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1.
Addict Behav ; 124: 107116, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34562776

RESUMO

This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of "supportive" social contacts and "risky" social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.


Assuntos
Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Nebraska/epidemiologia , Meio Social , Rede Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
2.
J Genet Couns ; 30(5): 1233-1243, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34617357

RESUMO

The COVID-19 pandemic has altered the delivery of genetics services. In response to the pandemic, our genetics department offered telehealth visits to all outpatients, regardless of their physical proximity to Omaha, Nebraska. Traditionally, our department did not offer telehealth visits to patient's homes or to patients who lived in close proximity to a genetics clinic. Therefore, we designed a survey to gain insight into the patient experience with remote genetic counseling appointments during the pandemic. Any patient referred to see a genetics provider in pediatrics, prenatal, adult, or cancer between March 16, 2020 and October 28, 2020 was eligible for the study. The survey included both quantitative and qualitative measures to assess patient demographics, patient experience, stressors during the COVID-19 pandemic, and anxiety and depression. We hypothesized that patients would report they received quality care by telehealth despite the presence of COVID-19-related stressors or anxiety/depression. From the 143 survey participants, 80% had their first telehealth appointment during the pandemic. The vast majority (96%) reported that they felt like they received quality care by telehealth. Additionally, more than 93% of participants strongly or somewhat agreed that their genetic providers were attentive to their emotional needs, medical needs, and privacy. Since March 2020, participants reported experiencing several COVID-19-related stressors including fear of illness (86%), feelings of isolation (45%), and safety concerns (33%). Relatively low levels of depressive and anxiety symptoms were recorded using the HADS questionnaire. Despite the prevalence of COVID-19 stressors, depression, and/or anxiety, our participants felt they received quality care via telehealth. In fact, 51% agree that they prefer to receive future genetics services virtually. These results suggest the value of telehealth as an alternative service delivery model, even for local patients, and should be offered for future appointments, beyond the COVID-19 pandemic.


Assuntos
COVID-19 , Telemedicina , Adulto , Criança , Feminino , Aconselhamento Genético , Humanos , Nebraska/epidemiologia , Pandemias , Avaliação de Resultados da Assistência ao Paciente , Gravidez , SARS-CoV-2
3.
Child Obes ; 17(S1): S62-S69, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34569846

RESUMO

Pediatric weight management interventions (PWMIs) have resulted in positive changes among family members and, if widely disseminated, could have an impact on pediatric weight management in rural communities. The purpose of this article is to describe a backward design approach taken to create an online packaged program and implementation blueprint for building healthy families (BHF), an effective PWMI for implementation in rural communities. The backward design process included the identification of end users: primary (facilitators to be trained through the packaged program and implementation blueprint), secondary (researchers and evaluators), terminal (caregivers and children impacted by PWMI participation), tertiary (community support organizations, funding agency promoting widespread PWMI, and payors), as well as, key outcomes for respective end user groups based on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. This process resulted in the BHF Online Training Resources and Program package and implementation blueprint that included a modular approach encompassing the interplay of training modules for program facilitators, knowledge checks to ensure mastery of program components, recruitment resources for school and clinical settings, all program materials, embedded fidelity assessments for quality assurance, and a data portal to track participant success. Next steps include preliminary product testing with potential facilitators and a type 3 effectiveness implementation trial to determine the utility of the BHF Online Training Resources and Program package with and without participation in a learning collaborative to support implementation and sustainability.


Assuntos
Obesidade Pediátrica , População Rural , Criança , Família , Humanos , Nebraska/epidemiologia , Obesidade Pediátrica/prevenção & controle , Avaliação de Programas e Projetos de Saúde
4.
Am J Drug Alcohol Abuse ; 47(4): 433-443, 2021 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-34114916

RESUMO

Background: Bisexual and mostly heterosexual women report higher substance use than exclusively heterosexual or lesbian women. In sexual minority men, sex-linked substance use (SLSU) can increase risk for substance use problems; equivalent research in women is lacking.Objectives: To test if sexual excitation and inhibition mediate the association between sexual minority status and women's SLSU.Methods: We surveyed a convenience sample of 595 undergraduate women who identified as exclusively heterosexual (n = 499), mostly heterosexual (n = 59), or bisexual (n = 37). Participants reported on their last month use of alcohol, cannabis, and other drugs (e.g., cocaine) in sexual and non-sexual contexts, and symptoms of alcohol and non-alcohol drug use disorders (e.g., withdrawal symptoms). Drug use symptoms were collapsed across non-alcohol substances. We used structural equation modeling to test serial mediations of women's SLSU and overall drug and alcohol use.Results: Bisexual and mostly heterosexual women reported higher cannabis use (η2 = 0.030) and drug use disorder symptoms (η2 = 0.050) than heterosexual women. Mostly heterosexual women's SLSU was a stronger predictor of alcohol use (η2 = 0.019) and binge drinking frequency (η2 = 0.015) than for other orientation groups. Bisexual and mostly heterosexual women's higher sexual excitation predicted their higher SLSU, which in turn predicted higher cannabis use frequency and drug use disorder symptoms. However, sexual inhibition failed to mediate either SLSU or overall substance use.Conclusion: These findings point to SLSU as a mechanism by which sexual minority women may experience disparities in substance use related harms.


Assuntos
Bissexualidade/efeitos dos fármacos , Heterossexualidade/efeitos dos fármacos , Excitação Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Uso da Maconha/epidemiologia , Nebraska/epidemiologia , Minorias Sexuais e de Gênero , Inquéritos e Questionários , Adulto Jovem
5.
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
COVID-19 , Transmissão de Doença Infecciosa/prevenção & controle , Indústria de Processamento de Alimentos , Controle de Infecções , Indústria de Embalagem de Carne , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/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 , SARS-CoV-2/isolamento & purificação , Local de Trabalho/normas
6.
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
Atenção à Saúde/organização & administração , Pandemias , Saúde Pública , Estudantes/estatística & dados numéricos , Universidades/estatística & dados numéricos , Betacoronavirus , COVID-19 , Infecções por Coronavirus , Humanos , Nebraska/epidemiologia , Pneumonia Viral , SARS-CoV-2 , Mídias Sociais
8.
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
9.
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
10.
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
11.
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
12.
BMC Vet Res ; 16(1): 70, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087722

RESUMO

BACKGROUND: In a beef cattle facility an outbreak of abortions occurred over a 36-day period and included samples from two aborted (non-viable) fetuses and 21 post-abortion clinical cases. There are numerous etiologies, including clinical listeriosis. At the species level, Listeria monocytogenes is ubiquitous in cattle production environments, including soil, feed, and occasionally water sources, and is a common enteric resident of cattle and other mammals. There are four genetically distinct lineages of L. monocytogenes (I-IV), with most lineage III and IV isolates obtained from ruminants. Definitive diagnosis of L. monocytogenes as a causative agent in disease outbreaks relies upon case identification, appropriate sample collection, and laboratory confirmation. Furthermore, clearly establishing a relationship between a pathogen source and clinical disease is difficult. RESULTS: Of the two fetal and 21 clinical case submissions, 19 were positive for L. monocytogenes. Subsequent culture for L. monocytogenes from water and silage sources identified both as potential origins of infection. Using whole-genome sequencing and phylogenetic analyses, clinical, water and silage L. monocytogenes strains grouped into two of four lineages. All water and silage strains, plus 11 clinical strains placed in lineage III, with identical or nearly identical genomic sequences. The remaining eight clinical strains placed in lineage I, with seven having nearly identical sequences and one distinctly different. CONCLUSION: Three genetically distinct strains within two lineages of L. monocytogenes caused the abortion outbreak. The etiology of abortion in 11 cases was directly linked to water and silage contamination from a lineage III L. monocytogenes strain. The source of infection for the remaining abortion cases with two different strains from lineage I is unknown. This is the first report of L. monocytogenes genomics being used as part of an outbreak investigation of cattle abortion.


Assuntos
Aborto Animal/microbiologia , Listeria monocytogenes/classificação , Listeria monocytogenes/isolamento & purificação , Listeriose/veterinária , Aborto Animal/epidemiologia , Animais , Bovinos , Surtos de Doenças/veterinária , Feminino , Genoma Bacteriano , Listeria monocytogenes/genética , Listeriose/epidemiologia , Nebraska/epidemiologia , Gravidez , Silagem/microbiologia , Microbiologia da Água , Sequenciamento Completo do Genoma
13.
J Agromedicine ; 25(3): 319-329, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31941431

RESUMO

Objectives: Migrant farmworkers face many hardships in both their working and living environments including dangerous and demanding tasks, long hours, and inadequate rest. This study sought to explore gender differences in the reporting of fatigue and pain and to identify predictors of fatigue and pain among migrant farmworkers in Nebraska (n = 241). Methods: Bivariate tests were used to assess associations among study variables. Linear and generalized linear mixed effect models were used to assess gender as a predictor of fatigue and pain respectively while controlling for covariates. Results: Females reported significantly higher levels of fatigue (M score = 15.5, SD = 6.1 compared to M score = 12.8, SD = 4.3) than their male counterparts. Females were also more likely to report pain (56.9% of females compared to 36.3% of males). Being female, pain, hours of sleep, and job demands were significant predictors of fatigue. Fatigue and job-related injury were the only significant predictors of pain. Conclusions: There are gender-related disparities in the reporting of fatigue and pain among Latino/a migrant farmworkers. Extra precautions need to be taken to protect worker health and safety and reduce fatigue, particularly for female workers. Implications for employers, supervisors, and healthcare providers are discussed.


Assuntos
Doenças dos Trabalhadores Agrícolas/epidemiologia , Fazendeiros/estatística & dados numéricos , Fadiga/epidemiologia , Dor/epidemiologia , Migrantes/estatística & dados numéricos , Adulto , Doenças dos Trabalhadores Agrícolas/etnologia , Estudos Transversais , Fadiga/etnologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nebraska/epidemiologia , Dor/etnologia , Fatores Sexuais , Adulto Jovem
14.
Laryngoscope ; 130(3): 567-574, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31050824

RESUMO

OBJECTIVES/HYPOTHESIS: To evaluate the trend and factors associated with surgical management of orbital cellulitis. STUDY DESIGN: Retrospective database study. METHODS: Study using the State Inpatient Databases (SIDs) from 2008 to 2015. Patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for orbital cellulitis were identified in the SIDs for the following states: Arkansas, Florida, Iowa, Maryland, Nebraska, New York, and Wisconsin. Surgery was defined as an ICD-9-CM procedure code for orbitotomy and/or functional endoscopic sinus surgery. The trend of surgery over time was evaluated using the Cochran-Armitage test. Multivariable logistic regression models were used to identify patient- and hospital-level factors associated with surgery. RESULTS: From 2008 to 2013, the number of hospitalizations for orbital cellulitis ranged from 1,349 to 1,574, but declined to 865 in 2014. From 2008 to 2015, the number of surgeries ranged from 103 to 154. For children (n = 3,041), age, ophthalmologic comorbidity, and conjunctival edema were significantly associated with surgery, whereas for adults (n = 7,961), male gender, private insurance, optic neuritis, and cranial nerves III/VI/VI palsy were associated with surgery. CONCLUSIONS: Although the number of inpatient hospitalizations for orbital cellulitis has markedly declined, the number of surgeries for orbital cellulitis has remained fairly stable, leading to an observed higher proportion of hospitalized patients undergoing surgery. Future directions include extending the time frame to the present day to assess current rates of hospitalization and surgery. Knowledge of surgical trends and patient- and hospital-level characteristics associated with surgery may help improve management guidelines for and understanding of this vision-threatening disease. LEVEL OF EVIDENCE: NA Laryngoscope, 130:567-574, 2020.


Assuntos
Procedimentos Cirúrgicos Oftalmológicos/tendências , Celulite Orbitária/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arkansas/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Florida/epidemiologia , Hospitalização/tendências , Humanos , Lactente , Pacientes Internados/estatística & dados numéricos , Iowa/epidemiologia , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Nebraska/epidemiologia , New York/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Wisconsin/epidemiologia , Adulto Jovem
15.
Int J Artif Organs ; 43(2): 109-118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530254

RESUMO

In selected patients with left ventricular assist device-associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Infecções Relacionadas à Prótese , Reoperação/estatística & dados numéricos , Trombose , Análise de Falha de Equipamento/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Coração Auxiliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nebraska/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Recidiva , Estudos Retrospectivos , Trombose/diagnóstico , Trombose/epidemiologia , Trombose/etiologia
16.
Prev Chronic Dis ; 16: E100, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370918

RESUMO

INTRODUCTION: Effective collaboration between public health and the health care system is essential for connecting medical and community health-related resources and improving population health. We investigated the linkages between local health departments and primary care clinics in Nebraska. METHODS: We conducted a mixed-method study by using semistructured in-person and telephone interviews and surveys in 2017 and 2018 with directors of 19 Nebraska local health departments. Interviews and surveys assessed activities and programs that health departments implemented or planned with clinics in their jurisdictions. Barriers, benefits, and opportunities for building the linkages were identified. RESULTS: Strong linkages existed between local health departments and primary care clinics. Linkages focused on the control and prevention of chronic diseases and on traditional public health programs, including screening for cancer and other chronic diseases, vaccinations, worksite wellness programs, home visits, clinic and medication assistance referrals, health message development, electronic health records data analyses, staff education, and improvements in policies and procedures. The most frequently reported barrier was funding, and the most frequently reported benefit was patient behavior change. The opportunity most frequently reported was chronic disease health coaching. CONCLUSION: Extensive linkages exist between Nebraska local health departments and the health care systems in their areas. Additional funding, effective workforce management, community needs assessments, and program evaluation can support joint initiatives to address community health priorities.


Assuntos
Doença Crônica , Atenção à Saúde , Promoção da Saúde , Administração em Saúde Pública/métodos , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Colaboração Intersetorial , Nebraska/epidemiologia , Determinação de Necessidades de Cuidados de Saúde
17.
J Pediatr Ophthalmol Strabismus ; 56(4): 261-264, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322718

RESUMO

PURPOSE: To determine whether there are common factors that may help predict if a child is at a higher risk for surgical failure for nasolacrimal duct obstruction. METHODS: This retrospective, observational case-control clinical study reviewed patient factors present prior to surgical intervention and their correlation with the necessity of multiple surgeries. A pediatric ophthalmologist identified patients who required surgical correction based on symptom history refractory to conservative management. Patients were grouped by the need for multiple surgical interventions versus single surgery. Patient factors hypothesized to predispose patients to an unsuccessful initial procedure were compared via odds ratio analysis. Patient success was based on symptom resolution 6 months postoperatively. RESULTS: Patient factors with statistically significant increased odds ratios were trisomy 21, allergic rhinitis/seasonal allergies, history of an upper respiratory tract infection within 1 month, and obstructive sleep apnea. CONCLUSIONS: This study suggests that patients with trisomy 21 or a history of recent upper respiratory tract infection may be correlated with a higher risk of failure with a probing and irrigation surgery only. Patients with trisomy 21 may benefit from an initial balloon dilation procedure rather than probing and irrigation, due to an increased risk profile. Patients with a recent upper respiratory tract infection may benefit from postponing surgery until symptom treatment or resolution. [J Pediatr Ophthalmol Strabismus. 2019;56(4):261-264.].


Assuntos
Dacriocistorinostomia/efeitos adversos , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Incidência , Masculino , Nebraska/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
MMWR Morb Mortal Wkly Rep ; 68(28): 627-630, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31318854

RESUMO

In October 2017, the Nebraska Department of Health and Human Services (NDHHS) was notified by a local health department of a gastrointestinal illness outbreak among attendees of a wedding reception at facility A, an event center. Shortly thereafter, state and local public health officials began receiving reports of similar gastrointestinal illness among attendees of subsequent facility A events. An investigation was initiated to identify cases, establish the cause, assess possible transmission routes, and provide control recommendations. Overall, 159 cases consistent with norovirus infection (three confirmed and 156 probable) were identified among employees of facility A and attendees of nine facility A events during October 27-November 18, 2017. The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work <24 hours after symptom resolution, suggesting that a combination of contaminated environmental surfaces and infected food handlers likely sustained the outbreak. Recommendations regarding sanitation and excluding ill employees were communicated to facility A management. However, facility A performed minimal environmental cleaning and did not exclude ill employees. Consequently, transmission continued. To prevent persistent norovirus outbreaks in similar settings, public health officials should ensure that involved facilities implement a comprehensive prevention strategy as early as possible that includes extensive sanitation and strict exclusion of ill food handlers for at least 48 hours after symptom resolution (1).


Assuntos
Infecções por Caliciviridae/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Logradouros Públicos , Infecções por Caliciviridae/prevenção & controle , Surtos de Doenças/prevenção & controle , Fezes/virologia , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Gastroenterite/virologia , Genótipo , Humanos , Nebraska/epidemiologia , Norovirus/genética , Norovirus/isolamento & purificação , Prática de Saúde Pública
19.
J Obes ; 2019: 7932750, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944736

RESUMO

Objective: Purely web-based weight loss and weight-loss maintenance interventions show promise to influence behavior change. Yet, little is known about user engagement with features of web-based interventions that predict clinically meaningful weight loss (≥5% bodyweight loss). This study examines level of website feature engagement with the likelihood of attaining ≥5% bodyweight loss after 6 and 18 months participation in a web-based intervention, among rural women at high risk of obesity-related diseases and disability. Methods: In this secondary analysis of clinical trial data of 201 rural women, we examined weight change and user engagement, measured as clicks on specific web-based intervention features (messaging and self-tracking), as associated with clinically meaningful weight loss (baseline to 6 months) and weight-loss maintenance (6 to 18 months). Results: Generalized estimating equations, adjusted for age, intervention group, and intervention phase, revealed high engagement with messaging predicted whether women achieved ≥5% weight loss at 6 months and at 18 months. There was no effect of self-tracking. Conclusions: Being engaged with messages was associated with attaining clinically meaningful short-term and longer-term weight loss. This trial is registered with NCT01307644.


Assuntos
Promoção da Saúde/métodos , Internet , Sobrepeso/prevenção & controle , População Rural , Telemedicina , Programas de Redução de Peso , Adulto , Manutenção do Peso Corporal , Dieta Redutora , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Nebraska/epidemiologia , Sobrepeso/terapia , Cooperação do Paciente , Autocuidado , Autorrelato , Grupos de Autoajuda , Apoio Social , Perda de Peso , Programas de Redução de Peso/métodos
20.
MMWR Morb Mortal Wkly Rep ; 68(7): 169-173, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789878

RESUMO

In March 2017, the Nebraska Department of Health and Human Services (NDHHS) and the Southwest Nebraska Public Health Department were notified of an apparent cluster of Campylobacter jejuni infections in city A and initiated an investigation. Overall, 39 cases were investigated, including six confirmed and 33 probable. Untreated, unboiled city A tap water (i.e., well water) was the only exposure significantly associated with illness (odds ratio [OR] = 7.84; 95% confidence interval [CI] = 1.69-36.36). City A is served by four untreated wells and an interconnected distribution system. Onsite investigations identified that a center pivot irrigation system intended to pump livestock wastewater from a nearby concentrated animal feeding operation onto adjacent farmland had malfunctioned, allowing excessive runoff to collect in a road ditch near two wells that supplied water to the city. These wells were promptly removed from service, after which no subsequent cases occurred. This coordinated response rapidly identified an important risk to city A's municipal water supply and provided the evidence needed to decommission the affected wells, with plans to build a new well to safely serve this community.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter jejuni/isolamento & purificação , Surtos de Doenças , Microbiologia da Água , Abastecimento de Água , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Campylobacter/prevenção & controle , Criança , Pré-Escolar , Cidades , Análise por Conglomerados , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nebraska/epidemiologia , Adulto Jovem
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