Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 15.436
Filtrar
1.
BMC Health Serv Res ; 22(1): 4, 2022 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-34974826

RESUMO

BACKGROUND: Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations. METHODS: Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings. RESULTS: By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis. CONCLUSION: While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone.


Assuntos
Mortalidade Infantil , Medicaid , Humanos , Lactente , Ohio , Organizações , Estados Unidos
2.
BMJ Open ; 12(1): e055490, 2022 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996797

RESUMO

PURPOSE: Obesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings. PARTICIPANTS: Between December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months. FINDINGS TO DATE: Children in the cohort are diverse relative to gestational age at birth (16%, 28-31 completed weeks' gestation; 21%, 32-36 weeks' gestation; 63%, ≥37 weeks' gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child's biological mother (93%) and are diverse in age (range 18-54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%,

Assuntos
COVID-19 , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Obesidade , Ohio , SARS-CoV-2 , Adulto Jovem
3.
Health Commun ; 37(1): 125-126, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32981335

RESUMO

In this essay, the author offers a poem constructed in a COVID-19 themed narrative medicine seminar at the Ohio University Heritage College of Osteopathic Medicine. The poem is situated within reflections about what came into focus during a global pandemic and its accomplices of social unrest. The author concludes by emphasizing the importance of self-care in broader efforts toward healing and social justice.


Assuntos
COVID-19 , Medicina Osteopática , Humanos , Ohio , SARS-CoV-2
4.
Trials ; 22(1): 948, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930410

RESUMO

BACKGROUND: Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD. METHODS: We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and barriers. We estimated prevalence ratios to assess for gender, preferred drug use, and geographic differences using log-binomial models. RESULTS: Most participants were male (55%) and preferred methamphetamine (36%) over heroin (35%). Participants reported confidentiality, amount of financial compensation, and time required as primary influential factors for research participation. Primary motivations for participation include financial compensation, free HIV/HCV testing, and contribution to research. Changed or false participant contact information and transportation are principal barriers to retention. Respondents who prefer methamphetamines over heroin reported being influenced by the purpose and use of their information (PR = 1.12; 95% CI: 1.00, 1.26). Females and Oregonians (versus Appalachians) reported knowing and wanting to help the research team as participation motivation (PR = 1.57; 95% CI: 1.09, 2.26 and PR = 2.12; 95% CI: 1.51, 2.99). CONCLUSIONS: Beyond financial compensation, researchers should emphasize confidentiality, offer testing and linkage with care, use several contact methods, aid transportation, and accommodate demographic differences to improve research participation and retention among rural PWUD.


Assuntos
Motivação , Preparações Farmacêuticas , Estudos Transversais , Humanos , Kentucky/epidemiologia , Masculino , Ohio
5.
J Dent Child (Chic) ; 88(3): 164-172, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34937626

RESUMO

Purpose: This cross-sectional study evaluated knowledge, practices, and beliefs of Ohio dentists treating school-aged children regarding school absenteeism in relation to compliance with dental appointments.
Methods: A 26-item questionnaire was distributed to 7,274 dentists licensed in the state of Ohio in 2019. Eligible participants were pediatric dentists (PDs) and general dentists (GDs) who treated individuals younger than 16 years of age.
Results: A return rate of 13.5 percent (958 total participants) provided a sample consisting of approximately 90 percent of GDs, a mean age of 48.5 years and primarily practicing in suburban locations. Respondents felt parental attitudes had changed over the past five years, with a significantly higher proportion of PDs reporting increased parental concerns about school absences than GDs (59.5 percent versus 31.5 percent; P <0.001). Length of excused absence increased with treatment complexity. PDs were more likely to permit longer absences than GDs and to allow parents to decide the length of absence, particularly for children with special health care needs. PDs were 6.6 times more likely to report that concerns about school absences often negatively affected oral health (P <0.001).
Conclusion: Dentists acknowledged that school absences and school policy affected parental choices regarding dental visits, with PDs consistently stating a greater effect than GDs.


Assuntos
Absenteísmo , Padrões de Prática Odontológica , Atitude do Pessoal de Saúde , Criança , Estudos Transversais , Assistência Odontológica , Odontólogos , Humanos , Pessoa de Meia-Idade , Ohio , Odontopediatria , Instituições Acadêmicas
6.
JAMA Netw Open ; 4(11): e2134241, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34757409

RESUMO

Importance: The influence of sleep-disordered breathing (SDB) and sleep-related hypoxemia in SARS-CoV-2 viral infection and COVID-19 outcomes remains unknown. Controversy exists regarding whether to continue treatment for SDB with positive airway pressure given concern for aerosolization with limited data to inform professional society recommendations. Objective: To investigate the association of SDB (identified via polysomnogram) and sleep-related hypoxia with (1) SARS-CoV-2 positivity and (2) World Health Organization (WHO)-designated COVID-19 clinical outcomes while accounting for confounding including obesity, underlying cardiopulmonary disease, cancer, and smoking history. Design, Setting, and Participants: This case-control study was conducted within the Cleveland Clinic Health System (Ohio and Florida) and included all patients who were tested for COVID-19 between March 8 and November 30, 2020, and who had an available sleep study record. Sleep indices and SARS-CoV-2 positivity were assessed with overlap propensity score weighting, and COVID-19 clinical outcomes were assessed using the institutional registry. Exposures: Sleep study-identified SDB (defined by frequency of apneas and hypopneas using the Apnea-Hypopnea Index [AHI]) and sleep-related hypoxemia (percentage of total sleep time at <90% oxygen saturation [TST <90]). Main Outcomes and Measures: Outcomes were SARS-CoV-2 infection and WHO-designated COVID-19 clinical outcomes (hospitalization, use of supplemental oxygen, noninvasive ventilation, mechanical ventilation or extracorporeal membrane oxygenation, and death). Results: Of 350 710 individuals tested for SARS-CoV-2, 5402 (mean [SD] age, 56.4 [14.5] years; 3005 women [55.6%]) had a prior sleep study, of whom 1935 (35.8%) tested positive for SARS-CoV-2. Of the 5402 participants, 1696 were Black (31.4%), 3259 were White (60.3%), and 822 were of other race or ethnicity (15.2%). Patients who were positive vs negative for SARS-CoV-2 had a higher AHI score (median, 16.2 events/h [IQR, 6.1-39.5 events/h] vs 13.6 events/h [IQR, 5.5-33.6 events/h]; P < .001) and increased TST <90 (median, 1.8% sleep time [IQR, 0.10%-12.8% sleep time] vs 1.4% sleep time [IQR, 0.10%-10.8% sleep time]; P = .02). After overlap propensity score-weighted logistic regression, no SDB measures were associated with SARS-CoV-2 positivity. Median TST <90 was associated with the WHO-designated COVID-19 ordinal clinical outcome scale (adjusted odds ratio, 1.39; 95% CI, 1.10-1.74; P = .005). Time-to-event analyses showed sleep-related hypoxia associated with a 31% higher rate of hospitalization and mortality (adjusted hazard ratio, 1.31; 95% CI, 1.08-1.57; P = .005). Conclusions and Relevance: In this case-control study, SDB and sleep-related hypoxia were not associated with increased SARS-CoV-2 positivity; however, once patients were infected with SARS-CoV-2, sleep-related hypoxia was an associated risk factor for detrimental COVID-19 outcomes.


Assuntos
COVID-19 , Causas de Morte , Hospitalização , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/complicações , Idoso , COVID-19/complicações , COVID-19/mortalidade , COVID-19/terapia , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Prestação Integrada de Cuidados de Saúde , Oxigenação por Membrana Extracorpórea , Feminino , Florida , Mortalidade Hospitalar , Humanos , Hipóxia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Ohio , Respiração Artificial , Fatores de Risco , SARS-CoV-2 , Sono , Síndromes da Apneia do Sono/patologia , Síndromes da Apneia do Sono/terapia
8.
MMWR Morb Mortal Wkly Rep ; 70(42): 1472-1477, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34673748

RESUMO

During December 2018-February 2019, a multistate investigation identified 101 patients with vaccination-associated adverse events among an estimated 940 persons in Kentucky, Indiana, and Ohio who had received influenza; hepatitis A; pneumococcal; or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines at the workplace during September 11-November 28, 2018. These vaccines had been administered by staff members of a third-party health care company contracted by 24 businesses. Company A provided multiple vaccine types during workplace vaccination events across 54 locations in these adjoining states. Injection-site wound isolates from patients yielded Mycobacterium porcinum, a nontuberculous mycobacteria (NTM) species in the Mycobacterium fortuitum group; subtyping using pulsed-field gel electrophoresis of all 28 available isolates identified two closely related clusters. Site visits to company A and interviews with staff members identified inadequate hand hygiene, improper vaccine storage and handling, lack of appropriate medical record documentation, and lack of reporting to the Vaccine Adverse Event Reporting System (VAERS). Vaccination-associated adverse events can be prevented by training health care workers responsible for handling or administering vaccines in safe vaccine handling, administration, and storage practices, timely reporting of any suspected vaccination-associated adverse events to VAERS, and notifying public health authorities of any adverse event clusters.


Assuntos
Mycobacteriaceae/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Vacinação/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Indiana/epidemiologia , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Adulto Jovem
9.
Am J Public Health ; 111(10): 1851-1854, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499540

RESUMO

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


Assuntos
/estatística & dados numéricos , Geografia Médica/estatística & dados numéricos , Overdose de Opiáceos/etnologia , Overdose de Opiáceos/mortalidade , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Kentucky , Massachusetts , New York , Ohio
10.
ScientificWorldJournal ; 2021: 8881390, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34566522

RESUMO

Air pollution has been associated with poor health outcomes and continues to be a risk factor for respiratory health in children. While higher particulate matter (PM) levels are associated with increased frequency of symptoms, lower lung function, and increase airway inflammation from asthma, the precise composition of the particles that are more highly associated with poor health outcomes or healthcare utilization are not fully elucidated. PM is measured quantifiably by current air pollution monitoring systems. To better determine sources of PM and speciation of such sources, a particulate matter (PM) source apportionment study, the Cleveland Multiple Air Pollutant Study (CMAPS), was conducted in Cleveland, Ohio, in 2009-2010, which allowed more refined assessment of associations with health outcomes. This article presents an evaluation of short-term (daily) and long-term associations between motor vehicle and industrial air pollution components and pediatric asthma emergency department (ED) visits by evaluating two sets of air quality data with healthcare utilization for pediatric asthma. Exposure estimates were developed using land use regression models for long-term exposures for nitrogen dioxide (NO2) and coarse (i.e., with aerodynamic diameters between 2.5 and 10 µm) particulate matter (PM) and the US EPA Positive Matrix Factorization receptor model for short-term exposures to fine (<2.5 µm) and coarse PM components. Exposure metrics from these two approaches were used in asthma ED visit prevalence and time series analyses to investigate seasonal-averaged short- and long-term impacts of both motor vehicles and industry emissions. Increased pediatric asthma ED visits were found for LUR coarse PM and NO2 estimates, which were primarily contributed by motor vehicles. Consistent, statistically significant associations with pediatric asthma visits were observed, with short-term exposures to components of fine and coarse iron PM associated with steel production. Our study is the first to combine spatial and time series analysis of ED visits for asthma using the same periods and shows that PM related to motor vehicle emissions and iron/steel production are associated with increased pediatric asthma visits.


Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Adolescente , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Asma/etiologia , Biomassa , Criança , Pré-Escolar , Exposição Ambiental/análise , Feminino , Combustíveis Fósseis , Humanos , Indústrias , Masculino , Ohio/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Análise de Regressão , População Urbana , Emissões de Veículos
11.
Optom Vis Sci ; 98(9): 1070-1077, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34570031

RESUMO

SIGNIFICANCE: The Ohio Contrast Cards are a repeatable test of contrast sensitivity, and they reveal higher contrast sensitivity for low-vision patients than is shown by the Pelli-Robson chart. PURPOSE: This study aimed to compare the contrast sensitivity results and test/retest ±limits of agreement for the Ohio Contrast Cards and the Pelli-Robson letter contrast sensitivity chart on two challenging groups of participants, and to compare the Ohio Contrast Card results with grating acuity and the Pelli-Robson results with letter acuity. METHODS: The Ohio Contrast Card and Pelli-Robson tests were each performed twice by two different examiners within one visit on 40 elder patients in Primary Vision Care (>65 years old) and 23 to 27 low-vision school-aged students. Grating acuity was measured using the Teller Acuity Cards (all participants), and letter acuity was measured using ClearChart (elders) or the Bailey-Lovie chart (students). RESULTS: The ±95% limits of agreement were similar for the Ohio Contrast Cards and the Pelli-Robson chart. The elders' limits of agreement were ±0.27 (Ohio Contrast Cards) and ±0.28 (Pelli-Robson); the students' limits of agreement were ±0.42 (Ohio Contrast Cards) and ±0.51 (Pelli-Robson). However, Ohio Contrast Card results were 0.41 log10 Michelson units more sensitive than the Pelli-Robson chart (over one line on the Pelli-Robson chart) for the elders and 0.90 log10 Michelson units (three lines on the Pelli-Robson chart) more sensitive for the elders (0.11 and 0.6 log10 Weber units, respectively). The Pelli-Robson results were correlated with letter acuities and Ohio Contrast Card results for both groups, and the Ohio Contrast Card results were correlated with Teller Acuity Card acuities for the elders. CONCLUSIONS: The Ohio Contrast Cards and Pelli-Robson chart are similarly repeatable. Both contrast sensitivity tests can provide additional clinical information that is not available through visual acuity testing, and Ohio Contrast Card may provide additional information not available from the Pelli-Robson chart.


Assuntos
Testes Visuais , Baixa Visão , Idoso , Criança , Sensibilidades de Contraste , Humanos , Ohio , Acuidade Visual
12.
J Cardiovasc Electrophysiol ; 32(11): 3027-3034, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34554620

RESUMO

INTRODUCTION: Defibrillation testing (DT) is recommended during the subcutaneous defibrillator (S-ICD) placement. We sought to compare 10 J shock impedance in sinus rhythm (SR) with 65 J defibrillation impedance and evaluate device position on a postimplant chest X-ray (CXR) using an intermuscular (IM) technique. METHODS: Consecutive S-ICD implantations between 12/2019 and 12/2020 at The Ohio State University were reviewed. All implantations were performed using a two-incision IM technique. Standard DT with 65 J shock and 10 J shock in SR were performed unless contraindicated. The PRAETORIAN score was calculated based on CXR. RESULTS: A total of 37 patients (age: 47.2 ± 15.8 years old, male: n = 26 [70.3%], body mass index: 30.1 ± 6.7 kg/m2 ) underwent IM S-ICD implantation, and of those, 27 (73%) underwent both 65 J shock and 10 J shock in SR. The coefficient of determination (R2 ) between 10 J shock impedance and 65 J shock impedance was 0.84. The mean of an impedance difference was 1.6 ± 4.8 Ω (minimum - 11 and maximum 8). Postimplant CXR was available for 33 out of 37 patients (89.2%). The PRAETORIAN score was less than 90 in all patients and the mean score was 32.7 ± 8.8. CONCLUSION: We demonstrated that 10 J shock impedance in SR correlated well with 65 J defibrillation impedance during IM S-ICD implantation. An IM implantation technique provides excellent generator location on postimplant CXR. The IM technique combined with 10 J shock in SR may be sufficient to predict and ensure the defibrillation efficacy of the S-ICD.


Assuntos
Desfibriladores Implantáveis , Adulto , Arritmias Cardíacas , Cardioversão Elétrica , Impedância Elétrica , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Tela Subcutânea
13.
Am J Orthopsychiatry ; 91(5): 589-597, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516157

RESUMO

This study describes findings of a phenomenological study of Black women's experiences with a community-based perinatal support organization based in Cleveland, Ohio. Twenty-five women participated in interviews after their babies were born about how the organization in general, and perinatal support professionals (PSPs) in particular supported them during their pregnancies and the meaning of that support. The overall meaning of perinatal support was described as easing participants' transitions into motherhood through reducing uncertainty, social isolation, and stress. The three main themes described the meaning of perinatal support and included (a) easing the transition to motherhood through emotional support, expressed via love and help managing relationships; (b) easing the transition to motherhood through instrumental support, expressed via helping with basic needs and obtaining material goods for the baby; and (c) easing the transition to motherhood through informational support, expressed via help navigating systems and information, and gaining knowledge and skills around mothering and self-care. Implications for practice, policy, and research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Afro-Americanos , Mães , Feminino , Humanos , Ohio , Gravidez , Pesquisa Qualitativa , Apoio Social
14.
Sci Total Environ ; 801: 149757, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34467932

RESUMO

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 129 million confirm cases. Many health authorities around the world have implemented wastewater-based epidemiology as a rapid and complementary tool for the COVID-19 surveillance system and more recently for variants of concern emergence tracking. In this study, three SARS-CoV-2 target genes (N1 and N2 gene regions, and E gene) were quantified from wastewater influent samples (n = 250) obtained from the capital city and 7 other cities in various size in central Ohio from July 2020 to January 2021. To determine human-specific fecal strength in wastewater samples more accurately, two human fecal viruses (PMMoV and crAssphage) were quantified to normalize the SARS-CoV-2 gene concentrations in wastewater. To estimate the trend of new case numbers from SARS-CoV-2 gene levels, different statistical models were built and evaluated. From the longitudinal data, SARS-CoV-2 gene concentrations in wastewater strongly correlated with daily new confirmed COVID-19 cases (average Spearman's r = 0.70, p < 0.05), with the N2 gene region being the best predictor of the trend of confirmed cases. Moreover, average daily case numbers can help reduce the noise and variation from the clinical data. Among the models tested, the quadratic polynomial model performed best in correlating and predicting COVID-19 cases from the wastewater surveillance data, which can be used to track the effectiveness of vaccination in the later stage of the pandemic. Interestingly, neither of the normalization methods using PMMoV or crAssphage significantly enhanced the correlation with new case numbers, nor improved the estimation models. Viral sequencing showed that shifts in strain-defining variants of SARS-CoV-2 in wastewater samples matched those in clinical isolates from the same time periods. The findings from this study support that wastewater surveillance is effective in COVID-19 trend tracking and provide sentinel warning of variant emergence and transmission within various types of communities.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Ohio , Águas Residuárias , Vigilância Epidemiológica Baseada em Águas Residuárias
15.
Soc Psychiatry Psychiatr Epidemiol ; 56(11): 2107-2116, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34480595

RESUMO

PURPOSE: Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS: OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS: Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION: Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.


Assuntos
Militares , Transtornos de Estresse Pós-Traumáticos , Criança , Estudos de Coortes , Humanos , Saúde Mental , Ohio/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia
16.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34417288

RESUMO

BACKGROUND: Hospital discharge delays can negatively affect patient flow and hospital charges. Our primary aim was to increase the percentage of acute care cardiology patients discharged within 2 hours of meeting standardized medically ready (MedR) discharge criteria. Secondary aims were to reduce length of stay (LOS) and lower hospital charges. METHODS: A multidisciplinary team used quality improvement methods to implement and study MedR discharge criteria in our hospital electronic health record. The criteria were ordered on admission and modified on daily rounds. Bedside nurses documented the time when all MedR discharge criteria were met. A statistical process control chart measured interventions over time. Discharge before noon and 30-day readmissions were also tracked. Average LOS was examined, comparing the first 6 months of the intervention period to the last 6 months. Inpatient charges were reviewed for patients with >2 hours MedR discharge delay. RESULTS: The mean percentage of patients discharged within 2 hours of meeting MedR discharge criteria increased from 20% to 78% over 22 months, with more patients discharged before noon (19%-32%). Median LOS decreased from 11 days (interquartile range: 6-21) to 10 days (interquartile range: 5-19) (P = .047), whereas 30-day readmission remained stable at 16.3%. A total of 265 delayed MedR discharges beyond 2 hours occurred. The sum of inpatient charges from care provided after meeting MedR criteria was $332 038 (average $1253 per delayed discharge). CONCLUSIONS: Discharge timeliness in pediatric acute care cardiology patients can be improved by standardizing medical discharge criteria, which may shorten LOS and decrease medical charges.


Assuntos
Serviço Hospitalar de Cardiologia , Unidades Hospitalares , Alta do Paciente , Pediatria , Melhoria de Qualidade/organização & administração , Benchmarking , Hospitais Pediátricos , Humanos , Tempo de Internação/estatística & dados numéricos , Ohio , Equipe de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos
17.
Artigo em Inglês | MEDLINE | ID: mdl-34444490

RESUMO

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails.


Assuntos
Exercício Físico , Caminhada , Humanos , Ohio , Projetos de Pesquisa , Características de Residência
18.
PLoS One ; 16(8): e0255343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351971

RESUMO

BACKGROUND: Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. OBJECTIVE: To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. DESIGN: Observational cohort study. SETTING: Outpatient and emergency care. PATIENTS: 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. INTERVENTIONS: Nasopharyngeal PCR test for SARS-CoV-2 infection. MEASUREMENTS: Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. RESULTS: We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. LIMITATIONS: Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. CONCLUSION: Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.


Assuntos
Teste para COVID-19/tendências , COVID-19/diagnóstico , Fatores Socioeconômicos , Adulto , Idoso , COVID-19/economia , COVID-19/psicologia , Teste para COVID-19/métodos , Estudos de Coortes , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Ohio/epidemiologia , Pandemias , Fatores de Risco , SARS-CoV-2/patogenicidade
19.
PLoS Med ; 18(8): e1003736, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34339408

RESUMO

BACKGROUND: Cardiovascular disease is a leading cause of death in general population and the second leading cause of mortality and morbidity in cancer survivors after recurrent malignancy in the United States. The growing awareness of cancer therapy-related cardiac dysfunction (CTRCD) has led to an emerging field of cardio-oncology; yet, there is limited knowledge on how to predict which patients will experience adverse cardiac outcomes. We aimed to perform unbiased cardiac risk stratification for cancer patients using our large-scale, institutional electronic medical records. METHODS AND FINDINGS: We built a large longitudinal (up to 22 years' follow-up from March 1997 to January 2019) cardio-oncology cohort having 4,632 cancer patients in Cleveland Clinic with 5 diagnosed cardiac outcomes: atrial fibrillation, coronary artery disease, heart failure, myocardial infarction, and stroke. The entire population includes 84% white Americans and 11% black Americans, and 59% females versus 41% males, with median age of 63 (interquartile range [IQR]: 54 to 71) years old. We utilized a topology-based K-means clustering approach for unbiased patient-patient network analyses of data from general demographics, echocardiogram (over 25,000), lab testing, and cardiac factors (cardiac). We performed hazard ratio (HR) and Kaplan-Meier analyses to identify clinically actionable variables. All confounding factors were adjusted by Cox regression models. We performed random-split and time-split training-test validation for our model. We identified 4 clinically relevant subgroups that are significantly correlated with incidence of cardiac outcomes and mortality. Among the 4 subgroups, subgroup I (n = 625) has the highest risk of de novo CTRCD (28%) with an HR of 3.05 (95% confidence interval (CI) 2.51 to 3.72). Patients in subgroup IV (n = 1,250) had the worst survival probability (HR 4.32, 95% CI 3.82 to 4.88). From longitudinal patient-patient network analyses, the patients in subgroup I had a higher percentage of de novo CTRCD and a worse mortality within 5 years after the initiation of cancer therapies compared to long-time exposure (6 to 20 years). Using clinical variable network analyses, we identified that serum levels of NT-proB-type Natriuretic Peptide (NT-proBNP) and Troponin T are significantly correlated with patient's mortality (NT-proBNP > 900 pg/mL versus NT-proBNP = 0 to 125 pg/mL, HR = 2.95, 95% CI 2.28 to 3.82, p < 0.001; Troponin T > 0.05 µg/L versus Troponin T ≤ 0.01 µg/L, HR = 2.08, 95% CI 1.83 to 2.34, p < 0.001). Study limitations include lack of independent cardio-oncology cohorts from different healthcare systems to evaluate the generalizability of the models. Meanwhile, the confounding factors, such as multiple medication usages, may influence the findings. CONCLUSIONS: In this study, we demonstrated that the patient-patient network clustering methodology is clinically intuitive, and it allows more rapid identification of cancer survivors that are at greater risk of cardiac dysfunction. We believed that this study holds great promise for identifying novel cardiac risk subgroups and clinically actionable variables for the development of precision cardio-oncology.


Assuntos
Fibrilação Atrial/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Insuficiência Cardíaca/epidemiologia , Infarto do Miocárdio/epidemiologia , Neoplasias/complicações , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Idoso , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia
20.
Am J Med ; 134(11): 1424-1426, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34339676

RESUMO

BACKGROUND: A decrease in coronavirus disease 2019 (COVID-19) vaccination rates has led some states to consider various incentives to boost demand for vaccines. On May 13, 2021, Ohio announced a free weekly lottery for individuals who received at least 1 COVID-19 vaccination. This study seeks to rigorously quantify the impact of Ohio's vaccination lottery. METHODS: A synthetic control consisting of a weighted combination of other states was used to approximate the demographic characteristics, new cases, and vaccination rates in Ohio prior to the lottery announcement. The difference in vaccination rates in Ohio and the synthetic control following the lottery announcement was then used to estimate the lottery's impact. RESULTS: Prior to the lottery announcement, Ohio and synthetic Ohio had similar demographic characteristics and new case rates. Ohio and synthetic Ohio also had identical first vaccination rates. By the final lottery enrollment date of June 20, the percentage of the population with first vaccinations increased to 47.41% in Ohio and 46.43% in synthetic Ohio for a difference of 0.98% (95% confidence interval [CI] 0.42-1.54). CONCLUSION: An additional 114,553 Ohioans received vaccinations as a result of the Vax-a-Million program (95% CI 49,094-180,012) at a cost of approximately $49 per Ohioan vaccinated (95% CI $31-$114). However, a majority of Ohioans remained unvaccinated by the end of the lottery, indicating that additional efforts are needed to address barriers to vaccination. This synthetic control approach may also be useful to evaluate other COVID-19 incentive programs.


Assuntos
Controle Comportamental/métodos , COVID-19 , Programas de Imunização , Vacinação em Massa , Motivação , Cobertura Vacinal , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Masculino , Vacinação em Massa/psicologia , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Ohio/epidemiologia , SARS-CoV-2 , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos , Recusa de Vacinação/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...