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1.
Sci Total Environ ; 805: 150333, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-34543794

RESUMO

Estimating environmental lead exposure using ecologic risk models is an inexpensive strategy to inform public health departments and to develop location-based intervention strategies such as targeted screening and mitigation. Importantly, studies in this area have not assessed temporal and spatio-temporal lead exposure risk trends. Due to lead abatement efforts and targeted screening efforts, it is anticipated that lead exposure risk has decreased over time. However, it is unknown if decreases have occurred, and if the decreases are evenly distributed across neighborhoods. Thus, the purpose of this study was to examine the association between neighborhood deprivation and risk of elevated blood lead levels (EBLLs) in both temporal and spatio-temporal contexts within the US state of Maryland in 2005-2015. To consider the temporal dimension of lead risk, we used a novel extension of Bayesian index models to estimate time-varying neighborhood deprivation indices along with time-varying index effects. The results showed that overall EBLL proportion decreased over time, from a high of 0.11 in 2006 to a low of 0.02 in 2015. The association between neighborhood deprivation and EBLL risk was positive and significant annually, but generally diminished over time. The most important variables in the neighborhood deprivation index were percent of houses built before 1940 and median household income. In summary, using Bayesian index models that can account for both temporal and spatio-temporal contexts is a promising approach to inform public health efforts to remediate lead and focus testing efforts and may be useful in studies in other geographic areas and times.


Assuntos
Chumbo , Características de Residência , Teorema de Bayes , Criança , Exposição Ambiental/análise , Humanos , Maryland , Fatores Socioeconômicos
2.
Nurs Educ Perspect ; 43(1): 63-65, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34897203

RESUMO

ABSTRACT: This article describes outcomes of a statewide initiative to increase the number of faculty with the National League for Nursing's Certified Nurse Educator (CNE®) credential. After offering CNE preparation workshops and creating a certification award, data were collected on perceived workshop effectiveness, readiness to test, certification pass rates, and characteristics of award recipients. The number of certified faculty increased by 92.3 percent, representing 24 of 28 nursing programs. Maryland faculty were awarded $625,000 through the Academic Nurse Educator Certification award.


Assuntos
Certificação , Docentes de Enfermagem , Humanos , Maryland
3.
Nutrients ; 13(12)2021 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-34959958

RESUMO

Asian Indians (AIs) are at increased risk for type 2 diabetes mellitus than other ethnic groups. AIs also have lower body mass index (BMI) values than other populations, so can benefit from strategies other than weight reduction. Macronutrient distributions are associated with improved glycemic control; however, no specific distribution is generally recommended. This study looks at whether a macronutrient distribution of 50:30:20 (percent of total calories from carbohydrates, fats, and protein) is related to diabetes status in AIs. Diet and Hemoglobin A1c (HbA1c) were assessed from convenience sample of AI adults in Maryland. A ratio of actual to needed calories using the 50:30:20 macronutrient distribution was then tested against diabetes status to identify associations. All groups except non-diabetic females, were in negative energy balance. The non-diabetic group consumed larger actual to needed ratios of protein than pre-diabetics and diabetics. However, all groups consumed protein at the lower end of the Acceptable Macronutrient Distribution Range (AMDR), and the quality of all macronutrients consumed was low. Therefore, weight loss may not be the recommendation for diabetes management for AIs. Increasing protein and insoluble fiber consumption, could play a critical role.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/etnologia , Ingestão de Alimentos/fisiologia , Adulto , Idoso , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/fisiopatologia , Fibras na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Feminino , Hemoglobina A Glicada , Controle Glicêmico , Humanos , Índia , Masculino , Maryland , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Risco , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-34769558

RESUMO

Maryland's growing chicken industry, including concentrated animal feeding operations (CAFOs) and meat processing plants, raises a number of concerns regarding public health and environmental justice. Using hot spot analysis, we analyzed the totality of Maryland's CAFOs and meat processing plants and those restricted to the Eastern Shore to assess whether communities of color and/or low socioeconomic status communities disproportionately hosted these types of facilities at the census tract level. We used zero-inflated regression modeling to determine the strength of the associations between environmental justice variables and the location of CAFOs and meatpacking facilities at the State level and on the Eastern Shore. Hot spot analyses demonstrated that CAFO hot spots on the Eastern Shore were located in counties with some of the lowest wealth in the State, including the lowest ranking county-Somerset. Zero-inflated regression models demonstrated that increases in median household income across the state were associated with a 0.04-unit reduction in CAFOs. For every unit increase in the percentage of people of color (POC), there was a 0.02-unit increase in meat processing facilities across the state. The distribution of CAFOs and meat processing plants across Maryland may contribute to poor health outcomes in areas affected by such production, and contribute to health disparities and health inequity.


Assuntos
Agricultura , Galinhas , Ração Animal , Animais , Humanos , Indústrias , Maryland
5.
J Law Med Ethics ; 49(3): 500-502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665093

RESUMO

On January 3, 2019, U.S. District Judge Theodore D. Chuang of the U.S. District Court of the District of Maryland took a crucial first step in redressing one of the worst human subjects research ethics violations in U.S. history.


Assuntos
Aborto Induzido , Preparações Farmacêuticas , Direitos Civis , Feminino , Direitos Humanos , Humanos , Jurisprudência , Responsabilidade Legal , Maryland , Gravidez , Governo Estadual
6.
West J Emerg Med ; 22(5): 1196-1201, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34546898

RESUMO

Reducing cost without sacrificing quality of patient care is an important yet challenging goal for healthcare professionals and policymakers alike. This challenge is at the forefront in the United States, where per capita healthcare costs are much higher than in similar countries around the world. The state of Maryland is unique in the hospital financing landscape due to its "capitation" payment system (also known as "global budget"), in which revenue for hospital-based services is set at the beginning of the year. Although Maryland's system has yielded many benefits, including reduced Medicare spending, it also has had unintentional adverse consequences. These consequences, such as increased emergency department boarding and ambulance diversion, constrain Maryland hospitals' ability to fulfill their role as emergency care providers and act as a safety net for vulnerable patient populations. In this article, we suggest policy remedies to mitigate the unintended consequences of Maryland's model that should also prove instructive for a variety of emerging alternative payment mechanisms.


Assuntos
Orçamentos , Serviço Hospitalar de Emergência/organização & administração , Acesso aos Serviços de Saúde/economia , Custos Hospitalares , Medicare , Idoso , Hospitais , Humanos , Maryland , Estados Unidos
8.
Am J Cardiol ; 157: 42-47, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34384590

RESUMO

Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the "Early Phase" of the pandemic (March 1 - June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the "Later Phase" of the pandemic (October 1, 2020 - January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the "Early Phase" and 621 during the "Later Phase." Maximum troponin-I in the "Early Phase" was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the "Later Phase" (p = 0.553). In-hospital mortality was significantly higher in the "Later Phase" (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more "Early Phase" patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of "Early Phase" and 0.8% of "Later Phase" patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.


Assuntos
COVID-19/epidemiologia , Infarto do Miocárdio/terapia , Troponina I/sangue , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Estudos de Coortes , Angiografia Coronária/estatística & dados numéricos , District of Columbia/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Pandemias , Admissão do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos
9.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34429338

RESUMO

OBJECTIVES: To evaluate newborn pulse oximetry screening (POS) outcomes at a large community hospital and the impact of the recommended revised POS algorithm. METHODS: A retrospective cohort study was performed to evaluate the results of POS in the well-infant nursery between 2012 and 2020. The POS results were obtained from an electronic platform. Chart review was completed for newborns with failed screens. The recommended revision to POS, no second rescreen, was applied to the data to evaluate screening outcomes. RESULTS: Of the total 65 414 infants admitted to the well-infant nursery during this 8-year period, >99% (n = 64 780) received POS. Thirty-one infants failed POS (4.6 per 10 000 screened). All infants who failed POS were found to have a disorder, with 12 (39%) having critical congenital heart disease (CCHD), 9 (29%) having non-CCHD requiring further follow-up, and 10 (32%) having noncardiac conditions. One false-negative screen result was identified through the Maryland Department of Health Newborn Screening Follow-up Program. The positive predictive value of POS for those screened was 39% for CCHD, with a specificity of 99.97%. Eliminating the second rescreen in the POS algorithm would have resulted in an additional 5 newborns without CCHD failing POS, increasing the false-positive rate from 0.03% to 0.04%. CONCLUSIONS: POS is an effective tool for identifying CCHD and secondary conditions. POS was successfully implemented with few missed screens and was highly specific. Elimination of the second rescreen in the pulse oximetry algorithm would have resulted in a minimal increase in false-positive results and faster evaluation of newborns with CCHD.


Assuntos
Cardiopatias Congênitas/diagnóstico , Triagem Neonatal , Oximetria , Algoritmos , Estudos de Coortes , Feminino , Hospitais Comunitários , Humanos , Recém-Nascido , Masculino , Maryland , Estudos Retrospectivos
10.
Nutrients ; 13(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34444833

RESUMO

Background: Lower body mass index (BMI) has been associated with lower serum urate (SU), but only in observational studies. We sought to determine the effects of behavioral weight loss and metformin treatment on SU in a randomized trial. Methods and Findings: The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a parallel three-arm randomized controlled trial of overweight/obese adult cancer survivors without gout at a single center in Maryland, United States. Participants were randomized to: (1) coach-directed weight loss (behavioral telephonic coaching), (2) metformin (up to 2000 mg daily), or (3) self-directed weight loss (informational brochures; reference group). SU and BMI were assessed at baseline and at 3, 6, and 12 months post-randomization. The 121 participants had a mean ± standard deviation (SD) age of 60 ± 9 years, 79% were female, and 45% were Black. At baseline, BMI was 35 ± 5 kg/m2, and SU was 5.6 ± 1.3 mg/dL. Compared to the self-directed group, at 12 months, the coach-directed group reduced BMI by 0.9 kg/m2 (95% confidence interval (CI): -1.5, -0.4) and metformin reduced BMI by 0.6 kg/m2 (95% CI: -1.1, -0.1). However, compared to the self-directed group, the coach-directed group unexpectedly increased SU by 0.3 mg/dL (95% CI: 0.05, 0.6), and metformin non-significantly increased SU by 0.2 mg/dL (95% CI: -0.04, 0.5); these effects were attenuated when analyses included change in estimated glomerular filtration rate (eGFR). Conclusions: In this randomized trial of cancer survivors without gout, reductions in BMI either increased or did not change SU, potentially due to effects on eGFR. These results do not support a focus on BMI reduction for SU reduction; however, long-term studies are needed. ClinicalTrials.gov Registration: NCT02431676.


Assuntos
Terapia Comportamental , Metformina/uso terapêutico , Ácido Úrico/sangue , Perda de Peso , Idoso , Índice de Massa Corporal , Feminino , Gota , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Obesidade/tratamento farmacológico , Sobrepeso/tratamento farmacológico
11.
Crit Care Med ; 49(10): e989-e1000, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259439

RESUMO

OBJECTIVES: Paroxysmal sympathetic hyperactivity occurs in a subset of critically ill traumatic brain injury patients and has been associated with worse outcomes after traumatic brain injury. The goal of this study was to identify admission risk factors for the development of paroxysmal sympathetic hyperactivity in traumatic brain injury patients. DESIGN: Retrospective case-control study of age- and Glasgow Coma Scale-matched traumatic brain injury patients. SETTING: Neurotrauma ICU at the R. Adams Cowley Shock Trauma Center of the University of Maryland Medical System, January 2016 to July 2018. PATIENTS: Critically ill adult traumatic brain injury patients who underwent inpatient monitoring for at least 14 days were included. Cases were identified based on treatment for paroxysmal sympathetic hyperactivity with institutional first-line therapies and were confirmed by retrospective tabulation of established paroxysmal sympathetic hyperactivity diagnostic and severity criteria. Cases were matched 1:1 by age and Glasgow Coma Scale to nonparoxysmal sympathetic hyperactivity traumatic brain injury controls, yielding 77 patients in each group. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Admission characteristics independently predictive of paroxysmal sympathetic hyperactivity included male sex, higher admission systolic blood pressure, and initial CT evidence of diffuse axonal injury, intraventricular hemorrhage/subarachnoid hemorrhage, complete cisternal effacement, and absence of contusion. Paroxysmal sympathetic hyperactivity cases demonstrated significantly worse neurologic outcomes upon hospital discharge despite being matched for injury severity at admission. CONCLUSIONS: Several anatomical, epidemiologic, and physiologic risk factors for clinically relevant paroxysmal sympathetic hyperactivity can be identified on ICU admission. These features help characterize paroxysmal sympathetic hyperactivity as a clinical-pathophysiologic phenotype associated with worse outcomes after traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Agitação Psicomotora/etiologia , Adulto , Lesões Encefálicas Traumáticas/enzimologia , Estudos de Casos e Controles , Feminino , Escala de Coma de Glasgow , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Agitação Psicomotora/epidemiologia , Estudos Retrospectivos , Fatores de Risco
12.
BMC Public Health ; 21(1): 1415, 2021 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273951

RESUMO

BACKGROUND: Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes toward FGM/C and confidence for related clinical care may affect the quality of care, yet there are no validated instruments to measure these constructs. METHODS: We developed the instruments via review of the FGM/C literature, the development of scale items, expert review, and pre-testing. We validated the instruments using a convenience sample of providers in Arizona and Maryland. We used exploratory factor analysis (EFA) to confirm factor structures, and compared scores between known groups to assess validity. RESULTS: The EFA revealed a two-factor solution for attitudes, including subscales for Negative Attitudes and Empathetic Attitudes toward FGM/C and those who practice with Cronbach's alphas of 0.814 and 0.628 respectively. The EFA for confidence revealed a two-factor solution including Confidence in Clinical FGM/C Care and Confidence in Critical Communication Skills for FGM/C Care with Cronbach's alphas of 0.857 and 0.694 respectively. CONCLUSIONS: Health care provider attitudes and confidence toward FGM/C care may affect quality of care and health outcomes for women and girls. Our study describes the rigorous psychometric analysis to create reliable and valid instruments to assess health care provider attitudes and confidence for the care of women and girls who have experienced FGM/C. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03249649 . Registered on 15 August 2017. Retrospectively registered.


Assuntos
Circuncisão Feminina , Arizona , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde , Humanos , Maryland , Reprodutibilidade dos Testes
13.
BMJ Open ; 11(7): e049494, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315797

RESUMO

OBJECTIVES: To examine the knowledge, attitudes and practices (KAP) of COVID-19 of rural and urban residents in Liberia to inform the development of local social and behaviour change communication strategies. DESIGN: Cross-sectional, mixed-mode (online and telephone) survey using non-probability sampling. SETTING: All 15 counties in Liberia with a focus on Maryland County. PARTICIPANTS: From 28 May to 28 June 2020, data were collected from a total of 431 adults aged 18 years and older (telephone 288 (66.8%); online 143 (33.2%)) out of a total of 741 contacts. MAIN OUTCOME MEASURES: KAP scores. Frequencies and proportions were calculated, followed by univariate and multivariable analyses to examine the association between KAP scores and the sociodemographic variables. RESULTS: Around 69% of the online survey respondents were younger than 35 years of age, compared with 56% in the telephone interviews. The majority (87%) of online respondents had completed tertiary education, compared with 77% of the telephone respondents. Male participants, on average, achieved higher knowledge (52%) and attitude scores (72%), in contrast to females (49% and 67%, respectively). Radio (71%) was the most cited source for COVID-19 information, followed by social media (63%). After controlling for sociodemographic variables, adaptive regression modelling revealed that survey mode achieved 100% importance for predicting knowledge and practice levels with regard to COVID-19. CONCLUSIONS: The survey population demonstrated moderate COVID-19 knowledge, with significant differences between survey mode and educational level. Correct knowledge of COVID-19 was associated with appropriate practices in Maryland County. Generalisation of survey findings must be drawn carefully owing to the limitations of the sampling methods. Yet, given the differences in knowledge gaps between survey modes, sex, education, occupation and place of residence, it is recommended that information is tailored to different audiences.


Assuntos
COVID-19 , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Libéria , Masculino , Maryland , SARS-CoV-2 , Inquéritos e Questionários
14.
J Am Geriatr Soc ; 69(10): 2865-2876, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34298583

RESUMO

OBJECTIVES: To determine whether lower serum albumin in community-dwelling, older adults is associated with increased risk of hospitalization and death independent of pre-existing disease. DESIGN: Prospective cohort study of participants in the fifth visit of the Atherosclerosis Risk in Communities (ARIC) study. Baseline data were collected from 2011 to 2013. Follow-up was available to December 31, 2017. Replication was performed in Geisinger, a health system in rural Pennsylvania. SETTING: For ARIC, four US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota. PARTICIPANTS: A total of 4947 community-dwelling men and women aged 66 to 90 years. EXPOSURE: Serum albumin. MAIN OUTCOMES: Incident all-cause hospitalization and death. RESULTS: Among the 4947 participants, mean age was 75.5 years (SD: 5.12) and mean baseline serum albumin concentration was 4.05 g/dL (SD: 0.30). Over a median follow-up period of 4.42 years (interquartile interval: 4.16-5.05), 553 participants (11.2%) died and 2457 participants (49.7%) were hospitalized at least once. The total number of hospitalizations was 5725. In analyses adjusted for demographics and numerous clinical characteristics, including tobacco use, obesity, frailty, cardiovascular disease, kidney disease, diabetes C-reactive protein (CRP), cognitive status, alcohol use, medication use, respiratory disease, and systolic blood pressure, 1 g/dL lower baseline serum albumin concentration was associated with higher risk of both hospitalization (incidence rate ratio [IRR]: 1.58; 95% confidence interval [CI]: 1.36-1.82; p < 0.001) and death (hazard ratio [HR]: 1.67; 95% CI: 1.24-2.24; p < 0.001). Associations were weaker with older age but not different by frailty status or level of high-sensitivity CRP. Associations between serum albumin, hospitalizations, and death were also similar in a real-world cohort of primary care patients. CONCLUSIONS: Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin should be considered a high-risk population and targeted for interventions to reduce the risk of adverse outcomes.


Assuntos
Hospitalização/estatística & dados numéricos , Mortalidade/tendências , Albumina Sérica/análise , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/sangue , Aterosclerose/etiologia , Aterosclerose/mortalidade , Feminino , Humanos , Incidência , Vida Independente/estatística & dados numéricos , Masculino , Maryland/epidemiologia , Minnesota/epidemiologia , Mississippi/epidemiologia , North Carolina/epidemiologia , Pennsylvania/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
15.
PLoS One ; 16(7): e0255214, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34324577

RESUMO

Testing is critical to mitigating the COVID-19 pandemic, but testing capacity has fallen short of the need in the United States and elsewhere, and long wait times have impeded rapid isolation of cases. Operational challenges such as supply problems and personnel shortages have led to these bottlenecks and inhibited the scale-up of testing to needed levels. This paper uses operational simulations to facilitate rapid scale-up of testing capacity during this public health emergency. Specifically, discrete event simulation models were developed to represent the RT-PCR testing process in a large University of Maryland testing center, which retrofitted high-throughput molecular testing capacity to meet pandemic demands in a partnership with the State of Maryland. The simulation models support analyses that identify process steps which create bottlenecks, and evaluate "what-if" scenarios for process changes that could expand testing capacity. This enables virtual experimentation to understand the trade-offs associated with different interventions that increase testing capacity, allowing the identification of solutions that have high leverage at a feasible and acceptable cost. For example, using a virucidal collection medium which enables safe discarding of swabs at the point of collection removed a time-consuming "deswabbing" step (a primary bottleneck in this laboratory) and nearly doubled the testing capacity. The models are also used to estimate the impact of demand variability on laboratory performance and the minimum equipment and personnel required to meet various target capacities, assisting in scale-up for any laboratories following the same process steps. In sum, the results demonstrate that by using simulation modeling of the operations of SARS-CoV-2 RT-PCR testing, preparedness planners are able to identify high-leverage process changes to increase testing capacity.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , COVID-19/virologia , Humanos , Laboratórios , Maryland , Pandemias/prevenção & controle
16.
Am J Med ; 134(10): 1247-1251, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34242620

RESUMO

BACKGROUND: Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the coronavirus disease 2019 (COVID-19) pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVIs) and related respiratory conditions. METHODS: In this observational study of ED encounters in a 11-hospital system in Maryland during 2019-2020, year-on-year ratios for all complaints were calculated to account for "lockdowns" and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history. RESULTS: There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend toward an association between the year-on-year ratio for all ED visits and the Maryland stay-at-home order (parameter estimate = -0.0804, P = .10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for NCVI and exacerbations of asthma exacerbations and chronic obstructive pulmonary disease, respectively (P < .001 for all). CONCLUSIONS: Increasing the prevalence of masking is associated with a decrease in ED visits for viral illnesses and exacerbations of asthma and COPD. These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Serviço Hospitalar de Emergência/estatística & dados numéricos , Máscaras , Doenças Respiratórias/epidemiologia , Viroses/epidemiologia , Feminino , Humanos , Masculino , Maryland/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2
17.
J Am Heart Assoc ; 10(14): e017487, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34261361

RESUMO

Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48-0.52; P<0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22-0.29; P<0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97-1.03; P=0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33-0.40; P<0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55-0.82 P<0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65-0.90; P=0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.


Assuntos
Afro-Americanos/estatística & dados numéricos , Estenose da Valva Aórtica/etnologia , Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , /estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Causas de Morte , Feminino , Equidade em Saúde , Hospitalização , Humanos , Incidência , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/mortalidade , Substituição da Valva Aórtica Transcateter/tendências
18.
Prehosp Disaster Med ; 36(5): 570-575, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34256885

RESUMO

INTRODUCTION: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population. HYPOTHESIS/PROBLEM: This study examines the impact of the pandemic on prehospital care amongst pregnant women. METHODS: A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods. RESULTS: There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020). CONCLUSIONS: In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.


Assuntos
COVID-19 , Serviços Médicos de Emergência , Feminino , Humanos , Maryland/epidemiologia , Pandemias , Gravidez , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos
19.
Artigo em Inglês | MEDLINE | ID: mdl-34207818

RESUMO

Contaminants of Emerging Concern (CECs) with estrogenic or estrogenic-like activity have been increasingly detected in aquatic environments and have been an issue of global concern due to their potential negative effects on wildlife and human health. This study used the MCF-7 cell proliferation assay (E-Screen) to assess the estrogenic activity profiles in Maryland Coastal Bays (MCBs), a eutrophic system of estuaries impacted by human activities. Estrogenic activity was observed in all study sites tested. Water samples from MCBs increased MCF-7 cell proliferation above the negative control from 2.1-fold at site 8, located in Sinepuxent Bay close to the Ocean City Inlet, to 6.3-fold at site 6, located in Newport Bay. The proliferative effects of the sediment samples over the negative control ranged from 1.9-fold at the Assateague Island National Seashore site to 7.7-fold at the Public Landing site. Moreover, elevated cell proliferation (p < 0.05) was observed when cells were co-exposed with 17ß-Estradiol (E2), while reduction in cell proliferation was observed when cells were co-exposed with the antagonist ICI 182, 780 suggesting that cell proliferative effects were primarily mediated by the estrogen receptor (ER). These results suggest the occurrence of some estrogenic or hormonal-like compounds in the MCBs and are consistent with our previous findings based on vitellogenin analyses.


Assuntos
Baías , Estrogênios , Proliferação de Células , Humanos , Células MCF-7 , Maryland
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