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2.
Proc Natl Acad Sci U S A ; 119(32): e2108208119, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35914134

RESUMO

Many important social and policy decisions are made by small groups of people (e.g., juries, college admissions officers, or corporate boards) with the hope that a collective process will yield better and fairer decisions. In many instances, it is possible for these groups to fail to reach a decision by not garnering a minimum number of votes (e.g., hung juries). Our research finds that pivotal voters vote to avoid such decision failure-voters who can "tip" their group into a punishment decision will be more likely to do so. This effect is distinct from well-known social pressures to simply conform with others or reach unanimity. Using observational data from Louisiana court cases, we find a sharp discontinuity in juries' voting decisions at the threshold between indecision and conviction (Study 1). In a third-party punishment paradigm, pivotal voters were more likely to vote to punish a target than nonpivotal voters, even when holding social information constant (Study 2), and adopted harsher views about the target's deservingness of punishment (Study 3). Using vignettes, we find that pivotal voters are judged to be differentially responsible for the outcomes of their votes-those who "block" the group from reaching a punishment decision are deemed more responsible for the outcome than those who "fall in line" (Study 4). These findings provide insight into how we might improve group decision-making environments to ensure that their outcomes accurately reflect group members' actual beliefs and not the influence of social pressures.


Assuntos
Tomada de Decisão Compartilhada , Processos Grupais , Função Jurisdicional , Punição , Humanos , Louisiana , Infuência dos Pares , Punição/psicologia , Incerteza
3.
J Environ Manage ; 321: 115722, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35988404

RESUMO

Factors driving community recovery trajectories after disaster are not well understood. We assess why some communities show stronger recoveries from disaster than others, examining the role of four policy toolkits that U.S. county governments frequently adopt to recover from disaster. Using mixed methods, we examine the cases of Hurricanes Katrina and Rita with a novel dataset of recovery policies adopted within each Louisiana parish following the disasters. We typologize recovery strategies and analyze policy adoption patterns after crises. To compare which policy toolkit leads to the best recovery outcomes, we use synthetic control experiments on the 20 parishes hit by Hurricanes Katrina and Rita between August and September 2005, tracking net income inflow and net in-migration measures from 1997 to 2018 over 1408 parish-year observations, paired with qualitative case studies of parish policies and recovery outcomes. On average, soft and local recovery policies focused on community policies and feedback helped parishes stem the flow of finances away from the disaster-zone, as did infrastructural 'hard' policies, to a degree. in comparison, state policies focused on top-down planning experienced weaker recovery. Evidence shows that soft and local policy toolkits can accelerate recovery and that governments seeking to rebuild infrastructure should invest in locally-engaged community development in order to attain better overall recovery.


Assuntos
Tempestades Ciclônicas , Planejamento em Desastres , Desastres , Louisiana , Políticas
4.
J Environ Manage ; 319: 115730, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35982554

RESUMO

This paper depicts a simulation-based assessment of sediment quality on the performance of dedicated dredging projects for barrier island restoration in coastal Louisiana, USA. The research involved the development and integration of two sub-models. In the first, geomorphic modeling was used to simulate sediment transport dynamics within a proxy barrier island template over a 50-year trajectory. The template was assumed to be nourished with one of two sources of dredged material: nearshore (NS) sediments of lower quality (smaller grain diameter, higher organic fines); or higher quality sediments from distal sources located on the Outer Continental Shelf (OCS). In the second model, agency project records and commercial bids were used to estimate project construction costs as a function of dredge material quantity, transport distance, and project target elevation. These sub-models were coupled within a net present value framework from which average annual break-even values for ecosystem services (EBEV) were derived as an efficiency metric for comparing the economic performance of NS- and OCS-sourced projects. Results indicate that in some cases, the physical resiliency afforded by even small increases in sand diameter (+4 µm d50) can translate to greater long-term economic viability (lower EBEV) for OCS-sourced sediment transported over longer distances. Moreover, projects constructed with much higher diameter OCS sediment (+44 µm d50) with low fines and transported over relatively long distances (200 µm, 5% fines, 15-20 miles) were found to be more cost-effective than all comparably-sized projects constructed with lower quality NS sediments obtained from proximal sources (156 µm, 20% fines, 3-5 miles). For some comparisons, this quality advantage yielded a lower EBEV for OCS-sourced projects with transport distances exceeding 30 miles. Under storm-punctuated simulations, these quality advantages were more pronounced, with greater physical and economic implications for earlier (Y5) versus later (Y20) occurring storms. Budgeting for dedicated dredging projects has traditionally centered on the value of sediment as a commodity, with a focus on material placement cost. The findings of this study, however, indicate that a more comprehensive accounting of sediment quality and performance is required to maximize the economic efficiency of coastal restoration spending.


Assuntos
Ecossistema , Recuperação e Remediação Ambiental , Sedimentos Geológicos , Louisiana
5.
Artigo em Inglês | MEDLINE | ID: mdl-35954839

RESUMO

Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t0 (baseline) and t1 (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population.


Assuntos
Infecções por HIV , Motivação , Infecções por HIV/epidemiologia , Humanos , Louisiana/epidemiologia , Inquéritos e Questionários , Carga Viral
6.
Int J Drug Policy ; 107: 103770, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35780564

RESUMO

BACKGROUND: Most states in the U.S. have enacted prescription opioid quantity limits to curb long-term opioid dependency. While several studies of these policies find reductions in subsequent prescriptions, others find mixed results in reducing overall opioid prescriptions and prescription length. Our objective was to examine three opioid restriction policies implemented in Louisiana Medicaid: (1) a 15-day quantity limit for opioid-naïve acute pain patients, (2) a subsequent further reduction to a 7-day quantity limit and a Morphine Milligram Equivalent Dosing (MME) limit of 120mg per day, and (3) a final reduction in daily MMEs to 90mg per day. METHODS: Using interrupted time series (ITS) models with Medicaid pharmacy claims data, we estimated changes in trends of opioid prescription fills associated with opioid restriction policies in Louisiana Medicaid. Outcomes of interest included average opioid prescription length, average MMEs per day, and the likelihood that an opioid-naïve beneficiary who received their first opioid prescription filled a second prescription within 30 or 60 days of their initial fill. RESULTS: 15-day and 7-day opioid prescription quantity limits were associated with a 0.720 and a 0.401 day reduction in average opioid prescription lengths. 7-day limits were associated with a 2.7 and a 3.0 percentage point reduction in the likelihood of a second opioid prescription fill within 30 or 60 days of the initial fill. The 120mg per day MME limit was associated with a 0.80 MMEs per day reduction in average daily MMEs. Further restricting daily MMEs to 90mg per day had no statistically significant association with average daily MMEs. CONCLUSION: These findings suggest that efforts to limit opioid exposure through the implementation of prescription quantity limits and MME restrictions in Louisiana's Medicaid program were successful and are likely to be associated with a reduction in future opioid dependency among the state's Medicaid population.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Humanos , Louisiana , Medicaid , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Padrões de Prática Médica , Estados Unidos
7.
BMC Pregnancy Childbirth ; 22(1): 555, 2022 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-35818040

RESUMO

BACKGROUND: Congenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient's health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting. METHODS: Between May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants' understanding of health disparities and vulnerable populations; perinatal patient's health and prenatal care preferences; and participants' perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment. RESULTS: Site-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment. CONCLUSIONS: Our findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people's access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Adolescente , California , Criança , Etnicidade , Feminino , Humanos , Louisiana , Grupos Minoritários , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Sífilis/diagnóstico , Sífilis Congênita/diagnóstico , Sífilis Congênita/prevenção & controle , Estados Unidos
9.
J Prev Med Hyg ; 63(1): E115-E124, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35647374

RESUMO

Background: Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. Methods: We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. Results: Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. Conclusions: Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.


Assuntos
Síndrome de Imunodeficiência Adquirida , Influenza Humana , Adulto , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Louisiana/epidemiologia , Vacinação , Cobertura Vacinal
10.
J Prev Med Public Health ; 55(3): 289-296, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35678003

RESUMO

OBJECTIVES: Integrating retail and manufacturing enables limitless potential for food businesses, but also creates challenges for navigating within complex food safety regulations. From public health inspectors' (PHIs) perspective, this study aimed (1) to describe the characteristics of crossover businesses in Louisiana, and (2) to evaluate regulation awareness and food safety education needs for business owners and PHIs who inspect crossover businesses. METHODS: A self-administered questionnaire was administered to Louisiana Department of Health PHIs using Qualtrics®. A descriptive analysis was performed, focusing on the frequency of each item. RESULTS: In total, 1774 retailers were conducting or planned to conduct specialized processes, while 552 food manufacturers were performing or planned to perform retail functions. Reduced oxygen packaging, the use of additives such as vinegar as a method of preservation, and smoking food as a method of preservation were observed by 62%, 36%, and 35% of the PHIs, respectively. The PHIs perceived crossover businesses as "not aware" or "somewhat aware" of the food safety regulations. The current food safety training level for these businesses was reported to range from "no training" to "some training but not sufficient." When asked for a self-assessment, the majority of PHIs reported themselves as being "familiar" with the variance requirement for specialized processing. Their confidence in inspecting crossover businesses, however, leaned towards "not confident" or "somewhat confident." CONCLUSIONS: To better guard public health, food safety training is needed for crossover food business owners, as well as PHIs, on regulations and conducting or inspecting specialized processes.


Assuntos
Inocuidade dos Alimentos , Saúde Pública , Comércio , Humanos , Louisiana , Inquéritos e Questionários , Estados Unidos
11.
Prehosp Disaster Med ; 37(4): 558-560, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35670299

RESUMO

This report describes the medical response, action plan, and after-action summary adopted by the Louisiana State University (LSU) New Orleans - Emergency Medicine (EM) Residency Program in response to Hurricane Ida which occurred in New Orleans, Louisiana (USA) late August through early September 2021. New Orleans has an estimated 385,000 people within the 350 square miles surrounding the metropolitan area, with greater than one million residents in all of Louisiana. In the two-week time span during and following the event, residents, nurses, attendings, ancillary staff, and Emergency Medical Services (EMS) managed a substantial intensification in daily EM activities due to a substantial lack of resources (ie, food, electricity, water, housing, medications, oxygen, and primary care). This report outlines the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); describes the daily communication flow from the chief residents and program director; describes the daily EM response; describes the pre- and post-action plans based on those efforts during hurricane operations; and summarizes the obtained information.


Assuntos
Tempestades Ciclônicas , Desastres , Medicina de Emergência , Centros Médicos Acadêmicos , Humanos , Louisiana
13.
Arch Environ Contam Toxicol ; 83(1): 13-20, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35699748

RESUMO

Total mercury (THg) concentrations were measured in wild alligators inhabiting a coastal marsh in southern Louisiana, to determine the tissue distribution of THg among various body organs and tissue compartments. Concentrations of THg in claws and dermal tail scutes were compared to those in blood, brain, gonad, heart, kidney, liver, and skeletal muscle to determine if the former tissues, commonly available by non-lethal sampling, could be used as measures of body burdens in various internal organs. Mercury was found in all body organs and tissue compartments. However, overall, THg concentrations measured in alligators were below the FDA action level for fish consumption and were comparable to previous data reported from southwestern Louisiana. Our results suggest consumption of meat from alligators found in this region may be of little public health concern. However, the extended period of time between sampling (in this study) and the present-day highlight the need for continuous, additional, and more recent sampling to ensure consumer safety. Total mercury concentrations were highest in the kidney (3.18 ± 0.69 mg/kg dw) and liver (3.12 ± 0.76 mg/kg dw). THg levels in non-lethal samples (blood, claws, and dermal tail scutes) were positively correlated with all tissue THg concentrations (blood: R2 = 0.513-0.988; claw: R2 = 0.347-0.637, scutes: R2 = 0.333-0.649). Because THg concentrations from blood, claws, and scutes were correlated with those of the internal organs, non-lethal sampling methods may be a viable method of estimating levels of THg in other body tissues.


Assuntos
Jacarés e Crocodilos , Mercúrio , Poluentes Químicos da Água , Animais , Monitoramento Ambiental/métodos , Louisiana , Mercúrio/análise , Distribuição Tecidual , Poluentes Químicos da Água/análise , Áreas Alagadas
14.
J Correct Health Care ; 28(4): 220-226, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35648043

RESUMO

As prison-based hospice programs are slowly implemented across the United States, scarce attention has been devoted to the views of correctional staff who provide essential end-of-life care to dying incarcerated individuals. These professionals must maneuver their diverse responsibilities and emotional perspectives to deliver compassionate care to a marginalized population. A textual analysis of narratives of correctional staff participating in the hospice program at Louisiana State Penitentiary was incorporated to explore the transformative experiences resulting from staff members' collaboration with incarcerated volunteers to dispense hospice-based care for critically ill incarcerated individuals. Prevalent themes focus on provider identity, role satisfaction, bonds with incarcerated individuals, and achieving care mandates. Future research should further examine end-of-life care provider narratives to effectively address the unmet needs of dying incarcerated individuals.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Humanos , Louisiana , Prisões , Estados Unidos , Voluntários
15.
Proc Natl Acad Sci U S A ; 119(27): e2123533119, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35759671

RESUMO

High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.


Assuntos
Afro-Americanos , COVID-19 , Equidade em Saúde , Disparidades em Assistência à Saúde , COVID-19/mortalidade , Disparidades em Assistência à Saúde/etnologia , Humanos , Louisiana/epidemiologia , Densidade Demográfica , Fatores Raciais
16.
Health Phys ; 123(3): 218-228, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35678725

RESUMO

ABSTRACT: Louisiana has aligned its radiological emergency program with the 2017 US Environmental Protection Agency Protective Action Guides Manual but has added a child thyroid dose evacuation threshold in lieu of distributing potassium iodide to the public. The nuclear power plants will continue to align with the 1992 manual for the foreseeable future, which could lead to possible accident scenarios in which state recommendations would differ from those of the utility. The objective of this study is to predict what accident and weather conditions will lead to a differing set of recommendations. This study performs a representative set of simulations of potential nuclear power plant accidents using a combination of the RASCAL software package, provided by the Nuclear Regulatory Commission, and a Software system used by Entergy combining an older RASCAL dose modeling methodology with plant-specific input. Four preliminary results of this study are presented: a spent fuel fire where differences in whole body dose lead to very different evacuations, a loss of coolant accident in which the child thyroid dose is the determining factor, a core melt accident using stack monitors to locate the evacuation threshold point, and a spiked coolant accident that could lead to an evacuation order before the plant declares a General Emergency. Weather plays as great a role as accident conditions in determining whether the evacuation recommendations differ. The completed results of this study can provide guidance to states as they evaluate the transition to the 2017 guidelines.


Assuntos
Acidente Nuclear de Fukushima , Centrais Nucleares , Acidentes , Criança , Humanos , Louisiana , Glândula Tireoide
17.
Am J Prev Med ; 63(1 Suppl 1): S83-S92, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35725146

RESUMO

INTRODUCTION: Breast cancer is a heterogeneous disease, consisting of multiple molecular subtypes. Obesity has been associated with an increased risk for postmenopausal breast cancer, but few studies have examined breast cancer subtypes separately. Obesity is often complicated by type 2 diabetes, but the possible association of diabetes with specific breast cancer subtypes remains poorly understood. METHODS: In this retrospective case-control study, Louisiana Tumor Registry records of primary invasive breast cancer diagnosed in 2010-2015 were linked to electronic health records in the Louisiana Public Health Institute's Research Action for Health Network. Controls were selected from Research Action for Health Network and matched to cases by age and race. Conditional logistic regression was used to identify metabolic risk factors. Data analysis was conducted in 2020‒2021. RESULTS: There was a significant association between diabetes and breast cancer for Luminal A, Triple-Negative Breast Cancer, and human epidermal growth factor 2‒positive subtypes. In multiple logistic regression, including both obesity status and diabetes as independent risk factors, Luminal A breast cancer was also associated with overweight status. Diabetes was associated with increased risk for Luminal A and Triple-Negative Breast Cancer in subgroup analyses, including women aged ≥50 years, Black women, and White women. CONCLUSIONS: Although research has identified obesity and diabetes as risk factors for breast cancer, these results underscore that comorbid risk is complex and may differ by molecular subtype. There was a significant association between diabetes and the incidence of Luminal A, Triple-Negative Breast Cancer, and human epidermal growth factor 2‒positive breast cancer in Louisiana.


Assuntos
Neoplasias da Mama , Diabetes Mellitus Tipo 2 , Obesidade , Neoplasias de Mama Triplo Negativas , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Incidência , Louisiana/epidemiologia , Obesidade/epidemiologia , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Estudos Retrospectivos , Fatores de Risco , Neoplasias de Mama Triplo Negativas/epidemiologia
18.
Cancer ; 128(15): 2865-2870, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35607821

RESUMO

Comprehensive biomarker testing has become the standard of care for informing the choice of the most appropriate targeted therapy for many patients with advanced cancer. Despite evidence demonstrating the need for comprehensive biomarker testing to enable the selection of appropriate targeted therapies and immunotherapy, the incorporation of biomarker testing into clinical practice lags behind recommendations in National Comprehensive Cancer Network guidelines. Coverage policy differences across insurance health plans have limited the accessibility of comprehensive biomarker testing largely to patients whose insurance covers the recommended testing or those who can pay for the testing, and this has contributed to health disparities. Furthermore, even when insurance coverage exists for recommended biomarker testing, patients may incur burdensome out-of-pocket costs depending on their insurance plan benefits, which may also create barriers to testing. Prior authorization for biomarker testing for some patients can add an administrative burden and may delay testing and thus treatment if it is not done in a timely manner. Recently, three states (Illinois, Louisiana, and California) passed laws designed to improve access to biomarker testing at the state level. However, there is variability among these laws in terms of the population affected, the stage of cancer, and whether the coverage of testing is mandated, or the legislation addresses only prior authorization. Advocacy efforts by patient advocates, health care professionals, and professional societies are imperative at the state level to further improve coverage for and access to appropriate biomarker testing.


Assuntos
Gastos em Saúde , Cobertura do Seguro , Biomarcadores , Humanos , Illinois , Louisiana , Estados Unidos
19.
Ann Epidemiol ; 71: 1-8, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35472488

RESUMO

PURPOSE: To quantify and compare SARS-CoV-2 transmission potential across Alabama, Louisiana, and Mississippi and selected counties. METHODS: To determine the time-varying reproduction number Rt of SARS-CoV-2, we applied the R package EpiEstim to the time series of daily incidence of confirmed cases (mid-March 2020 - May 17, 2021) shifted backward by 9 days. Median Rt percentage change when policies changed was determined. Linear regression was performed between log10-transformed cumulative incidence and log10-transformed population size at four time points. RESULTS: Stay-at-home orders, face mask mandates, and vaccinations were associated with the most significant reductions in SARS-CoV-2 transmission in the three southern states. Rt across the three states decreased significantly by ≥20% following stay-at-home orders. We observed varying degrees of reductions in Rt across states following other policies. Rural Alabama counties experienced higher per capita cumulative cases relative to urban ones as of June 17 and October 17, 2020. Meanwhile, Louisiana and Mississippi saw the disproportionate impact of SARS-CoV-2 in rural counties compared to urban ones throughout the study period. CONCLUSION: State and county policies had an impact on local pandemic trajectories. The rural-urban disparities in case burden call for evidence-based approaches in tailoring health promotion interventions and vaccination campaigns to rural residents.


Assuntos
COVID-19 , SARS-CoV-2 , Alabama/epidemiologia , COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Humanos , Louisiana/epidemiologia , Mississippi/epidemiologia , Estados Unidos
20.
Toxins (Basel) ; 14(4)2022 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-35448879

RESUMO

The corn earworm/bollworm, Helicoverpa zea (Boddie), is a pest species that is targeted by both Bacillus thuringiensis (Bt) maize and cotton in the United States. Cry1Ab and Vip3Aa20 are two common Bt toxins that are expressed in transgenic maize. The objective of this study was to determine the resistance allele frequency (RAF) to Cry1Ab and Vip3Aa20 in H. zea populations that were collected during 2018 and 2019 from four southeastern U.S. states: Louisiana, Mississippi, Georgia, and South Carolina. By using a group-mating approach, 104 F2 iso-lines of H. zea were established from field collections with most iso-lines (85) from Louisiana. These F2 iso-lines were screened for resistance alleles to Cry1Ab and Vip3Aa20, respectively. There was no correlation in larval survivorship between Cry1Ab and Vip3Aa20 when the iso-lines were exposed to these two toxins. RAF to Cry1Ab maize was high (0.256) and the RAFs were similar between Louisiana and the other three states and between the two sampling years. In contrast, no functional major resistance allele (RA) that allowed resistant insects to survive on Vip3Aa20 maize was detected and the expected RAF of major RAs with 95% probability was estimated to 0 to 0.0073. However, functional minor RAs to Vip3Aa20 maize were not uncommon; the estimated RAF for minor alleles was 0.028. The results provide further evidence that field resistance to Cry1Ab maize in H. zea has widely occurred, while major RAs to Vip3Aa20 maize are uncommon in the southeastern U.S. region. Information that was generated from this study should be useful in resistance monitoring and refinement of resistance management strategies to preserve Vip3A susceptibility in H. zea.


Assuntos
Bacillus thuringiensis , Mariposas , Animais , Bacillus thuringiensis/genética , Proteínas de Bactérias/genética , Endotoxinas/genética , Frequência do Gene , Proteínas Hemolisinas/genética , Proteínas Hemolisinas/farmacologia , Resistência a Inseticidas/genética , Louisiana , Mariposas/genética , Controle Biológico de Vetores , Plantas Geneticamente Modificadas/genética , Estados Unidos , Zea mays/genética
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