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1.
Subst Abus ; 43(1): 1011-1022, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435801

RESUMO

Background: Epidemiological research has indicated higher polysubstance use among individuals who misuse opioids in the United States. Polysubstance use is also associated with multiple emergency department (ED) engagements in intervention services. Less is known about polysubstance use among individuals who use opioids or were engaged in an ED setting as part of an opioid recovery intervention program. Examining emerging patterns of polysubstance use among individuals who use opioids may help shape policy and practice around developing drug markets and social norms. The objective of this study was to understand subpopulations who demonstrated distinct patterns of polysubstance use among participants in an ED Opioid Overdose Recovery Program (OORP) in New Jersey. Method: This study investigated patterns of polysubstance use among participants in a New Jersey OORP using latent class analysis (LCA; N = 1690; 70.2% male; 84.7% White non-Hispanic; meanage = 35.72 ± 11.95). Multinomial logistic regression analyses examined latent class (LC) membership based on clinically relevant indicators. Results: Five latent classes were identified (Model fit: L2 = 33.76, BIC = 4482.69, AIC = 4245.01, and the bootstrap L2 p-value =0.27; standard R2 value of 0.85). Multinomial logistic regression analyses showed that subgroups with the greatest odds of prior OORP engagement related to those participants in subgroups with heroin and polysubstance use. Conclusion: It is critical to examine the heterogeneity among people engaging in prescription opioid use and polysubstance use in the United States. This study represents an important contribution in identifying polysubstance use LC membership groups and associations with clinically relevant indicators among those engaged in an opioid recovery program. Results can be valuable in understanding the nature of the larger epidemic and how it can be addressed.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Adulto , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , New Jersey/epidemiologia , Estados Unidos , Adulto Jovem
3.
J Hosp Palliat Nurs ; 24(3): 167-174, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35486912

RESUMO

The need for hospice care is increasing in the United States, but insufficient lengths of stay and disparity in access to care continue. Few studies have examined the relationship between the presence of symptoms and hospice referral. The study measured the association between hospice referral and demographic characteristics and the presence of pain and depression in a cohort of people hospitalized with metastatic cancer in New Jersey in 2018. This study was secondary analysis of the 2018 New Jersey State Inpatient Database. The sample was limited to adult patients with metastatic cancer. Descriptive statistics evaluated the composition of the sample. Generalized linear modeling estimated the effect of pain and depression on incidence of hospice referral in a racially and economically diverse population. Absence of pain resulted in lower odds of receiving a referral to hospice upon discharge (adjusted odds ratio [AOR], 0.44; 95% confidence interval [CI], 0.40-0.49; P = .00). Likewise, an absence of depression also resulted in decreased odds of a hospice referral (AOR, 0.85; 95% CI, 0.76-0.96; P = .008). Compared with Whites, Blacks (AOR, 0.86; 95% CI, 0.76-0.97; P = .00) and Hispanics had significantly lower odds of receiving a hospice referral (AOR, 0.84; 95% CI, 0.72-0.96; P = .01). Patients with a primary language other than English, there were significantly lower odds of receiving a hospice referral (AOR, 0.85; 95% CI, 0.73-0.99; P = .03). Patients with pain and depression had increased hospice referrals. Disparities persist in hospice referral, particularly in Black and Hispanic cases and those without a primary language of English.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Neoplasias , Adulto , Cuidados Paliativos na Terminalidade da Vida/métodos , Humanos , Neoplasias/complicações , Neoplasias/terapia , New Jersey/epidemiologia , Dor , Encaminhamento e Consulta , Estados Unidos
5.
Am J Infect Control ; 50(5): 572-574, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35158011

RESUMO

Nurses play an important role in the vaccine readiness process and high vaccination rates among nurses are essential to ensuring successful vaccination programs. This study sought to examine whether the intention to get vaccinated varied by race and/or ethnicity among a large sample of registered nurses in New Jersey.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Vacinas contra COVID-19 , Estudos Transversais , Humanos , New Jersey , SARS-CoV-2 , Vacinação
6.
Eur J Cancer Care (Engl) ; 31(2): e13553, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35166393

RESUMO

OBJECTIVES: The aims were (1) to characterise preparedness for survivorship and (2) to evaluate sociodemographic, medical, survivorship care transition experiences (e.g., receiving a survivorship care plan), practical (e.g., cancer-related financial hardships and information needs) and psychological (e.g., fear of recurrence) factors with preparedness for survivorship. METHODS: Three hundred and forty-six residents of Southern New Jersey who were diagnosed in 2015 or 2016 with bladder, breast, gynaecological, colorectal, lung, melanoma, prostate or thyroid cancer were identified and consented by the New Jersey State Cancer Registry. Participants completed a questionnaire assessing preparedness, provider care transition practices, financial hardships, information needs and fear of cancer recurrence. Correlations and multivariate analyses were conducted to identify factors associated with preparedness for survivorship. RESULTS: Participants reported feeling somewhat prepared for survivorship. More than half reported not receiving a written survivorship care plan and many desired more information about follow-up tests, symptoms monitoring and maintaining good nutrition and health. Receipt of chemotherapy, limited transition care planning, limited discussion of medical and psychosocial effects, high information needs and financial hardship were predictors of low preparedness. CONCLUSION: Identifying and addressing factors associated with survivorship preparedness at end of treatment and over cancer survivorship trajectory will foster higher quality survivorship experiences.


Assuntos
Sobreviventes de Câncer , Neoplasias , Cuidado Transicional , Sobreviventes de Câncer/psicologia , Humanos , Masculino , Neoplasias/psicologia , Neoplasias/terapia , New Jersey , Sobrevivência
7.
Emerg Infect Dis ; 28(3): 625-630, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35202521

RESUMO

Incidence of Legionnaires' disease is increasing, particularly in the Mid-Atlantic states in the United States; since 2015, New Jersey has documented ≈250-350 legionellosis cases per year. We used SaTScan software to develop a semiautomated surveillance tool for prospectively detecting legionellosis clusters in New Jersey. We varied temporal window size and baseline period to evaluate optimal parameter selections. The surveillance system detected 3 community clusters of Legionnaires' disease that were subsequently investigated. Other, smaller clusters were detected, but standard epidemiologic data did not identify common sources or new cases. The semiautomated processing is straightforward and replicable in other jurisdictions, likely by persons with even basic programming skills.


Assuntos
Legionelose , Doença dos Legionários , Humanos , Incidência , Legionelose/epidemiologia , Doença dos Legionários/epidemiologia , New Jersey/epidemiologia , Estudos Prospectivos , Estados Unidos/epidemiologia
8.
BMC Public Health ; 22(1): 195, 2022 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-35093050

RESUMO

BACKGROUND: Suboptimal human papillomavirus (HPV) vaccination rates persist among adolescents in the United States (U.S.). New Jersey (NJ), among the top, most racially/ethnically diverse states in the U.S., had among the lowest HPV vaccine initiation rates, prior to 2018. This study examined parental HPV vaccine knowledge and adolescent HPV vaccine initiation among multiethnic parents in NJ, where access to language concordant HPV vaccine information and vaccination services may differ, for immigrant parents. METHODS: We surveyed parents of adolescents (ages 11-18) at community events in NJ to examine parental HPV vaccine knowledge and adolescent HPV vaccine uptake. Vaccine knowledge was assessed using an 11-item question stem that covered vaccine efficacy, gender recommendation, vaccine protection, and myths. Multivariable models assessed the association of parent nativity on HPV vaccine knowledge scores and adolescent HPV vaccine initiation, controlling for sociodemographic factors. RESULTS: Of the 77 parents, most parents (84%) were aware of the HPV vaccine. However, knowledge scores were low and differed by parent nativity. Non-U.S. born parents had significantly lower knowledge scores - 1.7 [- 3.1, - 0.4] and lower odds of adolescent children initiating the HPV vaccine 0.3 [0.1, 0.9] compared to U.S.-born parents after adjusting demographic characteristics. CONCLUSIONS: Our findings reveal that parental HPV vaccine knowledge remains low among suburban dwelling, immigrant parents, even though they have higher education and access to health care. Multilevel strategies to reduce missed opportunities for HPV vaccine education among parents and HPV vaccination for adolescents are needed, including for suburban, immigrant communities.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adolescente , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , New Jersey , Infecções por Papillomavirus/prevenção & controle , Pais/educação , Estados Unidos , Vacinação
9.
J Water Health ; 20(1): 1-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35100150

RESUMO

Over 1 million people in New Jersey (NJ) are estimated to receive drinking water from private wells. The most commonly detected contaminants in NJ private well water are naturally occurring arsenic and gross alpha (8.3 and 10.9%, respectively). Between 2015 and 2018, three free and voluntary private well testing events tested a total of 571 at-risk wells and 226 (40%) were identified as having one or more contaminants exceeding drinking water standards. Participants were invited to complete a survey to evaluate household characteristics, participant experience, and private well stewardship behavior patterns. Of 529 delivered surveys, 211 (40%) participants completed surveys. Among respondents, 63% reported plans to test their private wells in the future. Among failed wells, 45% of households reported performing mitigative action in response to the event, either through the installation of water treatment system or switching to bottled water. The survey evaluation identified previous knowledge of well contamination risks and discussing test results with a third party as important factors for promoting self-reported stewardship behavior. The evaluation provides guidance for outreach organizers to develop effective testing events and further considers the private well owners' experience of the outreach events to identify information for 'best practices' and improvements of future programs.


Assuntos
Arsênio , Poluentes Químicos da Água , Arsênio/análise , Humanos , New Jersey , Poluentes Químicos da Água/análise , Abastecimento de Água , Poços de Água
10.
PLoS One ; 17(1): e0262352, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34986205

RESUMO

INTRODUCTION: COVID-19 infection has been hypothesized to precipitate venous and arterial clotting events more frequently than other illnesses. MATERIALS AND METHODS: We demonstrate this increased risk of blood clots by comparing rates of venous and arterial clotting events in 4400 hospitalized COVID-19 patients in a large multisite clinical network in the United States examined from April through June of 2020, to patients hospitalized for non-COVID illness and influenza during the same time period and in 2019. RESULTS: We demonstrate that COVID-19 increases the risk of venous thrombosis by two-fold compared to the general inpatient population and compared to people with influenza infection. Arterial and venous thrombosis were both common occurrences among patients with COVID-19 infection. Risk factors for thrombosis included male gender, older age, and diabetes. Patients with venous or arterial thrombosis had high rates of admission to the ICU, re-admission to the hospital, and death. CONCLUSION: Given the ongoing scientific discussion about the impact of clotting on COVID-19 disease progression, these results highlight the need to further elucidate the role of anticoagulation in COVID-19 patients, particularly outside the intensive care unit setting. Additionally, concerns regarding clotting and COVID-19 vaccines highlight the importance of addressing the alarmingly high rate of clotting events during actual COVID-19 infection when weighing the risks and benefits of vaccination.


Assuntos
COVID-19/patologia , Trombose/patologia , Idoso , COVID-19/mortalidade , Estudos de Coortes , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , New Jersey , Estudos Retrospectivos , Trombose/mortalidade , Estados Unidos
11.
Antimicrob Agents Chemother ; 66(3): e0224221, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35007140

RESUMO

About 55% of U.S. Candida auris clinical cases were reported from New York and New Jersey from 2016 through 2020. Nearly all New York-New Jersey clinical isolates (99.8%) were fluconazole resistant, and 50% were amphotericin B resistant. Echinocandin resistance increased from 0% to 4% and pan-resistance increased from 0 to <1% for New York C. auris clinical isolates but not for New Jersey, highlighting the regional differences.


Assuntos
Antifúngicos , Candida , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Testes de Sensibilidade Microbiana , New Jersey/epidemiologia , New York/epidemiologia
12.
Med Care Res Rev ; 79(1): 161-170, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33213271

RESUMO

As nurse practitioners (NPs) are increasingly relied on to deliver primary care in rural communities, it is critical to understand the contexts in which they work and whether they are characterized by work environments and infrastructures that facilitate the provision of high-quality patient care. This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington. While rural and urban NPs have a number of similarities in terms of demographic characteristics, practice patterns, and job outcomes, they also have noteworthy differences. Rural NPs report higher levels of independent practice, fewer structural capabilities that facilitate quality care, and poorer relationships with physicians. Health care organizations in rural communities may need to invest in work environments and infrastructures that facilitate high-quality care and autonomous practice for NPs.


Assuntos
Profissionais de Enfermagem , Médicos , Humanos , New Jersey , Atenção Primária à Saúde , População Rural
13.
Environ Res ; 207: 112142, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-34597660

RESUMO

Airborne microplastics (MPs) could have negative impacts on human health and pollute water, soil, and sediment. This study explored the distributions, compositions, and morphology of airborne microplastics in the indoor and ambient air in New Jersey, United States. Microplastic fibers, films, and fragments of Polystyrene (PS), Polyethylene terephthalate (PET), Polyethyelene (PE), Polyvinyl chloride (PVC) and Polypropylene (PP) were identified in office, hallway, classroom, and single-family house in this study. The deposition rates of synthetic fibers with length from 35 µm to 1000 µm were highest in the single-family house ((1.96 ± 1.09) × 104 fibers/m2/day) and lowest in the classroom ((6.20 ± 0.57) × 103 fibers/m2/day), suggesting that residential houses are a major source of microplastic fibers. However, for film-like plastics with surface areas ranging from 200 µm2 to 5000 µm2, a high deposition rate of (8.13 ± 2.17) × 103 films/m2/day was observed in the classroom, whereas the lowest deposition rate of (4.45 ± 0.27) × 103 films/m2/day was found in the hallway, probably because plastic films such as PE are intensively used in the classroom environments. The deposition rate of microplastics in the ambient air acquired on a building roof was only about 2-8% of the indoor deposition rates. The microplastics with similar textures but different sizes were identified in both total atmospheric deposition and particulate samples (PM2.5 and PM10), suggesting degradation from microplastics to nanoplastics. The main microplastics found in indoor air samples were PE fragments or fibers, different from those in the outdoor ambient air that were dominated by PVC fragments. These results unravel the properties of airborne microplastics in urban environments that are important to understanding their fate, transport, and potential health risks.


Assuntos
Poluição do Ar em Ambientes Fechados , Poluentes Químicos da Água , Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental/métodos , Humanos , Microplásticos , New Jersey , Plásticos , Poluentes Químicos da Água/análise
14.
Crit Care Med ; 50(2): e154-e161, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34637417

RESUMO

OBJECTIVES: To determine the safety and efficacy of a rapidly deployed intensivist-led venovenous extracorporeal membrane oxygenation cannulation program in a preexisting extracorporeal membrane oxygenation program. DESIGN: A retrospective observational before-and-after study of 40 patients undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation in an established cannulation program by cardiothoracic surgeons versus a rapidly deployed medical intensivist cannulation program. SETTING: An adult ICU in a tertiary academic medical center in Camden, NJ. PATIENTS: Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation. INTERVENTIONS: Percutaneous cannulation for venovenous extracorporeal membrane oxygenation performed by cardiothoracic surgeons compared with cannulations performed by medical intensivists. MEASUREMENTS AND MAIN RESULTS: Venovenous extracorporeal membrane oxygenation cannulation site attempts were retrospectively reviewed. Subject demographics, specialty of physician performing cannulation, type of support, cannulation configuration, cannula size, imaging guidance, success rate, and complications were recorded and summarized. Twenty-two cannulations were performed by three cardiothoracic surgeons in 11 subjects between September 2019 and February 2020. The cannulation program rapidly transitioned to an intensivist-led and performed program in March 2020. Fifty-seven cannulations were performed by eight intensivists in 29 subjects between March 2020 and December 2020. Mean body mass index for subjects did not differ between groups (33.86 vs 35.89; p = 0.775). There was no difference in days on mechanical ventilation prior to cannulation, configuration, cannula size, or discharge condition. There was no difference in success rate of cannulation on first attempt per cannulation site (95.5 vs 96.7; p = 0.483) or major complication rate per cannulation site (4.5 vs 3.5; p = 1). CONCLUSIONS: There is no difference between success and complication rates of percutaneous venovenous extracorporeal membrane oxygenation canulation when performed by cardiothoracic surgeons versus medical intensivist in an already established extracorporeal membrane oxygenation program. A rapidly deployed cannulation program by intensivists for venovenous extracorporeal membrane oxygenation can be performed with high success and low complication rates.


Assuntos
Cateterismo/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Serviços de Saúde/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Fatores de Tempo , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Cateterismo/métodos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/provisão & distribuição , Humanos , Unidades de Terapia Intensiva/organização & administração , Medicina Interna/métodos , Medicina Interna/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New Jersey , Estudos Retrospectivos
15.
J Vasc Surg ; 75(2): 592-598.e1, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34508798

RESUMO

OBJECTIVE: Cerebral hyperperfusion syndrome (CHS) is a rare but potentially devastating complication after carotid endarterectomies (CEA). Its symptoms range from new-onset unilateral headache (HA) to intracranial hemorrhage (ICH). Risk factors for CHS in the literature to date have not yet yielded a consensus. This study examines intraoperative and postoperative blood pressure variations as potential risk factors for HA. METHODS: A single-center retrospective review at a tertiary care center from January 2010 to November 2019 was performed. Inclusion criteria were all patients undergoing CEA for symptomatic or asymptomatic carotid disease. Patients with incomplete charts were excluded. Primary endpoints were new-onset unilateral HA or postoperative ICH. Data on intraoperative and postoperative mean arterial pressure (MAP), systolic blood pressure (SBP), the mode of endarterectomy, shunt placement, and contralateral carotid status were collected. RESULTS: There were 735 patients who met the inclusion criteria: 430 patients underwent modified eversion CEA (59%) and 305 patients for patch angioplasty (42%). The incidence of HA was 19% (n = 142) in our total cohort. Of the 19% with HA, 1.5% (n = 11) demonstrated no relief with analgesics and strict blood pressure control; noncontrast head computed tomography scans were performed subsequently. One patient (0.1%) had an ipsilateral ICH. Univariate analysis demonstrated that greater intraoperative MAP peak had the highest risk for HA (odds ratio [OR], 1.014; 95% confidence interval [CI], 1.007-1.022; P = .0002), followed by intraoperative MAP variability (OR, 1.011; 95% CI,1.005-1.018; P ≤ .0008), and peak intraoperative SBP (OR, 1.01; 95% CI, 1.004-1.015; P = .0011). An unpaired Student t test identified change in intraoperative MAP (P < .005), change in the SBP (P < .005), and peak SBP (P < .001) were significantly associated with HA. Interestingly, there was no significant difference between postoperative MAP variability and HA (P = .1). The mode of endarterectomy showed no statistically significant difference in risk for developing HA (OR, 1.165; 95%; 95% CI, 0.801-1.694; P = .42). CONCLUSIONS: Greater intraoperative variability in blood pressures are significantly associated with a higher risk of HA. Adhering to stricter intraoperative blood pressure parameters and limiting blood pressure variability may be beneficial at decreasing the incidence of CHS and its complications.


Assuntos
Pressão Sanguínea/fisiologia , Endarterectomia das Carótidas/efeitos adversos , Cefaleia/etiologia , Hemorragias Intracranianas/complicações , Hemorragia Pós-Operatória/complicações , Medição de Risco/métodos , Idoso , Artérias Carótidas , Estenose das Carótidas/cirurgia , Feminino , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Humanos , Hipertensão , Incidência , Hemorragias Intracranianas/diagnóstico , Período Intraoperatório , Masculino , New Jersey/epidemiologia , Hemorragia Pós-Operatória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
16.
AIDS Behav ; 26(5): 1652-1659, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34787759

RESUMO

This study assessed the HIV prevalence among MSM in the greater Newark New Jersey area including Essex, Hudson, Morris and Union Counties and examined correlates of HIV infection among those men. By analyzing National HIV Behavioral Surveillance data on MSM from four counties in New Jersey (N = 175), which were collected via a venue-based sampling method in 2017, this study shows that HIV prevalence among all races/ethnicities (12.5-31.9%) and all age groups (15.1-47.8%) were high. Casual sex and unprotected sex with male partners were prevalent among these men, regardless of HIV test results. MSM who were tested HIV positive were more likely to have diagnosed any sexual transmitted diseases in the last 12 months (AOR: 6.7; 95% CI 2.2, 21.3) and less likely to have had alcohol use in the past 12 months (AOR: 0.3; 95% CI 0.1, 0.8). Findings from behavioral surveillance strengthens the response to the HIV epidemic by providing policy makers and care/prevention providers with peer reviewed data to base their decisions on.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , New Jersey/epidemiologia , Prevalência , Fatores de Risco , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais
17.
Nurs Res ; 71(1): 33-42, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34534185

RESUMO

BACKGROUND: Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse poststroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. OBJECTIVES: The aim of this study was to determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels. METHODS: We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7- and 30-day all-cause readmissions for Black and White ischemic stroke patients. RESULTS: Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black patients, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30- and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (less than three patients per nurse), Black and White stroke patients' disparities were no longer significant. DISCUSSION: Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/normas , Fatores Raciais , Acidente Vascular Cerebral/etnologia , Idoso , California/epidemiologia , California/etnologia , Estudos Transversais , Feminino , Florida/epidemiologia , Florida/etnologia , Hospitais/normas , Hospitais/estatística & dados numéricos , Hospitais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , New Jersey/etnologia , Readmissão do Paciente/tendências , Pennsylvania/epidemiologia , Pennsylvania/etnologia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , /estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia
19.
Cancer ; 128(1): 131-138, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34495547

RESUMO

BACKGROUND: Breast cancer (BrCa) outcomes vary by social environmental factors, but the role of built-environment factors is understudied. The authors investigated associations between environmental physical disorder-indicators of residential disrepair and disinvestment-and BrCa tumor prognostic factors (stage at diagnosis, tumor grade, triple-negative [negative for estrogen receptor, progesterone receptor, and HER2 receptor] BrCa) and survival within a large state cancer registry linkage. METHODS: Data on sociodemographic, tumor, and vital status were derived from adult women who had invasive BrCa diagnosed from 2008 to 2017 ascertained from the New Jersey State Cancer Registry. Physical disorder was assessed through virtual neighborhood audits of 23,276 locations across New Jersey, and a personalized measure for the residential address of each woman with BrCa was estimated using universal kriging. Continuous covariates were z scored (mean ± standard deviation [SD], 0 ± 1) to reduce collinearity. Logistic regression models of tumor factors and accelerated failure time models of survival time to BrCa-specific death were built to investigate associations with physical disorder adjusted for covariates (with follow-up through 2019). RESULTS: There were 3637 BrCa-specific deaths among 40,963 women with a median follow-up of 5.3 years. In adjusted models, a 1-SD increase in physical disorder was associated with higher odds of late-stage BrCa (odds ratio, 1.09; 95% confidence interval, 1.02-1.15). Physical disorder was not associated with tumor grade or triple-negative tumors. A 1-SD increase in physical disorder was associated with a 10.5% shorter survival time (95% confidence interval, 6.1%-14.6%) only among women who had early stage BrCa. CONCLUSIONS: Physical disorder is associated with worse tumor prognostic factors and survival among women who have BrCa diagnosed at an early stage.


Assuntos
Neoplasias da Mama , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Feminino , Humanos , New Jersey/epidemiologia , Prognóstico , Receptores de Estrogênio , Sistema de Registros
20.
Biol Trace Elem Res ; 200(4): 1844-1853, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34231196

RESUMO

Trace elements in aquatic environments pose a risk to biological communities; this study investigates the total concentrations of arsenic (As), silver (Ag), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), mercury (Hg), nickel (Ni), selenium (Se), lead (Pb), and zinc (Zn) within muscle, carapace, liver, and adipose tissues of diamondback terrapins and common snapping turtles in New Jersey. The effects of tissue type, sex, size, and location upon trace element accumulation were studied. The data obtained indicates that within diamondback terrapins and common snapping turtles, trace element accumulations displayed a significant difference among tissue types and sex (p < 0.005). The data indicates that Ag, Cd, Cu, and Hg can accumulate within the liver of diamondback terrapin. Se was found to accumulate in the livers of both diamondback terrapin and common snapping turtles. The highest mean concentrations of Co, Cr, Ni, and Pb were found in the carapace of both turtle species. Sex was found to have an impact on As, Hg, and Zn accumulation within different tissue types of diamondback terrapins. Diamondback terrapin males were found to have higher concentrations of As within the carapace. Diamondback terrapin females possessed higher concentrations of Hg in muscle tissues and Hg and Zn in the carapace. Turtle size and collection location land type and land cover did not display any correlation with trace element bioaccumulation for either species.


Assuntos
Mercúrio , Oligoelementos , Tartarugas , Animais , Feminino , Masculino , New Jersey , Tartarugas/fisiologia
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