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1.
PLoS One ; 16(12): e0260933, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34919560

RESUMO

Microbial communities are early responders to wetland degradation, and instrumental players in the reversal of this degradation. However, our understanding of soil microbial community structure and function throughout wetland development remains incomplete. We conducted a survey across cranberry farms, young retired farms, old retired farms, flooded former farms, ecologically restored former farms, and natural reference wetlands with no history of cranberry farming. We investigated the relationship between the microbial community and soil characteristics that restoration intends to maximize, such as soil organic matter, cation exchange capacity and denitrification potential. Among the five treatments considered, flooded and restored sites had the highest prokaryote and microeukaryote community similarity to natural wetlands. In contrast, young retired sites had similar communities to farms, and old retired sites failed to develop wetland microbial communities or functions. Canonical analysis of principal coordinates revealed that soil variables, in particular potassium base saturation, sodium, and denitrification potential, explained 45% of the variation in prokaryote communities and 44% of the variation in microeukaryote communities, segregating soil samples into two clouds in ordination space: farm, old retired and young retired sites on one side and restored, flooded, and natural sites on the other. Heat trees revealed possible prokaryotic (Gemmatimonadetes) and microeukaryotic (Rhizaria) indicators of wetland development, along with a drop in the dominance of Nucletmycea in restored sites, a class that includes suspected mycorrhizal symbionts of the cranberry crop. Flooded sites showed the strongest evidence of wetland development, with triple the soil organic matter accumulation, double the cation exchange capacity, and seventy times the denitrification potential compared to farms. However, given that flooding does not promote any of the watershed or habitat benefits as ecological restoration, we suggest that flooding can be used to stimulate beneficial microbial communities and soil functions during the restoration waiting period, or when restoration is not an option.


Assuntos
Recuperação e Remediação Ambiental , Inundações , Microbiologia do Solo , Solo , Vaccinium macrocarpon/crescimento & desenvolvimento , Áreas Alagadas , /análise , Massachusetts , Microbiota , Análise de Sequência de DNA
2.
Digit J Ophthalmol ; 27(3): 38-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34924881

RESUMO

Purpose: To present 2 cases of vitreoretinal surgery performed on a three-dimensional (3D) heads-up display surgical platform with real-time transfer of 3D video over a fifth-generation (5G) cellular network. Methods: An epiretinal membrane peel and tractional retinal detachment repair performed at Massachusetts Eye and Ear in April 2019 were broadcast live to the Verizon 5G Lab in Cambridge, MA. Results: Both surgeries were successful. The heads-up digital surgery platform, combined with a 5G network, allowed telesurgical transfer of high-quality 3D vitreoretinal surgery with minimal degradation. Average end-to-end latency was 250 ms, and average round-trip latency was 16 ms. Fine surgical details were observed remotely by a proctoring surgeon and trainee, with real-time communication via mobile phone. Conclusions: This pilot study represents the first successful demonstration of vitreoretinal surgery transmitted over a 5G network. Telesurgery has the potential to enhance surgical education, provide intraoperative consultation and guidance from expert proctors, and improve patient outcomes, especially in remote and low-resource areas.


Assuntos
Projetos Piloto , Humanos , Massachusetts
3.
Front Public Health ; 9: 664659, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34746071

RESUMO

Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3). Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed. Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity. Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.


Assuntos
Afro-Americanos , Saúde Materna , Feminino , Política de Saúde , Humanos , Massachusetts , Mortalidade Materna , Gravidez , Estados Unidos
4.
J Hist Dent ; 69(2): 104-113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34734791

RESUMO

Henry Jacob Bigelow (1818-1890) qualified in Medicine at Harvard and was appointed Surgeon at Massachusetts General Hospital (MGH) in 1847 and to the Chair of Surgery at Harvard Medical School in 1849. His international reputation was earned by two operations he developed, namely the treatment of hip dislocation and litholapaxy. Perhaps even more important to the practice of surgery was his role in facilitating the introduction of ether anesthesia. A dentist, William Morton (1819-1868), had used ether for the painless extraction of teeth. Through Bigelow's influence, Morton was given the opportunity to use ether for more advanced surgery at Massachusetts General Hospital. There, the leg of a patient was successfully amputated on November 7, 1846. Henry Bigelow published the first full account of ether in major surgery on November 18, 1846, while not even being in the surgical team and before his own Professor, John Collins Warren. Despite the slowness of others, he ensured that ether was used continuously in Massachusetts General Hospital, championing its use and supporting the claim of William Morton as the discoverer of anesthesia.


Assuntos
Anestesia Dentária , Anestesiologia , Anestesia Geral , Éter , História do Século XIX , Humanos , Massachusetts
6.
Adv Health Care Manag ; 202021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34779183

RESUMO

The long-term financial stability of hospital systems represents a "grand challenge" in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities - Montefiore Health System and Caritas Christi Health Care. Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt. By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals' property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain - not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.


Assuntos
Hospitais Filantrópicos , Propriedade , Eficiência , Instituições Privadas de Saúde , Humanos , Massachusetts , Estados Unidos
7.
Dyslexia ; 27(4): 510-524, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34612546

RESUMO

BACKGROUND: Dyslexia is a neurobiological condition affecting phonological processing and characterized by reading and phonological awareness difficulties. We assessed correlations between dyslexia knowledge and five independent variables among early elementary teachers in Massachusetts. METHODS: We designed a survey based on two published assessment tools and surveyed 92 early elementary teachers. Using univariate and multivariate linear regression models, we assessed the relationships among knowledge (dependent variable) and confidence, feelings of preparedness, years of teaching experience, informal education and professional development opportunities (independent variables). RESULTS: The mean knowledge score was 68 ± 14%; teachers performed best on questions about perceptions of dyslexia, classroom management/teaching strategies and some dyslexia characteristics. Informal education and years of teaching experience were consistently positively associated with knowledge. DISCUSSION AND CONCLUSIONS: Formal training and professional development opportunities may need to focus more specifically on learning disabilities and dyslexia. Teachers should also have input on professional development needs. Our findings suggest a need for additional studies on strategies to improve educator knowledge of dyslexia and assess outcomes.


Assuntos
Dislexia , Capacitação de Professores , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Massachusetts , Leitura
9.
Am J Public Health ; 111(10): 1830-1838, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529494

RESUMO

Objectives. To develop an imputation method to produce estimates for suppressed values within a shared government administrative data set to facilitate accurate data sharing and statistical and spatial analyses. Methods. We developed an imputation approach that incorporated known features of suppressed Massachusetts surveillance data from 2011 to 2017 to predict missing values more precisely. Our methods for 35 de-identified opioid prescription data sets combined modified previous or next substitution followed by mean imputation and a count adjustment to estimate suppressed values before sharing. We modeled 4 methods and compared the results to baseline mean imputation. Results. We assessed performance by comparing root mean squared error (RMSE), mean absolute error (MAE), and proportional variance between imputed and suppressed values. Our method outperformed mean imputation; we retained 46% of the suppressed value's proportional variance with better precision (22% lower RMSE and 26% lower MAE) than simple mean imputation. Conclusions. Our easy-to-implement imputation technique largely overcomes the adverse effects of low count value suppression with superior results to simple mean imputation. This novel method is generalizable to researchers sharing protected public health surveillance data. (Am J Public Health. 2021; 111(10):1830-1838. https://doi.org/10.2105/AJPH.2021.306432).


Assuntos
Algoritmos , Prescrições de Medicamentos/estatística & dados numéricos , Disseminação de Informação/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Analgésicos Opioides , Interpretação Estatística de Dados , Humanos , Massachusetts , Projetos de Pesquisa/estatística & dados numéricos
10.
Child Obes ; 17(S1): S48-S54, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34569841

RESUMO

Background: Although proven effective interventions for childhood obesity exist, there remains a substantial gap in the adoption of recommended practices by clinicians. Objective: The aims are to: (1) package implementation and training supports to facilitate the adoption of the evidence-based Healthy Weight Clinic Pediatric Weight Management Intervention (PWMI) (based on three previous effectiveness trials); (2) pilot and evaluate the packaged Healthy Weight Clinic PWMI; and (3) develop a sustainability and dissemination plan. Design/Methods: We used the Consolidated Framework of Implementation Research constructs to create an Implementation Research Logic Model that defined the facilitators and barriers of the Healthy Weight Clinic PWMI. We linked these constructs to implementation strategies and mechanisms. Packaging and design will be informed by the core essential components and functions of the PWMI along with stakeholder engagement. Once the package is complete, we will pilot the PWMI by using a Type III effectiveness-implementation hybrid design. Implementation outcomes will be evaluated by using the RE-AIM framework. Results: We will create an integrated, multisystems level package for national dissemination. The package will include training and a suite of resources for primary care physicians and healthy weight clinic staff, including: patient and caregiver facing videos, patient and caregiver handouts, group curriculum guide, online provider trainings, and access to a virtual learning collaborative. Conclusion: The results will highlight the extent to which the package of the Healthy Weight Clinic PWMI facilitates the adoption of effective strategies for treating childhood obesity. Lessons learned will inform modifications to the Healthy Weight Clinic PWMI and strategies for future scaling.


Assuntos
Terapia Nutricional , Obesidade Pediátrica , Criança , Nível de Saúde , Humanos , Massachusetts , Obesidade Pediátrica/prevenção & controle , Projetos de Pesquisa
11.
Child Obes ; 17(S1): S55-S61, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34569842

RESUMO

Background: Despite evidence that offering multidisciplinary treatment for children with obesity is effective, access to evidence-based pediatric weight management interventions (PWMIs) is limited. The Healthy Weight Clinic PWMI is a multidisciplinary approach in primary care that improves BMI among children with a BMI ≥ 85th percentile. Objective: To describe the method by which we will evaluate the adoption, acceptability, and feasibility of integrating and implementing a multidisciplinary Healthy Weight Clinic (HWC) into primary care. Design/Methods: We used the Consolidated Framework for Implementation Research (CFIR) domains and constructs to inform our implementation strategies. We will use a Type III hybrid effectiveness-implementation design to test our implementation strategies and improvement in BMI. Sources of data collection will include qualitative interviews with patient caregivers, HWC staff and surveys with HWC staff, patient caregivers, and electronic health record data. Our outcomes are guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: We identified all five CFIR domains as integral for successful implementation. Some strategies to address barriers within these domains include online self-paced training modules for the HWC staff, a virtual learning collaborative, and engagement of site leadership. Outcomes will be measured at the patient and pilot site levels, and they will include patients reached, patient health outcomes such as BMI and quality of life, level of adoption, acceptability, feasibility, and sustainability of the PWMI. Conclusion: Our use of implementation science frameworks in the planning of Healthy Weight Clinic PWMI could create a sustainable and effective program for dissemination.


Assuntos
Obesidade Pediátrica , Qualidade de Vida , Criança , Humanos , Massachusetts , Obesidade Pediátrica/prevenção & controle , Atenção Primária à Saúde , Projetos de Pesquisa
12.
Am J Public Health ; 111(10): 1851-1854, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499540

RESUMO

Objectives. To examine trends in opioid overdose deaths by race/ethnicity from 2018 to 2019 across 67 HEALing Communities Study (HCS) communities in Kentucky, New York, Massachusetts, and Ohio. Methods. We used state death certificate records to calculate opioid overdose death rates per 100 000 adult residents of the 67 HCS communities for 2018 and 2019. We used Poisson regression to calculate the ratio of 2019 to 2018 rates. We compared changes by race/ethnicity by calculating a ratio of rate ratios (RRR) for each racial/ethnic group compared with non-Hispanic White individuals. Results. Opioid overdose death rates were 38.3 and 39.5 per 100 000 for 2018 and 2019, respectively, without a significant change from 2018 to 2019 (rate ratio = 1.03; 95% confidence interval [CI] = 0.98, 1.08). We estimated a 40% increase in opioid overdose death rate for non-Hispanic Black individuals (RRR = 1.40; 95% CI = 1.22, 1.62) relative to non-Hispanic White individuals but no change among other race/ethnicities. Conclusions. Overall opioid overdose death rates have leveled off but have increased among non-Hispanic Black individuals. Public Health Implications. An antiracist public health approach is needed to address the crisis of opioid-related harms. (Am J Public Health. 2021;111(10):1851-1854. https://doi.org/10.2105/AJPH.2021.306431).


Assuntos
/estatística & dados numéricos , Geografia Médica/estatística & dados numéricos , Overdose de Opiáceos/etnologia , Overdose de Opiáceos/mortalidade , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Kentucky , Massachusetts , New York , Ohio
13.
Forensic Sci Int ; 327: 110982, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34521021

RESUMO

The questions of the frequency, distance, and maximum size of the bones that carnivores, rodents, and other common taxa can disperse have been little addressed, especially in the later phases of skeletonization when individual bones are more subject to transport and loss. The present research utilized a sample of dry white-tailed deer (Odocoileus virginianus) bones in two locations in a forested urban environment dense with eastern gray squirrels (Sciurus carolinensis), chipmunks (Tamias striatus), coyotes (Canis latrans), raccoons (Procyon lotor), and other potential scavenging taxa. Game cameras were used to document their dispersal behavior. A total of 1731 visits were recorded, by a minimum of 12 mammalian and 9 avian taxa. Small amounts of dispersal impacted the bone samples continuously throughout the observation period, with 52.2% of all movement in the range of 1-5 cm. The bones were dispersed a maximum distance of 1252 cm, and the largest bone moved had an initial mass of 194.6 g. Rodent dry-bone gnawing behavior affected 72.7% of the sample. The project also assessed a smaller sample of Tile Mate® tracking chips for their utility in dispersal research, and these were found to have a useful potential though were not pivotal in acquiring the data presented here. Forensic surface search methods and interpretations of skeletal recovery patterns should take into consideration the ability of these common species to disperse even dry bones away from their initial locations, and this behavior may continue years after the time of initial deposition.


Assuntos
Animais Selvagens , Restos Mortais , Osso e Ossos , Movimento , Animais , Massachusetts , Parques Recreativos , Gravação de Videoteipe
14.
Am J Orthopsychiatry ; 91(6): 800-811, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516147

RESUMO

Supportive school and community resources are associated with reduced risk of suicidality among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ +) adolescents as well as their cisgender, heterosexual peers. This study examined whether adolescents attending schools and living in communities with more versus fewer LGBTQ +-supportive resources were at lower risk of a past-year suicide attempt. Data on sexual orientation and past-year suicide attempt were obtained from student surveys administered in 30 Massachusetts public high schools between 2014 and 2017 (N = 20,790). Data on school resources were obtained from a questionnaire administered to school officials, and community resources were assessed through internet searching. Modified Poisson generalized estimating equations tested associations between school and community LGBTQ +-supports and suicide attempt separately by sex/gender, adjusting for student, school, and community covariates. Several school resources and the availability of community-wide LGBTQ +-supportive resources were associated with lower risk of a suicide attempt among several subgroups of students, even after controlling for the presence of multiple school and community resources and covariates. For example, the risk of a suicide attempt among gay, bisexual and questioning boys in schools with a gender-neutral restroom was approximately half compared to gay, bisexual and questioning boys in schools without this resource. Past year suicide attempts were also significantly lower among questioning, RR = 0.56, CI [0.37-0.86], and heterosexual, RR = 0.59, CI [0.50-0.68], girls living in communities with more supportive resources compared to those in communities with fewer resources. LGBTQ +-supportive resources in schools and communities may be beneficial for all adolescents regardless of sexual orientation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Minorias Sexuais e de Gênero , Tentativa de Suicídio , Adolescente , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Instituições Acadêmicas , Estudantes
15.
J Sch Health ; 91(11): 894-905, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34553384

RESUMO

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) youth experience poor physical and mental health outcomes relative to their non-LGBTQ peers. School health professionals (SHPs), such as school nurses, play a key role in addressing LGBTQ student health needs. However, few studies examine school health needs of LGBTQ students from both the youth and SHP perspective. METHODS: From August 2017 to July 2018, 28 LGBTQ youth and 19 SHPs (N = 47) in Massachusetts participated in online focus groups and a brief survey on school health needs and experiences. Qualitative themes were coded using Rapid Qualitative Inquiry principles and NVIVO. RESULTS: Both LGBTQ students and SHPs identified an urgent need for inclusive sexual education and mental health services. LGBTQ students raised access to safer bathrooms, information, and guidance on gender transitioning, and access to safe spaces as school-based needs. Missing from SHPs' perspectives, students also discussed sexual violence/harassment of transgender students and racism impacting youth of color. CONCLUSIONS: LGBTQ students, especially transgender students and LGBTQ youth of color, have unmet health needs that need to be addressed. Recognizing these needs is the first step towards inclusive health services and support for all students in schools. Next, interventions to increase the capacity of SHPs to address LGBTQ student health are necessary.


Assuntos
Instituições Acadêmicas , Minorias Sexuais e de Gênero , Adolescente , Bissexualidade , Feminino , Humanos , Massachusetts , Estudantes
16.
PLoS One ; 16(9): e0252794, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469450

RESUMO

While there has been much speculation on how the pandemic has affected work location patterns and home location choices, there is sparse evidence regarding the impacts that COVID-19 has had on amenity visits in American cities, which typically constitute over half of all urban trips. Using aggregate app-based GPS positioning data from smartphone users, this study traces the changes in amenity visits in Somerville, MA from January 2019 to December 2020, describing how visits to particular types of amenities have changed as a result of business closures during the public health emergency. Has the pandemic fundamentally shifted amenity-oriented travel behavior or is consumer behavior returning to pre-pandemic trends? To address this question, we calibrate discrete choice models that are suited to Census block-group level analysis for each of the 24 months in a two-year period, and use them to analyze how visitors' behavioral responses to various attributes of amenity clusters have shifted during different phases of the pandemic. Our findings suggest that in the first few months of the pandemic, amenity-visiting preferences significantly diverged from expected patterns. Even though overall trip volumes remained far below normal levels throughout the remainder of the year, preferences towards specific cluster attributes mostly returned to expected levels by September 2020. We also construct two scenarios to explore the implications of another shutdown and a full reopening, based on November 2020 consumer behavior. While government restrictions have played an important role in reducing visits to amenity clusters, our results imply that cautionary consumer behavior has played an important role as well, suggesting a likely long and slow path to economic recovery. By drawing on mobile phone location data and behavioral modeling, this paper offers timely insights to help decision-makers understand how this unprecedented health emergency is affecting amenity-related trips and where the greatest needs for intervention and support may exist.


Assuntos
COVID-19 , Comportamento do Consumidor/economia , Pandemias/economia , SARS-CoV-2 , Smartphone , Viagem/economia , COVID-19/economia , COVID-19/epidemiologia , Cidades , Humanos , Massachusetts/epidemiologia , Estados Unidos
18.
JAMA Intern Med ; 181(10): 1315-1321, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34369964

RESUMO

Importance: COVID-19 incidence and mortality are higher among incarcerated persons than in the general US population, but the extent to which prison crowding contributes to their COVID-19 risk is unknown. Objective: To estimate the associations between prison crowding, community COVID-19 transmission, and prison incidence rates of COVID-19. Design, Setting, and Participants: This was a longitudinal ecological study among all incarcerated persons in 14 Massachusetts state prisons between April 21, 2020, and January 11, 2021. Exposures: The primary exposure of interest was prison crowding, measured by (1) the size of the incarcerated population as a percentage of the prison's design capacity and (2) the percentage of incarcerated persons housed in single-cell units. The analysis included the weekly COVID-19 incidence in the county where each prison is located as a covariate. Main Outcomes and Measures: The primary outcome was the weekly COVID-19 incidence rate as determined by positive SARS-CoV-2 tests among incarcerated persons at each prison over discrete 1-week increments. Results: There was on average 6876 people incarcerated in 14 prisons during the study period. The median level of crowding during the observation period ranged from 25% to 155% of design capacity. COVID-19 incidence was significantly higher in prisons where the incarcerated population was a larger percentage of the prison's design capacity (incidence rate ratio [IRR] per 10-percentage-point difference, 1.14; 95% CI, 1.03-1.27). COVID-19 incidence was lower in prisons where a higher proportion of incarcerated people were housed in single-cell units (IRR for each 10-percentage-point increase in single-cell units, 0.82; 95% CI, 0.73-0.93). COVID-19 transmission in the surrounding county was consistently associated with COVID-19 incidence in prisons (IRR [for each increase of 10 cases per 100 000 person-weeks in the community], 1.06; 95% CI, 1.05-1.08). Conclusions and Relevance: This longitudinal ecological study found that within 14 Massachusetts state prisons, increased crowding was associated with increased incidence rates of COVID-19. Researchers and policy makers should explore strategies that reduce prison crowding, such as decarceration, as potential ways to mitigate COVID-19 morbidity and mortality among incarcerated persons.


Assuntos
COVID-19/epidemiologia , Aglomeração , Prisões/estatística & dados numéricos , Adulto , COVID-19/diagnóstico , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Massachusetts , Estudos Retrospectivos
19.
J Am Heart Assoc ; 10(16): e020301, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387110

RESUMO

Background Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60-89 mL/min per 1.73 m2) with cardiovascular disease (CVD) in the community. Methods and Results We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80-89, 70-79, or 60-69 versus ≥90 mL/min per 1.73 m2 [referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m2) using Cox regression. Individuals with eGFR 60-69 mL/min per 1.73 m2 (n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02-2.80) compared with the referent group. Individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m2 had higher blood growth differentiating factor-15 concentrations (ß=0.131 and 0.058 per unit-increase in log-biomarker, respectively). Participants with eGFR 60-69 and 80-89 mL/min per 1.73 m2 had higher blood B-type natriuretic peptide concentrations (ß=0.119 and 0.116, respectively). On follow-up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m2 experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02-1.93 and 1.45, 95% CI, 1.05-2.00, respectively, versus referent). Participants with eGFR 60-69 mL/min per 1.73 m2 experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80-4.78 versus referent). Conclusions Individuals with mildly reduced eGFR 60-69 mL/min per 1.73 m2 have a higher burden of subclinical atherosclerosis cross-sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.


Assuntos
Doenças Cardiovasculares/epidemiologia , Taxa de Filtração Glomerular , Nefropatias/fisiopatologia , Rim/fisiopatologia , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Progressão da Doença , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Incidência , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo
20.
Public Health Rep ; 136(6): 765-773, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34388054

RESUMO

OBJECTIVES: Widespread SARS-CoV-2 testing is critical to identify infected people and implement public health action to interrupt transmission. With SARS-CoV-2 testing supplies and laboratory capacity now widely available in the United States, understanding the spatial heterogeneity of associations between social determinants and the use of SARS-CoV-2 testing is essential to improve testing availability in populations disproportionately affected by SARS-CoV-2. METHODS: We assessed positive and negative results of SARS-CoV-2 molecular tests conducted from February 1 through June 17, 2020, from the Massachusetts Virtual Epidemiologic Network, an integrated web-based surveillance and case management system in Massachusetts. Using geographically weighted regression and Moran's I spatial autocorrelation tests, we quantified the associations between SARS-CoV-2 testing rates and 11 metrics of the Social Vulnerability Index in all 351 towns in Massachusetts. RESULTS: Median SARS-CoV-2 testing rates decreased with increasing percentages of residents with limited English proficiency (median relative risk [interquartile range] = 0.96 [0.95-0.99]), residents aged ≥65 (0.97 [0.87-0.98]), residents without health insurance (0.96 [0.95-1.04], and people residing in crowded housing conditions (0.89 [0.80-0.94]). These associations differed spatially across Massachusetts, and localized models improved the explainable variation in SARS-CoV-2 testing rates by 8% to 12%. CONCLUSION: Indicators of social vulnerability are associated with variations in SARS-CoV-2 testing rates. Accounting for the spatial heterogeneity in these associations may improve the ability to explain and address the SARS-CoV-2 pandemic at substate levels.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Fatores Etários , Teste para COVID-19 , Habitação , Humanos , Idioma , Massachusetts/epidemiologia , Pandemias , Saúde Pública , SARS-CoV-2 , Fatores Socioeconômicos , Análise Espacial
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