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1.
Emerg Infect Dis ; 27(4): 1032-1038, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33591249

RESUMO

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Indústria de Processamento de Alimentos , Controle de Infecções , Indústria de Embalagem de Carne , Adulto , /epidemiologia , /transmissão , Feminino , Indústria de Processamento de Alimentos/métodos , Indústria de Processamento de Alimentos/organização & administração , Indústria de Processamento de Alimentos/tendências , Humanos , Incidência , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Indústria de Embalagem de Carne/métodos , Indústria de Embalagem de Carne/organização & administração , Indústria de Embalagem de Carne/tendências , Saúde das Minorias/estatística & dados numéricos , Nebraska/epidemiologia , Saúde do Trabalhador/normas , Avaliação de Resultados em Cuidados de Saúde , Equipamento de Proteção Individual/normas , Medição de Risco , Local de Trabalho/normas
2.
Breastfeed Med ; 16(1): 39-45, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33372829

RESUMO

Introduction: Effective social support can have a critical influence on a mother's ability to initiate and continue breastfeeding. Coronavirus disease (COVID-19) has created unprecedented barriers for breastfeeding mothers to obtain various types of support: emotional, instrumental, informational, and appraisal. However, no research has evaluated the influence the pandemic has had on breastfeeding supports. The purpose of this study was to explore perceptions of social support among breastfeeding mothers during the COVID-19 pandemic. Materials and Methods: A cross-sectional phenomenological approach was taken utilizing semistructured interviews (March-June 2020) with currently breastfeeding mothers (n = 29). Data were analyzed through a process of immersion and crystallization. Results: Mothers are still able to obtain each type of support, however, support has been negatively influenced by the pandemic. Mothers reported experiencing increased stress and isolation and had an immense desire to receive in-person support from peers, family, childcare providers, and lactation specialists. Furthermore, mothers of multiple children felt if they did not already have breastfeeding knowledge from previous experiences they would be unsuccessful in breastfeeding due to their current lack of support. Conversely, a majority of mothers felt the pandemic had positively influenced their breastfeeding journeys due to concerns of formula shortages and extended maternity leaves. Finally, mothers were concerned about safely expressing breast milk on their return to work. Conclusion: Mother's ability to obtain breastfeeding support has been negatively impacted by the pandemic due to the inability to engage with individuals in-person and the lack of access to childcare. First-time mothers may be at higher risk of early breastfeeding cessation due to lack of support. However, breastfeeding journeys have also been positively influenced by allowing mothers more time at home with their child. Resources are needed to support expressing breast milk in the workplace during COVID-19.


Assuntos
Aleitamento Materno/psicologia , Mães/psicologia , Apoio Social , Local de Trabalho/psicologia , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Nebraska , Cuidado Pós-Natal , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto Jovem
3.
Pest Manag Sci ; 77(1): 126-130, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32954607

RESUMO

BACKGROUND: Evolution and spread of resistance to glyphosate in kochia [Bassia scoparia (L.) A.J. Scott] is a major challenge for the sustainability of glyphosate-resistant crop technology in this region. Dicamba offers a viable option to manage glyphosate-resistant kochia. However, the recent and rapid evolution of dicamba resistance in glyphosate-resistant kochia populations in Kansas (KS), and other states in the USA is a threat to the management of this weed. Our previous research suggests that two distinct mechanisms confer dicamba resistance in KS (KSUR) and NE (CSUR) kochia. CSUR kochia is dicamba-resistant due to a double mutation in an auxin and dicamba coreceptor gene (Aux/IAA16), and CSUR kochia plants show reduced dicamba translocation. However, the mechanism of dicamba resistance in KSUR is not known. The objective of this research was to determine if dicamba resistance in KSUR is due to a different mechanism and therefore evolved independently from CSUR by measuring whether the resistance traits are chromosomally linked. RESULTS: The F1 and F2 progenies from KSUR × CSUR were generated. Single dicamba rate tests were conducted using the F1 and F2 progeny. The results indicate that two different genes confer dicamba resistance in KSUR and CSUR; importantly, these two genes are not linked. CONCLUSION: This research provides evidence that different populations of kochia have independently evolved resistance to dicamba by different mechanisms, and we confirmed that the genes conferring resistance to the same herbicide in different populations are not chromosomally linked.


Assuntos
Chenopodiaceae , Herbicidas , Dicamba , Resistência a Herbicidas/genética , Herbicidas/farmacologia , Kansas , Nebraska
4.
J Emerg Manag ; 18(5): 399-409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174193

RESUMO

OBJECTIVE: The objective of this study was to explore perceptions of senior leadership in hospitals on the motivations, cost, benefits, barriers, and facilitators of investment in emergency preparedness. STUDY DESIGN: This is a qualitative study which used a grounded theory approach to develop a theory of hospital emergency preparedness. SETTING AND STUDY PARTICIPANTS: A purposive sample of hospital leaders (n = 11) in the US state of Nebraska were interviewed. RESULTS: Results showed that the environmental risk associated with the hospital location, the hospital's position in the community, and the preparedness requirements of the Centers for Medicare and Medicaid Services contribute to investment decisions. Rural hospitals face unique challenges in preparing for disasters, for example, lack of trained personnel. Facilitators of disaster preparedness include the availability of federal funds, the commitment of leadership, and an organizational mission aligned toward emergency preparedness. Hospitals invest in hazard vulnerability assessments; partnerships with other organizations in the community; staff trainings and infrastructure. CONCLUSIONS: The authors concluded that hospitals in Nebraska are committed toward investing in preparedness activities. The theory of hospital emergency preparedness developed will be used in a subsequent study to develop a decision-support framework for hospital investment in preparedness.


Assuntos
Defesa Civil , Planejamento em Desastres , Idoso , Humanos , Liderança , Medicare , Nebraska , Estados Unidos
5.
J Environ Qual ; 49(3): 745-753, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-33016408

RESUMO

Manure is commonly used as a fertilizer or soil conditioner; however, land application of untreated manure may introduce pathogens and antibiotic-resistant bacteria (ARB) into the soil, with harmful implications for public health. Composting is a manure management practice wherein a carbon-rich bulking agent, such as corn (Zea mays L.) stalk residue, is added to manure to achieve desirable carbon/nitrogen ratios to facilitate microbial activities and generate enough heat to inactivate pathogens, including antibiotic-resistant pathogens. However, when comparing compost piles and stockpiles for ARB reduction, we noticed that bulking agents added ARB to composting piles and compromised the performance of composting in reducing ARB. We hypothesized that ARB could be prevalent in corn stalk residues, a commonly used bulking agent for composting. To test this hypothesis, corn stalk residue samples throughout Nebraska were surveyed for the presence of ARB. Of the samples tested, 54% were positive for antibiotic-resistant Escherichia coli or enterococci using direct plating or after enrichment. Although not statistically significant, there was a trend wherein the use of pesticides tended to result in a greater prevalence of some ARB. Results from this study suggest that bulking agents can be a source of ARB in manure composting piles and highlight the importance of screening bulking agents for effective ARB reduction in livestock manure during composting.


Assuntos
Compostagem , Antibacterianos , Bactérias , Esterco , Nebraska , Zea mays
7.
Environ Pollut ; 265(Pt A): 115024, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32806406

RESUMO

Climate change will impact soil properties such as soil moisture, organic carbon and temperature and changes in these properties will influence the sorption, biodegradation and leaching of trace organic contaminants to groundwater. In this study, we conducted a modeling case study to evaluate atrazine and estrone transport in the subsurface under current and future climate conditions at a field site in central Nebraska. According to the modeling results, in the future, enhanced evapotranspiration and increased average air temperature may cause drier soil conditions, which consequently reduces the biodegradation of atrazine and estrone in the water phase. On the other hand, greater transpiration rates lead to greater root solute uptake which may decrease the concentration of atrazine and estrone in the soil profile. Another consequence of future climate is that the infiltration and leaching rates for both atrazine and estrone may be lower under future climate scenarios. Reduced infiltration of trace organic compounds may indicate that lower trace organic concentrations in groundwater may occur under future climate scenarios.


Assuntos
Atrazina , Agricultura , Mudança Climática , Estrona , Nebraska
8.
Prev Chronic Dis ; 17: E81, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32790607

RESUMO

The Student Response Team at the University of Nebraska Medical Center answered the statewide call to assist local health departments during the coronavirus disease 2019 (COVID-19) pandemic. As a voluntary student-led effort, the SRT assisted health departments to conduct contact tracing, monitor social media, and educate the public. Their experience demonstrates how students can increase the public health surge capacity of local health departments while gaining applied experience during public health emergencies. This call-to-action commentary proposes that SRTs should be formed, trained, and deployed through academic institutions across the nation and the globe, during and beyond the current pandemic.


Assuntos
Assistência à Saúde/organização & administração , Pandemias , Saúde Pública , Estudantes/estatística & dados numéricos , Universidades/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus , Humanos , Nebraska/epidemiologia , Pneumonia Viral , Mídias Sociais
10.
Am J Physiol Heart Circ Physiol ; 319(2): H456-H467, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706261

RESUMO

Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the leg arteries, which causes claudication. This may be in part due to vascular mitochondrial dysfunction and excessive reactive oxygen species (ROS) production. A mitochondrial-targeted antioxidant (MitoQ) has been shown to improve vascular mitochondrial function that, in turn, led to improved vascular function in older adults and animal models. However, the roles of vascular mitochondria in vascular function including endothelial function and arterial stiffness in patients with PAD are unknown; therefore, with the use of acute MitoQ intake, this study examined the roles of vascular mitochondria in endothelial function, arterial stiffness, exercise tolerance, and skeletal muscle function in patients with PAD. Eleven patients with PAD received either MitoQ or placebo in a randomized crossover design. At each visit, blood samples, brachial and popliteal artery flow-mediated dilation (FMD), peripheral and central pulse-wave velocity (PWV), blood pressure (BP), maximal walking capacity, time to claudication (COT), and oxygen utility capacity were measured pre- and-post-MitoQ and placebo. There were significant group by time interactions (P < 0.05) for brachial and popliteal FMD that both increased by Δ2.6 and Δ3.3%, respectively, and increases superoxide dismutase (Δ0.03 U/mL), maximal walking time (Δ73.8 s), maximal walking distance (Δ49.3 m), and COT (Δ44.2 s). There were no changes in resting heart rate, BP, malondialdehyde, total antioxidant capacity, PWV, or oxygen utility capacity (P > 0.05). MitoQ intake may be an effective strategy for targeting the vascular mitochondrial environment, which may be useful for restoring endothelial function, leg pain, and walking time in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that acute oral intake of mitochondrial-targeted antioxidant (MitoQ, 80 mg) is effective for improving vascular endothelial function and superoxide dismutase in patients with peripheral artery disease (PAD). Acute MitoQ intake is also effective for improving maximal walking capacity and delaying the onset of claudication in patients with PAD. These findings suggest that the acute oral intake of MitoQ-mediated improvements in vascular mitochondria play a pivotal role for improving endothelial function, the redox environment, and skeletal muscle performance in PAD.


Assuntos
Antioxidantes/uso terapêutico , Artéria Braquial/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Tolerância ao Exercício/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Claudicação Intermitente/tratamento farmacológico , Mitocôndrias/efeitos dos fármacos , Compostos Organofosforados/uso terapêutico , Doença Arterial Periférica/tratamento farmacológico , Artéria Poplítea/efeitos dos fármacos , Ubiquinona/análogos & derivados , Idoso , Antioxidantes/metabolismo , Pressão Arterial/efeitos dos fármacos , Artéria Braquial/metabolismo , Artéria Braquial/fisiopatologia , Estudos Cross-Over , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/metabolismo , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mitocôndrias/metabolismo , Contração Muscular/efeitos dos fármacos , Nebraska , Compostos Organofosforados/metabolismo , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/metabolismo , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/metabolismo , Artéria Poplítea/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Ubiquinona/metabolismo , Ubiquinona/uso terapêutico , Rigidez Vascular/efeitos dos fármacos , Caminhada
11.
Environ Monit Assess ; 192(8): 531, 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32683502

RESUMO

Aquatic invertebrates are excellent indicators of ecosystem quality; however, choosing a sampling method can be difficult. Each method and associated protocol has advantages and disadvantages, and finding the approach that minimizes biases yet fulfills management objectives is crucial. To test the effects of both sampling methods and sample handling-i.e., to composite samples or leave them as replicates-we collected aquatic invertebrates from the Niobrara River at Agate Fossil Beds National Monument, Nebraska, using three methods and two sample handling protocols. We compared aquatic invertebrate assemblages collected with a Hester-Dendy multi-plate sampler, Hess sampler, and a D-frame dipnet. We calculated six common bioassessment metrics from composite (combined) and replicate (separate) samples. Hess samples contained the highest taxonomic richness (capturing 77% of all taxa observed) and dipnet samples the least (47%). Hester-Dendy samples had the greatest proportion of Ephemeroptera, and Ephemeroptera, Plecoptera, and Trichoptera (EPT). Dipnet samples had the lowest evenness values. In terms of sample handling, composite samples had inflated richness, diversity, and evenness compared with replicate samples, but bioassessment metrics calculated from proportions or averages (i.e., Hilsenhoff's Biotic Index and the proportion of EPT taxa) did not differ between them. The proportion of invertebrate groups from composite samples were not statistically different among sampling methods, but several groups differed between replicate samples collected by different methods. Ultimately, we recommend collecting replicate samples with a Hess sampler when the goal of the study is to detect ecosystem change, among locations or differences in variables of interest.


Assuntos
Ecossistema , Rios , Animais , Benchmarking , Monitoramento Ambiental , Invertebrados , Nebraska
12.
MMWR Morb Mortal Wkly Rep ; 69(22): 666-669, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32497030

RESUMO

In August 2019, 30 attendees at a Nebraska wedding developed mumps after being exposed to one asymptomatic index patient who was fully vaccinated according to Advisory Committee on Immunization Practices (ACIP) recommendations (1), resulting in a multistate outbreak. A public health investigation and response revealed epidemiologic links that extended from the index patient through secondary, tertiary, and quaternary patients and culminated in a measles-mumps-rubella (MMR) booster vaccination campaign in the local community where approximately half of the patients resided.


Assuntos
Doenças Assintomáticas , Surtos de Doenças , Caxumba/epidemiologia , Caxumba/transmissão , Adolescente , Adulto , Criança , Feminino , Humanos , Esquemas de Imunização , Masculino , Casamento , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Pessoa de Meia-Idade , Caxumba/prevenção & controle , Nebraska/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
PLoS One ; 15(6): e0233723, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484821

RESUMO

Farmland management and irrigation scheduling are vital to a productive agricultural economy. A multistage stochastic programming model is proposed to maximize farmers' annual profit under uncertainty. The uncertainties considered include crop prices, irrigation water availability, and precipitation. During the first stage, pre-season decisions including seed type and plant density are made, while determinations of when to irrigate and how much water to be used for each irrigation are made in the later stages. The presented case study, based on a farm in Nebraska, U.S.A., showed that a 10% profit increase could be achieved by taking the corn price and irrigation water availability uncertainties into consideration using two-stage stochastic programming. An additional 13% profit increase could be achieved by taking precipitation uncertainty into consideration using multistage stochastic programming. The stochastic model outperforms the deterministic model, especially when there are limited water supplies. These results indicate that multistage stochastic programming is a promising method for farm-scale irrigation management and can increase farm profitability.


Assuntos
Irrigação Agrícola/métodos , Modelos Teóricos , Irrigação Agrícola/estatística & dados numéricos , Clima , Produção Agrícola/métodos , Produção Agrícola/estatística & dados numéricos , Nebraska , Processos Estocásticos , Incerteza , Zea mays/crescimento & desenvolvimento
14.
J Environ Manage ; 267: 110612, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32349952

RESUMO

Globally, the management of invasive plants is motivated by a desire to improve ecosystem services (e.g., recreation, flood mitigation, soil fertility for agriculture, aesthetics) and critical habitat for imperiled species. To reduce invader populations and impacts, it is important to document the social and ecological basis (i.e., the social-ecological system) for the management that has been employed and areas where a greater level of coordination among stakeholder groups (managers, scientists, legislators, resource users) could improve efforts. We present a conceptual model that builds on current thinking for how best to connect these four stakeholder groups-to foster stronger citizen lobbying for impacted resources, science-based governance, legislator-driven noxious weed laws and funding for management and science, knowledge co-production by scientists and managers, and co-management by managers and resource users. In light of our model, we present two case studies based in Nebraska and Utah, U.S.A. involving a common North American wetland invader, Phragmites australis (non-native common reed). In Nebraska, potential lawsuits stemming from water conveyance was strong motivation for funding management. In Utah, duck hunters and other resource users initially instigated management. Progress toward the successful management of Phragmites has been the result of manager-scientist partnerships addressing a knowing-doing gap among practitioners, the complexities of management mosaics, as well as overcoming economic and logistical constraints. Our model demonstrates how legislative initiatives can fund new research and bolster on-going management, while organically building strong partnerships among scientists, managers, and resource users that are key for successfully managing invasive species.


Assuntos
Ecossistema , Poaceae , Conservação dos Recursos Naturais , Espécies Introduzidas , Nebraska , Utah
15.
Artigo em Inglês | MEDLINE | ID: mdl-32340347

RESUMO

The COVID-19 pandemic caused the shutdown of entire nations all over the world. In addition to mobility restrictions of people, the World Health Organization and the Governments have prescribed maintaining an inter-personal distance of 1.5 or 2 m (about 6 feet) from each other in order to minimize the risk of contagion through the droplets that we usually disseminate around us from nose and mouth. However, recently published studies support the hypothesis of virus transmission over a distance of 2 m from an infected person. Researchers have proved the higher aerosol and surface stability of SARS-COV-2 as compared with SARS-COV-1 (with the virus remaining viable and infectious in aerosol for hours) and that airborne transmission of SARS-CoV can occur besides close-distance contacts. Indeed, there is reasonable evidence about the possibility of SARS-COV-2 airborne transmission due to its persistence into aerosol droplets in a viable and infectious form. Based on the available knowledge and epidemiological observations, it is plausible that small particles containing the virus may diffuse in indoor environments covering distances up to 10 m from the emission sources, thus representing a kind of aerosol transmission. On-field studies carried out inside Wuhan Hospitals showed the presence of SARS-COV-2 RNA in air samples collected in the hospitals and also in the surroundings, leading to the conclusion that the airborne route has to be considered an important pathway for viral diffusion. Similar findings are reported in analyses concerning air samples collected at the Nebraska University Hospital. On March 16th, we have released a Position Paper emphasizing the airborne route as a possible additional factor for interpreting the anomalous COVID-19 outbreaks in northern Italy, ranked as one of the most polluted areas in Europe and characterized by high particulate matter (PM) concentrations. The available information on the SARS-COV-2 spreading supports the hypothesis of airborne diffusion of infected droplets from person to person at a distance greater than two meters (6 feet). The inter-personal distance of 2 m can be reasonably considered as an effective protection only if everybody wears face masks in daily life activities.


Assuntos
Vírus da SARS , Aerossóis , Betacoronavirus , Infecções por Coronavirus , Europa (Continente) , Itália , Nebraska , Pandemias , Pneumonia Viral
16.
Cancer Causes Control ; 31(6): 583-599, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32314107

RESUMO

PURPOSE: The purpose of this study was to investigate associations between pesticide exposures and risk of Hodgkin lymphoma (HL) using data from the North American Pooled Project (NAPP). METHODS: Three population-based studies conducted in Kansas, Nebraska, and six Canadian provinces (HL = 507, Controls = 3886) were pooled to estimate odds ratios and 95% confidence intervals for single (never/ever) and multiple (0, 1, 2-4, ≥ 5) pesticides used, duration (years) and, for select pesticides, frequency (days/year) using adjusted logistic regression models. An age-stratified analysis (≤ 40/ > 40 years) was conducted when numbers were sufficient. RESULTS: In an analysis of 26 individual pesticides, ever use of terbufos was significantly associated with HL (OR: 2.53, 95% CI 1.04-6.17). In age-stratified analyses, associations were stronger among those ≤ 40 years of age. No significant associations were noted among those > 40 years old; however, HL cases ≤ 40 were three times more likely to report ever using dimethoate (OR: 3.76 95% CI 1.02-33.84) and almost twice as likely to have ever used malathion (OR: 1.86 95% CI 1.00-3.47). Those ≤ 40 years of age reporting use of 5 + organophosphate insecticides had triple the odds of HL (OR: 3.00 95% CI 1.28-7.03). Longer duration of use of 2,4-D, ≥ 6 vs. 0 years, was associated with elevated odds of HL (OR: 2.59 95% CI 1.34-4.97). CONCLUSION: In the NAPP, insecticide use may increase the risk of HL, but results are based on small numbers.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Doença de Hodgkin/epidemiologia , Praguicidas , Adulto , Canadá/epidemiologia , Humanos , Kansas/epidemiologia , Nebraska/epidemiologia
17.
JAMA Netw Open ; 3(4): e202727, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32282047

RESUMO

Importance: Several recent policy proposals have sought to expand the role of Medicaid in providing health insurance for low-income Americans, but there is little recent information on how physician participation in Medicaid compares with alternative forms of coverage for low-income Americans. Objective: To compare the number of office-based physicians included in Medicaid managed care and health insurance exchange plans that operate in the same geographic markets. Design, Setting, and Participants: This cross-sectional study used administrative data from physician network directories and survey data from office-based physicians for Kansas, Nebraska, New York, Tennessee, and Washington. The number of participants totaled 67 057 office-based physicians in the 5 sample states. Data were collected and analyzed from May 2018 to June 2019. Exposures: Physician participation in a Medicaid managed care or health insurance exchange plan network. Main Outcomes and Measures: The percentage of office-based physicians in a county who indicated during a phone survey that they participated in Medicaid; the percentage of office-based physicians in a county who participated in each Medicaid managed care and health insurance exchange plan network; and the percentage of office-based physicians in a county who participated in at least 1 Medicaid managed care plan or, separately, at least 1 health insurance exchange plan. Results: Of the 67 057 office-based physicians in our sample, 49 983 reported in a telephone survey that they accepted Medicaid. This survey-based measure undercounted the percentage of physicians participating in Medicaid by 5.2% (95% CI, 2.3%-8.1%; P < .001) relative to a measure based on physician network directories. Medicaid managed care physician networks covered a median (interquartile range) of 63.4% (48.0%-81.3%) of office-based physicians compared with health insurance exchange physician networks, which covered 51.0% (31.0%-70.5%). In adjusted analyses, Medicaid managed care plans covered 6.2% (95% CI, 3.2%-9.3%, P < .001) more office-based physicians than health insurance exchange plans operating in the same counties. In the states where the same insurers participated in both markets (New York, Tennessee, Washington), the Medicaid managed care physician networks were 6.5% (95% CI, 3.2%-9.8%, P < .001) larger than the health insurance exchange networks offered by the same insurer. Conclusions and Relevance: In this cross-sectional study of physician network data, Medicaid managed care physician networks included more office-based physicians than the physician networks of health insurance exchange plans operating in the same geographic markets. This suggests that Medicaid remains a viable option for expanding coverage in the United States.


Assuntos
Trocas de Seguro de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos Transversais , Humanos , Kansas , Nebraska , New York , Tennessee , Estados Unidos , Washington
18.
J Zoo Wildl Med ; 51(1): 170-176, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212560

RESUMO

Yersinia enterocolitica (YE) bioserotype 1B/O:8 (YE 1B/O:8) was identified in routine culture of a variety of zoo species housed at Omaha's Henry Doorly Zoo and Aquarium (OHDZA) from April to July 2011. Animal cases representing 12 species had YE detected from 34 cases during routine fecal monitoring and/or during postmortem examination: Coquerel's sifakas (Propithecus coquereli, two cases), black & white (BW) ruffed lemurs (Varecia variegata variegata, six cases), red ruffed lemurs (Varecia rubra, seven cases), white handed gibbon (Hylobates lar albimana, one case), black lemurs (Eulemur macaco, three cases), mongoose lemurs (Eulemur mongoz, two cases), African hunting dogs (Lycaon pictus, five cases), agile gibbons (Hylobates agilis, three cases), siamangs (Hylobates syndactylus, two cases), colobus monkey (Colobus angolensis palliates, one case), argus pheasant (Argusianus argus, one case), and orangutan (Pongo pygmaeus, one case). Most species were not symptomatic; however, three symptomatic cases in Coquerel's sifakas (two) and a white handed gibbon (one) showed clinical signs of diarrhea and lethargy that resulted in death for the Coquerel's sifakas. One unexpected death also occurred in a BW ruffed lemur. To the authors' knowledge, this is the first report of YE 1B/O:8 in such a large variety of zoo species. The source of the YE could not be identified, prompting the initiation of a diseases surveillance program to prevent further cases for the species that are sensitive to YE. To date, no additional cases have been identified, thus suggesting a single introduction of the YE 1B/O:8 strain into the zoo environment.


Assuntos
Carnívoros , Galliformes , Primatas , Yersiniose/veterinária , Yersinia enterocolitica/fisiologia , Doença Aguda/epidemiologia , Animais , Animais de Zoológico , Derrame de Bactérias , Nebraska/epidemiologia , Sorogrupo , Yersiniose/microbiologia , Yersiniose/mortalidade , Yersiniose/transmissão , Yersinia enterocolitica/genética , Yersinia enterocolitica/isolamento & purificação
19.
Environ Entomol ; 49(3): 607-614, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32159754

RESUMO

The establishment and spread of non-native species often results in negative impacts on biodiversity and ecosystem function. Several species of saltcedar, Tamarix spp. L., have been recently naturalized in large portions of the United States where they have altered plant and animal communities. To test the prediction that saltcedar negatively affects invertebrates, we measured ant genera diversity and the activity density of the exotic isopod Armadillidium vulgare Latrielle (Isopoda: Oniscoidea) for 2 yr using pitfall traps located within 30 5-m2 plots with or without saltcedar at a south-central Nebraska reservoir. From 2005 to 2006, we collected 10,837 ants representing 17 genera and 4,953 A. vulgare. Per plot, the average number of ant genera was not different between saltcedar (x̅ = 3.9) and non-saltcedar areas ( x̅ = 3.9); however, saltcedar plots were compositionally different and more similar from plot to plot (i.e., they had lower beta diversity than control plots) in 2005, but not in 2006. Isopods were likewise temporally affected with higher activity density (+89%) in control plots in 2005, but higher activity density (+27%) in saltcedar plots in 2006. The observed temporal differences occurred as the drought that initially enabled the saltcedar invasion became less severe in 2006. Combined, our results suggest that invertebrate groups like ants, which are generally omnivorous, may be better equipped than more specialized taxa like detritivores to withstand habitat changes due to invasions by non-native species, especially during extreme weather events such as prolonged droughts.


Assuntos
Formigas , Isópodes , Animais , Biodiversidade , Secas , Ecossistema , Nebraska
20.
MMWR Morb Mortal Wkly Rep ; 69(12): 335-338, 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32214081

RESUMO

Cryptosporidium is an enteric pathogen that is transmitted through animal-to-person or person-to-person contact or through ingestion of contaminated water or food. In the United States, Cryptosporidium affects an estimated 750,000 persons each year; however, only approximately 11,000 cases are reported nationally (1,2). Persons infected with Cryptosporidium typically develop symptoms within 2 to 10 days after exposure. Common symptoms include watery diarrhea, abdominal cramps, nausea, vomiting, or fever, which can last 1 to 2 weeks. Cryptosporidiosis is a nationally notifiable disease in the United States. Nebraska presents a unique setting for the evaluation of this pathogen because, compared with other states, Nebraska has a greater reliance on agriculture and a higher proportion of the population residing and working in rural communities. Cryptosporidium species and subtypes are generally indistinguishable using conventional diagnostic methods. Using molecular characterization, Nebraska evaluated the genetic diversity of Cryptosporidium and found a dichotomy in the distribution of cases of cryptosporidiosis caused by Cryptosporidium parvum and Cryptosporidium hominis among rural and urban settings. Characterizing clusters of C. hominis cases revealed that several child care facilities were affected by the same subtype, suggesting community-wide transmission and indicating a need for effective exclusion policies. Several cases of cryptosporidiosis caused by non-C. parvum or non-C. hominis species and genotypes indicated unique animal exposures that were previously unidentified. This study enhanced epidemiologic data by validating known Cryptosporidium sources, confirming outbreaks, and, through repeat interviews, providing additional information to inform cryptosporidiosis prevention and control efforts.


Assuntos
Criptosporidiose/epidemiologia , Criptosporidiose/transmissão , Cryptosporidium/classificação , Cryptosporidium/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Nebraska/epidemiologia , Fatores de Risco , Adulto Jovem
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