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1.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
2.
N C Med J ; 81(1): 28-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908329

RESUMO

This commentary evaluates access and barriers to perinatal care in North Carolina utilizing key goals the state has identified in its strategic plans, such as expanding health care access for North Carolinians, increasing access to preconception care for women and men, improving access to prenatal care, and undoing racism.


Assuntos
Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Assistência Perinatal , Qualidade da Assistência à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , North Carolina/epidemiologia , Gravidez
3.
N C Med J ; 81(1): 55-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908337

RESUMO

Maternal mortality in North Carolina remains a challenge to families, health systems, and communities. The Maternal Mortality Review Committee is part of the process required to prevent these events. In this commentary, we present an abbreviated description of the 2014-2015 Maternal Mortality Review Committee report, set for publication in December, 2019.


Assuntos
Morte Materna/prevenção & controle , Comitês Consultivos , Feminino , Humanos , Mortalidade Materna , North Carolina/epidemiologia , Gravidez
4.
N C Med J ; 80(6): 332-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685564

RESUMO

BACKGROUND In the United States each year nearly 570,000 people return from state prisons to the community. Prevalence data of chronic health problems for this population are lacking, impeding planning of health care programs to serve people with chronic conditions who are re-entering the community.METHOD We used medication dispensing records as a proxy for diagnoses in assessing the prevalence of 10 major and 20 substituent health conditions among incarcerated people released from the North Carolina state prison system from July 2015 through June 2016.RESULTS Among 20,585 released people, 13% were female; 50% were black; 43% were white; and 4% were aged 55 years or older. Thirty-three percent had ≥ 1 condition and 13% had two or more. The prevalence of chronic health conditions was the following: psychiatric, 15%; cardiovascular, 15%; neurologic, 7%; pulmonary, 6%; diabetes mellitus, 3%; and infectious, 3%. Seventy-one percent of those aged 55 years or older had a chronic medical condition. Among those with a psychiatric condition, 56% had another chronic illness.LIMITATIONS We could not identify unmedicated health conditions; medications prescribed across multiple disease categories were excluded from our analysis.CONCLUSION In North Carolina, at least one in three people released from the state prison system had a chronic health condition, and among those with psychiatric conditions, most had comorbid medical disease. Coordination of health care after release from incarceration is essential to avoid preventable complications and unnecessary utilization of acute care services. Greater eligibility for Medicaid is needed to scale up transition programs for this population.


Assuntos
Doença Crônica/epidemiologia , Prisioneiros/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Prevalência
5.
N C Med J ; 80(6): 367-371, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685575

RESUMO

This article will describe the mental health/substance use issues of justice-involved youth, highlight the role that trauma and adverse childhood experiences (ACEs) have in the development of these issues, discuss what services are offered at the highest levels of confinement, identify the service gaps and needs for this vulnerable population, and briefly examine the anticipated effects of the upcoming North Carolina Raise the Age legislation.


Assuntos
Delinquência Juvenil/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Criança , Humanos , North Carolina/epidemiologia
6.
Am Surg ; 85(8): 904-908, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560311

RESUMO

Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina. Using ICD-9 and ICD-10 codes, patients were stratified into two cohorts, those who underwent immediate splenectomy and those who were initially managed nonoperatively. DSB was then defined as splenectomy at greater than 24 hours after presentation. Of the 1688 patients included in the study, 269 patients (16%) underwent immediate splenectomy and 1419 (84%) were managed nonoperatively initially, with 32 (2%) having delayed splenectomy. Older age (≥30 years) was associated with increased odds of having delayed splenectomy (odds ratio 4.30; 95% confidence interval 1.08, 17.17; P = 0.04). Four per cent of patients managed nonoperatively and undergoing an angioembolization procedure eventually required splenectomy. Risk factors for DSB remain elusive. Splenic artery embolization may be used as an adjuvant to splenectomy for stable patients, but it is not always a definitive treatment, and patients may still require splenectomy.


Assuntos
Embolização Terapêutica , Hemorragia/etiologia , Hemorragia/terapia , Baço/lesões , Esplenectomia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Adulto , Fatores Etários , Feminino , Hemorragia/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Sistema de Registros , Fatores de Risco , Artéria Esplênica/lesões , Centros de Traumatologia , Ferimentos não Penetrantes/mortalidade
7.
MMWR Morb Mortal Wkly Rep ; 68(36): 784-786, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513559

RESUMO

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Electronic cigarettes (e-cigarettes) produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that users inhale, a behavior commonly referred to as "vaping." E-cigarettes can also be used to deliver marijuana and other drugs. In recent months, more than 200 possible cases of acute lung injury potentially associated with vaping were reported from 25 states (1). During July and August 2019, five patients were identified at two hospitals in North Carolina with acute lung injury potentially associated with e-cigarette use. Patients were adults aged 18-35 years and all experienced several days of worsening dyspnea, nausea, vomiting, abdominal discomfort and fever. All patients demonstrated tachypnea with increased work of breathing on examination, hypoxemia (pulse oximetry <90% on room air), and bilateral lung infiltrates on chest x-ray. All five patients shared a history of recent use of marijuana oils or concentrates in e-cigarettes. All of the products used were electronic vaping pens/e-cigarettes that had refillable chambers or interchangeable cartridges with tetrahydrocannabinol (THC) vaping concentrates or oils, which were all purchased on the street. Three of the patients also used nicotine-containing e-cigarettes, and two of the patients smoked marijuana or conventional cigarettes, although none used other illicit drugs. All five patients were hospitalized for hypoxemic respiratory failure; three required intensive care for acute respiratory distress syndrome, one of whom required intubation and mechanical ventilation. All of the patients survived.


Assuntos
Surtos de Doenças , Pneumonia Lipoide/epidemiologia , Vaping/efeitos adversos , Doença Aguda , Adolescente , Adulto , Humanos , North Carolina/epidemiologia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31540055

RESUMO

Recent reports from the Netherlands document the emergence of novel multilocus sequence typing (MLST) types (e.g., ST-398) of methicillin-resistant Staphylococcus aureus (MRSA) in livestock, particularly swine. In Eastern North Carolina (NC), one of the densest pig farming areas in the United States, as many as 14% of MRSA isolates from active case finding in our medical center have no matches in a repetitive sequence-based polymerase chain reaction (rep-PCR) library. The current study was designed to determine if these non-matched MRSA (NM-MRSA) were geographically associated with exposure to pig farming in Eastern NC. While residential proximity to farm waste lagoons lacked association with NM-MRSA in a logistic regression model, a spatial cluster was identified in the county with highest pig density. Using MLST, we found a heterogeneous distribution of strain types comprising the NM-MRSA isolates from the most pig dense regions, including ST-5 and ST-398. Our study raises the warning that patients in Eastern NC harbor livestock associated MRSA strains are not easily identifiable by rep-PCR. Future MRSA studies in livestock dense areas in the U.S. should investigate further the role of pig-human interactions.


Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Fazendas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , North Carolina/epidemiologia , Infecções Estafilocócicas/epidemiologia , Suínos , Centros de Atenção Terciária , Adulto Jovem
9.
Accid Anal Prev ; 132: 105272, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454739

RESUMO

Traffic crashes are outcomes of human activities interacting with the diverse cultural, socio-economic and geographic contexts, presenting a spatial and temporal nature. This study employs an integrated spatio-temporal modeling approach to untangle the crashed injury correlates that may vary across the space and time domain. Specifically, this study employs Geographically and Temporally Weighted Ordinal Logistic Regression (GTWOLR) to examine the correlates of pedestrian injury severity in motor vehicle crashes. The method leverages the space- and time-referenced crash data and powerful computational tools. This study performed non-stationarity tests to verify whether the local correlates of pedestrian injury severity have a significant spatio-temporal variation. Results showed that some variables passed the tests, indicating they have a significantly varying spatio-temporal relationship with the pedestrian injury severity. These factors include the pedestrian age, pedestrian position, crash location, motorist age and gender, driving under the influence (DUI), motor vehicle type and crash time in a day. The spatio-temporally varying correlates of pedestrian injury severity are valuable for researchers and practitioners to localize pedestrian safety improvement solutions in North Carolina. For example, in near future, special attention may be paid to DUI crashes in the city of Charlotte and Asheville, because in such areas DUI-involved crashes are even more likely to cause severe pedestrian injuries that in other areas. More implications are discussed in the paper.


Assuntos
Acidentes de Trânsito/mortalidade , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Dirigir sob a Influência , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Regressão Espacial , Adulto Jovem
10.
Accid Anal Prev ; 131: 284-296, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351231

RESUMO

There are more than 2000 pedestrians reported to be involved in traffic crashes with vehicles in North Carolina every year. 10%-20% of them are killed or severely injured. Research studies need to be conducted in order to identify the contributing factors and develop countermeasures to improve safety for pedestrians. However, due to the heterogeneity inherent in crash data, which arises from unobservable factors that are not reported by law enforcement agencies and/or cannot be collected from state crash records, it is not easy to identify and evaluate factors that affect the injury severity of pedestrians in such crashes. By taking advantage of the latent class clustering (LCC), this research firstly applies the LCC approach to identify the latent classes and classify the crashes with different distribution characteristics of contributing factors to the pedestrian-vehicle crashes. By considering the inherent ordered nature of the traffic crash severity data, a partial proportional odds (PPO) model is then developed and utilized to explore the major factors that significantly affect the pedestrian injury severities resulting from pedestrian-vehicle crashes for each latent class previously obtained in the LCC. This study uses police reported pedestrian crash data collected from 2007 to 2014 in North Carolina, containing a variety of features of motorist, pedestrian, environmental, roadway characteristics. Parameter estimates and associated marginal effects are mainly used to interpret the models and evaluate the significance of each independent variable. Lastly, policy recommendations are made and future research directions are also given.


Assuntos
Acidentes de Trânsito/mortalidade , Ambiente Construído/estatística & dados numéricos , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/classificação , Adulto , Dirigir sob a Influência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Ferimentos e Lesões/classificação , Adulto Jovem
11.
AIDS Behav ; 23(Suppl 3): 242-250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317363

RESUMO

HIV-related stigma is prevalent in the US Deep South; however, information regarding the types of stigma and their effects on HIV-related outcomes is limited. This study examined the prevalence of different forms of stigma and the association of stigma with medication and medical visit adherence in the Deep South. Survey participants included 201 individuals living with HIV recruited from Infectious Diseases Clinics (ID) and AIDS Service Organizations (ASOs) in four Deep South states. Study participants reported high levels of experienced, perceived, and internalized stigma. Multivariable analysis revealed that internalized stigma and recent stigmatizing experiences were significantly associated with poorer HIV medication adherence. Internalized stigma was also associated with having missed an HIV medical care visit in the last 6 months. These findings suggest the need to identify and develop effective interventions to address internalized HIV-related stigma and to address community HIV stigma to improve outcomes for individuals living with HIV.


Assuntos
Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Estigma Social , Cooperação e Adesão ao Tratamento/psicologia , Adolescente , Adulto , Alabama/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Mississippi/epidemiologia , North Carolina/epidemiologia , Prevalência , Apoio Social , South Carolina/epidemiologia , Estereotipagem , Inquéritos e Questionários , Adulto Jovem
12.
N C Med J ; 80(4): 197-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31278177

RESUMO

BACKGROUND Like the rest of the nation, North Carolina is experiencing the worst drug crisis in United States history, as deaths related to medication and drug overdoses are at an all-time high. Although the absolute numbers of deaths are highest among white populations, American Indians (AIs) experience disproportionally high rates.METHOD Using death certificate data, death rates due to unintentional medication and drug overdose were calculated for various races and ethnicities. Acute hepatitis B (HBV) and acute hepatitis C (HCV) rates were also calculated across racial and ethnic groups using data from the North Carolina Electronic Disease Surveillance System.RESULTS After adjusting for population size, AIs have as high or higher overdose death rates for all types of drugs except heroin, compared to other racial and ethnic groups. During the most recent 5 years of data (2012-2016), the highest rate of acute HCV infection occurred among AIs.LIMITATIONS Race/ethnicity data recorded on death certificates is often provided by family members and is difficult to verify independently. Another potential limitation is use of small numbers to calculate rates. Additionally, HBV and HCV are thought to be underreported.CONCLUSION Overdose death rates and rates of communicable diseases associated with injection drug use among AIs residing in North Carolina are as high as or higher than the overall North Carolina population. It is important to recognize and address these differences and provide prevention, harm reduction, and treatment services to all groups being impacted by the overdose epidemic.


Assuntos
Overdose de Drogas , Hepatite , Índios Norte-Americanos , Overdose de Drogas/etnologia , Overdose de Drogas/mortalidade , Hepatite/etnologia , Hepatite/mortalidade , Heroína , Humanos , North Carolina/epidemiologia , Estados Unidos
13.
AIDS Behav ; 23(11): 2946-2955, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31332597

RESUMO

Transactional sex is associated with socioeconomic disadvantage and HIV risk but few studies in the United States (US) have examined both individual and area-level predictors of transactional sex or distinguished transactional sex from sex work. We combined data from HIV Prevention Trials Network 064 study and the US Census to estimate prevalence ratios (PR) for the relationship between census-level and individual measures of economic deprivation and housing instability on transactional sex in 417 women in North Carolina. Increased transactional sex was associated with food insecurity (PR 1.86; 95%; CI 1.57, 2.19), housing instability (PR 1.33; 95% CI 1.11, 1.59), substance abuse (PR 1.90; 95% CI 1.64, 2.19) and partner incarceration (PR 1.32; 95% CI 1.09, 1.61). Census-level indicators were not associated with transactional sex, adjusted for individual-level covariates. Interventions should support housing stability and financial opportunities among southern African American women to reduce HIV risk, particularly among women with incarcerated partners.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/prevenção & controle , Habitação , Pobreza , Trabalho Sexual , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Masculino , Análise Multinível , North Carolina/epidemiologia , Prevalência , Trabalho Sexual/estatística & dados numéricos , Parceiros Sexuais , Rede Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos
14.
South Med J ; 112(6): 331-337, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31158888

RESUMO

OBJECTIVES: Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit [neuro-ICU] bed capacity) for North Carolina overall and by region and population density. We also assessed daily trends in hospital bed availability. METHODS: This statewide descriptive study was conducted with data from the State Medical Asset Resource Tracking Tool (SMARTT), a Web-based system used by North Carolina to track available medical resources within the state. The SMARTT system was queried for stroke-specific physician and bed resources at each North Carolina hospital during a 1-year period (June 2015-May 2016), including daily availability of neuro-ICU beds. We compared hospital resources by geographic region and population density (metropolitan, urban, and rural). RESULTS: Data from 108 acute care hospitals located in 75 of 100 counties in North Carolina were included in the analysis. Fifty-seven percent of hospitals had no neurology specialty physicians. Western and eastern North Carolina had the lowest prevalence of these physicians. Most hospitals (88%) had general ICUs, whereas only 17 hospitals (16%) had neuro-ICUs. Neuro-ICUs were concentrated in metropolitan areas and in central North Carolina. On average, there were 276 general ICU and 27 neuro-ICU beds available statewide each day. Daily neuro-ICU bed availability was lowest in eastern and southeastern regions and during the week compared with weekends. CONCLUSIONS: In North Carolina, stroke-specific hospital subspecialists and resources are not distributed evenly across the state. Daily bed availability, particularly in neuro-ICUs, is lacking in rural areas and noncentral regions and appears to decrease on weekdays. Regionalization of stroke care needs to consider the geographic distribution and daily variability of hospital resources.


Assuntos
Acesso aos Serviços de Saúde , Número de Leitos em Hospital/estatística & dados numéricos , Neurologistas/provisão & distribução , Acidente Vascular Cerebral/terapia , Humanos , Unidades de Terapia Intensiva/provisão & distribução , North Carolina/epidemiologia , Acidente Vascular Cerebral/epidemiologia
15.
Cancer Causes Control ; 30(9): 967-978, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236792

RESUMO

PURPOSE: Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes. METHODS: We harmonized risk factors and prognostic characteristics from eight U.S. STUDIES: the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS). RESULTS: Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race. CONCLUSION: OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.


Assuntos
Neoplasias Ovarianas/etnologia , Neoplasias Ovarianas/epidemiologia , Adulto , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Illinois/epidemiologia , Incidência , Pessoa de Meia-Idade , North Carolina/epidemiologia , Fatores de Risco , Estados Unidos , Adulto Jovem
16.
N C Med J ; 80(3): 135-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31072939

RESUMO

BACKGROUND Medicaid "lock-in" programs (MLIPs) are a widely used strategy for addressing potential misuse of prescription drugs among beneficiary populations. However, little is known about the health care needs and attributes of beneficiaries selected into these programs. Our goal was to understand the characteristics of those eligible, enrolled, and retained in a state MLIP.METHODS Demographics, comorbidities, and health care utilization were extracted from Medicaid claims from June 2009 through June 2013. Beneficiaries enrolled in North Carolina's MLIP were compared to those who were MLIP-eligible, but not enrolled. Among enrolled beneficiaries, those completing the 12-month MLIP were compared to those who exited prior to 12 months.RESULTS Compared to beneficiaries who were eligible for, but not enrolled in the MLIP (N = 11,983), enrolled beneficiaries (N = 5,424) were more likely to have: 1) substance use (23% versus 14%) and mental health disorders, 2) obtained controlled substances from multiple pharmacies, and 3) visited more emergency departments (mean: 8.3 versus 4.2 in the year prior to enrollment). One-third (N = 1,776) of those enrolled in the MLIP exited the program prior to completion.LIMITATIONS Accurate information on unique prescribers visited by beneficiaries was unavailable. Time enrolled in Medicaid differed for beneficiaries, which may have led to underestimation of covariate prevalence.CONCLUSIONS North Carolina's MLIP appears to be successful in identifying subpopulations that may benefit from provision and coordination of services, such as substance abuse and mental health services. However, there are challenges in retaining this population for the entire MLIP duration.


Assuntos
Comorbidade , Substâncias Controladas , Medicaid , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , North Carolina/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estados Unidos
18.
Med Care ; 57(7): 498-502, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31107395

RESUMO

BACKGROUND: Few studies have evaluated the years of life lost (YLL) and productivity loss due to sudden unexpected death (SUD). The burden of SUD on society is undetermined because of lack of population-based studies and comprehensive adjudication methods. OBJECTIVE: We estimated YLL and productivity loss from SUD in working-age adults and compared it with the leading causes of death in the United States. METHODS: We screened all out of hospital deaths among people aged 20-64 in Wake County, NC from 2013 to 2015 to adjudicate SUDs. We extrapolated Wake County incidence to estimate the age-standardized and sex-standardized rate of SUD in the United States. YLL was calculated based on the remaining life expectancy of the victims. Incorporating market and housekeeping value estimated the present value of lifetime productivity loss because of SUD. RESULTS: SUD incidence rates in the US adults aged 20-64 were 49.3 (95% confidence interval, 41.2-58.3) and 21.7 (95% confidence interval, 16.5-27.8) per 100,000 among men and women, respectively. SUD resulted in the loss of 2 million years of life, accounting for 10.0% of YLL from all causes of death. Among natural causes of death, YLL from SUD was only lower than that from all cancers combined and heart disease. Lifetime productivity loss because of SUD was ~$51 billion, exceeding productivity loss from any individual cancer. CONCLUSION: SUD is an important source of YLL and productivity loss among adults aged 20-64. Such a high burden on society justifies prioritizing health policies and interventions toward preventing SUD.


Assuntos
Morte Súbita/epidemiologia , Eficiência , Expectativa de Vida/tendências , Adulto , Causas de Morte , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Vigilância da População , Estados Unidos/epidemiologia
19.
PLoS One ; 14(5): e0217244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120972

RESUMO

Understanding which tobacco products adolescents use first can lead to insights for tobacco prevention interventions and policies. We used cross-sectional data from high school students who reported ever using a tobacco product from the 2017 North Carolina Youth Tobacco Survey (n = 1,053). In multivariable regressions, we examined how demographic and psychosocial factors were associated with adolescents' first product tried and how first product tried was associated with current tobacco use (i.e., no use, use of a single product, use of multiple products) and frequency of tobacco use. Cigarettes (34.8%) and e-cigarettes (33.7%) were the most frequently reported first products tried, followed by cigars (15.6%), smokeless tobacco (10.7%), waterpipe (4.0%), and other tobacco products (i.e., pipe tobacco or some other tobacco product) (1.2%). Demographic differences in adolescents' first product tried existed, with Black adolescents having higher odds of initiating tobacco use via cigars (aOR: 6.17, 95% CI: 3.75, 10.14). Adolescents who initiated tobacco use via cigars (aOR: 2.33, 95% CI: 1.31, 4.13) or smokeless tobacco (aOR: 2.45, 95% CI: 1.18, 5.04) had higher odds of being a multiple current tobacco product user, whereas adolescents who initiated tobacco use via e-cigarettes (aOR: 0.57, 95% CI: 0.34, 0.93) had lower odds of being a multiple current tobacco product user. Additionally, adolescents who initiated tobacco use via smokeless tobacco had higher odds of currently using at least one tobacco product frequently (aOR: 1.90, 95% CI: 1.04, 3.48), while adolescents who initiated tobacco use via e-cigarettes had lower odds of currently using at least one tobacco product frequently (aOR: 0.40, 95% CI: 0.23, 0.70). These findings suggest that most adolescents reported initiating tobacco use via cigarettes or e-cigarettes and that trying certain products first (e.g., cigars, smokeless tobacco) was associated with higher odds of multiple current tobacco product use.


Assuntos
Fumar/epidemiologia , Produtos do Tabaco , Uso de Tabaco/epidemiologia , Adolescente , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , North Carolina/epidemiologia , Razão de Chances , Psicologia do Adolescente , Fumar/psicologia , Prevenção do Hábito de Fumar/estatística & dados numéricos , Estudantes/psicologia , Inquéritos e Questionários , Produtos do Tabaco/estatística & dados numéricos , Uso de Tabaco/prevenção & controle , Uso de Tabaco/psicologia , Tabaco para Cachimbos de Água/estatística & dados numéricos
20.
Poult Sci ; 98(10): 5023-5027, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31028700

RESUMO

Human illness caused by the consumption of eggs contaminated with Salmonella Enteritidis is a continuing international public health concern. This pathogen is deposited inside the edible contents of eggs as a consequence of its ability to colonize reproductive tissues in infected hens. Conditions in the housing environment can influence the persistence and transmission of avian Salmonella infections, but the food safety ramifications of different poultry management systems are not entirely clear. The present study assessed the deposition of S. Enteritidis inside eggs laid by groups of experimentally infected laying hens of 4 commercial genetic lines (designated as white egg lines W1 and W2 and brown egg lines B1 and B2). Groups of hens from each line were housed at 555 cm2 of floor space per bird in both conventional cages and colony units enriched with access to perches and nesting areas. All hens were orally inoculated with 5.75 × 107 cfu of a 2-strain S. Enteritidis mixture, and the internal contents of eggs laid 5 to 24 D post-inoculation were cultured to detect the pathogen. No significant differences in egg contamination frequencies were found between the 2 housing systems for any of the hen lines. Contaminated eggs were laid between 7 and 21 D post-inoculation at an overall frequency of 2.47%, ranging from 0.25 to 4.38% for the 4 hen lines. The frequency of S. Enteritidis recovery from egg samples was significantly (P < 0.05) lower for line B2 than for any of the other lines, and the egg contamination frequency for line W1 was significantly greater than for line W2. The overall incidence of contamination among white eggs (3.38%) was significantly higher than among brown eggs (1.56%). These results demonstrate that S. Enteritidis deposition inside eggs can vary between genetic lines of infected laying hens, but housing these hens in 2 different systems did not affect the production of contaminated eggs.


Assuntos
Galinhas , Óvulo/microbiologia , Doenças das Aves Domésticas/epidemiologia , Salmonelose Animal/epidemiologia , Salmonella enteritidis/fisiologia , Criação de Animais Domésticos , Animais , Galinhas/genética , Cor , Feminino , Abrigo para Animais , Incidência , North Carolina/epidemiologia , Óvulo/fisiologia , Pigmentação , Doenças das Aves Domésticas/microbiologia , Salmonelose Animal/microbiologia
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