Using a 153 × 28 data matrix assembled from a southern California-wide bight monitoring program, we demonstrate by this approach that Port of Los Angeles (PLA) and San Diego Bay (SDB) contained the most toxic sediments in the bight in 2008, the nature of which was unique to each locality. (Note: Little toxicity was observed here in 2013 and 2018.) In PLA sediments, mussels were more affected than amphipods, with higher survivability associated with low Hg and Sn levels. Conversely, amphipods had higher mortality than mussel embryos in SDB sediments, with higher survivability associated with low Be and Co levels. Nitrogen, organic content, and finer sediment particles were not related to the survivability of these organisms.


Assuntos
Mytilus , Poluentes Químicos da Água , Animais , California , Ecossistema , Monitoramento Ambiental , Sedimentos Geológicos , Los Angeles , Análise Multivariada , Oceanos e Mares , Testes de Toxicidade , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade
19.
Drug Alcohol Depend ; 227: 108916, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34358770

RESUMO

California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). METHODS: We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N = 531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH. RESULTS: Age (40-49 years old vs age 50 or older: AOR = 5.85; 95 % CI = 2.18, 15.67), current homelessness (AOR = 3.75; 95 % CI = 1.28, 11.0), lifetime mental health history (AOR = 6.23; 95 % CI = 2.08, 18.66), and frequency of methamphetamine use (AOR = 1.01; 95 % CI = 1.00, 1.01) were statistically associated with increased odds of having experienced a TPH, while frequency of past month heroin/opioid use was associated with decreased odds of reporting a TPH (AOR = 0.99; 95 % CI = 0.99, 1.00) in multivariable analysis. CONCLUSIONS: Diverse factors were associated with TPH among PWID. Our analysis underscores the need for research on PWID with co-occurring substance-use and mental illness disorders and homelessness. There is urgent need for expanding access to lower barrier publicly funded mental health treatment from a harm-reduction approach.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Adulto , Humanos , Los Angeles/epidemiologia , Pessoa de Meia-Idade , Prevalência , São Francisco/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia
20.
Prehosp Disaster Med ; 36(5): 543-546, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34425934

RESUMO

INTRODUCTION: Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies. OBJECTIVE: The aim of this study was to evaluate how effective prehospital providers were in administering naloxone. METHODS: This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined. RESULTS: During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression. CONCLUSION: This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.


Assuntos
Overdose de Drogas , Serviços Médicos de Emergência , Insuficiência Respiratória , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Humanos , Los Angeles , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/tratamento farmacológico , Estudos Retrospectivos
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