Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.611
Filtrar
2.
Drug Alcohol Depend ; 232: 109341, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35134733

RESUMO

BACKGROUND: The United States continues to experience a crisis of mounting opioid overdose deaths involving cocaine and methamphetamine (hereafter illicit stimulants). Law enforcement drug seizure data present a unique opportunity to examine the association between illicit-stimulant-involved overdose deaths (ISODs) and the illicit drug supply. Our objective is to better understand correlations between illicit drug market trends and increases in ISODs in Ohio in 2014-2019. METHODS: This observational study analyzes the universe of ISODs and drug seizures in Ohio from 2014 to 2019. We use graphs and descriptive statistics to characterize trends over time and estimate a time series model of their association. ISODs were summed to yield monthly statewide counts of seizures containing methamphetamine, cocaine, illicitly manufactured fentanyl (IMF), and other non-IMF opioids (e.g., heroin). All rates were calculated per 100,000 persons. RESULTS: Roughly 80% of ISODs in Ohio from 2014 to 2019 involved an opioid, with IMF co-occurring in 90% of ISODs by 2019. Methamphetamine and cocaine seizures containing IMF were associated with 0.439 (p < .01) and 0.457 (p < .01) additional deaths per 100,000 persons per month, respectively. IMF seizures not containing cocaine nor methamphetamine were also associated with additional ISODs (0.119, p < .01) and seizures of illicit stimulants not containing IMF were not associated with ISODs. CONCLUSIONS: The number of ISODs was extremely high when IMF was co-involved and relatively low without IMF involvement. By demonstrating how supply-side trends correspond with ISOD rates, the current study bolsters the analytical utility of law enforcement seizures and complements growing literature in the field.


Assuntos
Cocaína , Overdose de Drogas , Drogas Ilícitas , Metanfetamina , Analgésicos Opioides , Fentanila , Humanos , Aplicação da Lei , Metanfetamina/efeitos adversos , Ohio/epidemiologia , Convulsões/induzido quimicamente , Convulsões/epidemiologia , Estados Unidos/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-35162700

RESUMO

This study examined if the associations between lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and unhealthy alcohol use or mental health problems differ by location of living (rural vs. urban). The lifetime history data of TBI with LOC, location of living, unhealthy alcohol use (binge drinking, heavy drinking), and mental health problems (depression diagnosis, number of poor mental health days) were sourced from the 2016, 2017, 2018, and 2019 Ohio Behavioral Risk Factory Surveillance Surveys, and the final sample included 16,941 respondents. We conducted multivariable logistic regressions to determine the odds ratios for each of the five outcomes between individuals living in rural vs. urban areas and between individuals with vs. without a lifetime history of TBI with LOC. No interaction between location of living and lifetime history of TBI with LOC was observed for any outcomes, indicating rurality did not modify these relationships. Living in a rural area was associated with decreased binge drinking or heavy drinking but not mental health outcomes. Lifetime history of TBI with LOC was associated with an increased risk of binge drinking, heavy drinking, depression diagnoses, and poor general mental health, regardless of location of living. Our findings support the need for TBI screenings as part of mental health intake evaluations and behavioral health screenings. Though rurality was not associated with mental health outcomes, rural areas may have limited access to quality mental health care. Therefore, future research should address access to mental health services following TBI among rural residents.


Assuntos
Consumo Excessivo de Bebidas Alcoólicas , Lesões Encefálicas Traumáticas , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Lesões Encefálicas Traumáticas/diagnóstico , Humanos , Ohio/epidemiologia , Inconsciência/diagnóstico , Inconsciência/epidemiologia
4.
Appl Clin Inform ; 13(1): 100-112, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35081656

RESUMO

OBJECTIVES: Social determinants of health (SDoH) can be measured at the geographic level to convey information about neighborhood deprivation. The Ohio Children's Opportunity Index (OCOI) is a composite area-level opportunity index comprised of eight health domains. Our research team has documented the design, development, and use cases of a dashboard solution to visualize OCOI. METHODS: The OCOI is a multidomain index spanning the following eight domains: (1) family stability, (2) infant health, (3) children's health, (4) access, (5) education, (6) housing, (7) environment, and (8) criminal justice. Information on these eight domains is derived from the American Community Survey and other administrative datasets. Our team used the Tableau Desktop visualization software and applied a user-centered design approach to developing the two OCOI dashboards-main OCOI dashboard and OCOI-race dashboard. We also performed convergence analysis to visualize the census tracts where different health indicators simultaneously exist at their worst levels. RESULTS: The OCOI dashboard has multiple, interactive components as follows: a choropleth map of Ohio displaying OCOI scores for a specific census tract, graphs presenting OCOI or domain scores to compare relative positions for tracts, and a sortable table to visualize scores for specific county and census tracts. A case study using the two dashboards for convergence analysis revealed census tracts in neighborhoods with low infant health scores and a high proportion of minority population. CONCLUSION: The OCOI dashboards could assist health care leaders in making decisions that enhance health care delivery and policy decision-making regarding children's health particularly in areas where multiple health indicators exist at their worst levels.


Assuntos
Saúde da Criança , Visualização de Dados , Disparidades nos Níveis de Saúde , Criança , Humanos , Lactente , Ohio/epidemiologia , Áreas de Pobreza , Características de Residência/estatística & dados numéricos , Determinantes Sociais da Saúde , Inquéritos e Questionários
5.
Am Surg ; 88(3): 404-408, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34645329

RESUMO

INTRODUCTION: There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC). METHODS: We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020. Patients were grouped into a pre-COVID or COVID period. The primary aim of this study was to compare rates of VAW between groups. Secondary aims sought to evaluate for any difference in traumatic mechanism between periods and to determine if a temporal relationship existed between COVID-19 and VAW rates. RESULTS: There was no difference in rates of VAW between the pre-COVID and COVID period (3.1% vs 3.6%, P = .6); however, rates of penetrating trauma were greater during the COVID period (38.2% vs 10.3%, P = .01). After controlling for patient age and race, the odds of penetrating trauma increased during the pandemic (OR 5.8, 95% CI 1.6-28.5, P < .01). From February 2020 through October 2020, there was a direct relationship between rates of COVID-19 and VAW (r2 .78, P < .01). CONCLUSION: Rates of VAW were unchanged between the pre-COVID and COVID periods, yet the odds of penetrating VAW were 5 times greater during the pandemic. Moving forward, trauma surgeons must remain vigilant for signs of violence and ensure that support services are available during future crises.


Assuntos
COVID-19/epidemiologia , Violência de Gênero/estatística & dados numéricos , Pandemias , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Adulto , COVID-19/prevenção & controle , Feminino , Violência de Gênero/etnologia , Humanos , Escala de Gravidade do Ferimento , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Modelos Lineares , Ohio/epidemiologia , Estudos Retrospectivos , Ferimentos não Penetrantes/etnologia , Ferimentos Penetrantes/etnologia , Adulto Jovem
6.
Matern Child Health J ; 26(2): 351-357, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34613555

RESUMO

INTRODUCTION: The effects of homelessness on pregnant women are substantial. We aim to identify key characteristics of a group of women identified as homeless and pregnant in order to understand their history of housing, family composition, health, and demographics as a first step for future intervention. METHODS: We present cross-sectional survey data on a sample of 100 women reporting homelessness and pregnancy in the prior year in Columbus, Ohio, identified through social service and housing not for profit agencies. Our analysis uses data collected from a survey of health behaviors, housing, employment status, and demographics. Continuous measures are described with means and standard deviations, and categorical variables are described with percentages. RESULTS: The majority (81%) of the women identified as African American. Over 95% of the women were single, and 74 women reported a prior pregnancy. Almost half of the women reported being behind on rent at least one time in the last 6 months, and 43% indicated that they had lived in more than three places in the last year. Approximately 34% of the sample reported cigarette use during pregnancy, while 12% and 30% reported alcohol and illicit drug use, respectively. DISCUSSION: Women who were pregnant and experiencing homelessness in our study reported a multitude of complex and severe problems ranging from high rates of substance use, longstanding housing insecurity and financial stress. Programs hoping to successfully support women will need to address a variety of service needs while recognizing the resilience of many women.


Assuntos
Pessoas em Situação de Rua , Gestantes , Estudos Transversais , Feminino , Habitação , Humanos , Ohio/epidemiologia , Gravidez
7.
Med Princ Pract ; 31(1): 83-87, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34875654

RESUMO

OBJECTIVE: In humans, males are born slightly in excess of females. Many factors have been shown to affect this ratio, including stressful events such as terrorist attacks. Two shootings occurred in early August 2019 in the Oregon District in Dayton, Montgomery County, Ohio, and in El Paso County, Texas, in the USA. This study was carried out in order to identify whether there were any effects on sex ratio at birth at the state or county level 3-5 months later. SUBJECT AND METHODS: Births by sex, month of birth (2015-2019), and county were obtained for Ohio and Texas from the website of the Centers for Disease Control and Prevention. Ordinary linear logistic regression was used to assess the time trend in the probability of boys and to investigate changes in the trend functions. Poisson regression (SAS GENMOD) and linear logistic regression using SAS procedure LOGISTIC was applied. RESULTS: This study analyzed 2,623,714 live births, 1,939,938 in Texas (sex odds [SO] 1.044) and 683,776 in Ohio (SO 1.045). The only significant effect noted was seasonality (month) at the state level. CONCLUSION: It has been postulated that male fetal loss in pregnant women during stressful periods may occur in accordance with the Trivers-Willard hypothesis. Several studies have found significant effects after terrorist attacks in the USA (as well as in other countries), but this study did not reveal such effects. This may be due to several reasons including underpowered datasets and the possibility that populations may be becoming relatively immured to these events.


Assuntos
Razão de Masculinidade , Feminino , Humanos , Recém-Nascido , Masculino , Ohio/epidemiologia , Gravidez , Texas/epidemiologia
8.
Prev Vet Med ; 198: 105530, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34798304

RESUMO

A cluster of five human Salmonella Guinea cases was identified among Ohio residents through core genome multilocus sequence typing of clinical isolates. An investigation was conducted to characterize illnesses and identify common exposures. Four patients were aged ≤5 years and three of four patients with information available regarding exposure to animals reported prior exposure to bearded dragons. Practices that potentially increased the risk for Salmonella transmission from reptiles to humans included allowing pet reptiles to roam freely in the home, cleaning reptile habitats indoors, and kissing reptiles. These findings prompted a multistate investigation that resulted in the identification of additional closely related Salmonella Guinea isolates from patients across multiple states. The investigation of cases in Ohio and information shared by other states indicated the potential association between human Salmonella Guinea infections and reptiles, particularly bearded dragons. To prevent Salmonella transmission from reptiles, continued educational efforts should address pet owners and focus on specific reptile ownership practices.


Assuntos
Zoonoses Bacterianas/epidemiologia , Lagartos , Salmonelose Animal , Animais , Humanos , Lagartos/microbiologia , Ohio/epidemiologia , Salmonella , Salmonelose Animal/epidemiologia , Salmonelose Animal/prevenção & controle
9.
Ann Surg ; 275(1): e238-e244, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32541223

RESUMO

OBJECTIVE: The aim of this study was to analyze the incidence of and risk factors for adrenocortical carcinoma (ACC) in adrenal incidentaloma (AI). SUMMARY OF BACKGROUND DATA: AI guidelines are based on data obtained with old-generation imaging and predominantly use tumor size to stratify risk for ACC. There is a need to analyze the incidence and risk factors from a contemporary series. METHODS: This is a retrospective review of 2219 AIs that were either surgically removed or nonoperatively monitored for ≥12 months between 2000 and 2017. Multivariate logistic regression was performed to define risk factors. ROC curves constructed to determine optimal size and attenuation cut-offs for ACC. RESULTS: 16.8% of AIs underwent upfront surgery and rest initial nonoperative management. Of conservatively managed patients, an additional 7.7% subsequently required adrenalectomy. Overall, ACC incidence in AI was 1.7%. ACC rates by size were 0.1%, 2.4%, and 19.5% for AIs of <4, 4 to 6, and >6 cm, respectively. The optimal size cut-off for ACC in AI was 4.6 cm. ACC risks by Hounsfield density were 0%, 0.5%, and 6.3% for lesions of <10, 10 to 20, and >20 HU, with an optimal cut-off of 20 HU to diagnose ACC. 15.5% of all AIs and 19.2% of ACCs were hormonally active. Male sex, large tumor size, high Hounsfield density, and >0.6 cm/year growth were independent risk factors for ACC. CONCLUSION: This contemporary analysis demonstrates that ACC risk per size in AI is less than previously reported. Given these findings, modern management of AIs should not be based just on size, but a combination of thorough hormonal evaluation and imaging characteristics.


Assuntos
Neoplasias das Glândulas Suprarrenais/epidemiologia , Estadiamento de Neoplasias/métodos , Medição de Risco/métodos , Neoplasias das Glândulas Suprarrenais/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X
11.
J Addict Med ; 16(2): e118-e122, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34172625

RESUMO

OBJECTIVE: During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years. METHODS: This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed. RESULTS: The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions. CONCLUSIONS: Based on these findings, Ohio has entered a COVID-19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Humanos , Estudos Longitudinais , Ohio/epidemiologia , Overdose de Opiáceos/epidemiologia , Pandemias
12.
J Vasc Surg Venous Lymphat Disord ; 10(1): 8-13, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34171532

RESUMO

OBJECTIVE: Plasma D-dimer levels >5000 ng/mL are encountered in a number of conditions other than venous thromboembolism (VTE). Recent studies have used plasma D-dimer levels as a prognostic indicator for coronavirus disease 2019 (COVID-19) infection. The implications of abnormal levels are less clear for patients diagnosed with COVID-19 with a baseline elevation in plasma D-dimer levels. In the present study, we reviewed the occurrence of plasma D-dimer levels >5000 ng/mL and investigated the clinical significance of this finding before the onset of the COVID-19 pandemic. METHODS: Inpatient records for a 4-year period were screened for laboratory results of plasma D-dimer levels >5000 ng/mL. The patient data were reviewed for the clinical identifiers commonly associated with elevated plasma D-dimer levels, including VTE, cancer, sepsis, pneumonia, other infection, bleeding, and trauma. The patients were then categorized into groups stratified by the plasma D-dimer level to allow for comparisons between the various clinical diagnoses. RESULTS: A total of 671 patients were included in the present study. VTE was the most common diagnosis for patients with a plasma D-dimer level >5000 ng/mL, followed by cancer and pneumonia. Multiple clinical diagnoses were present in 61% of the patients. No clear cause for the ultra-high plasma D-dimer level could be identified in 11.3% of the patients. Among the patients lacking a clinical diagnosis at discharge, mortality was 24% in the 5000- to 10,000-ng/mL group, 28.6% in the 10,000- to 15,000-ng/mL group, and 75% in the >15,000-ng/mL group. CONCLUSIONS: VTE, cancer, and pneumonia were frequently present when ultra-high plasma D-dimer levels were encountered, and mortality was high when the levels were >15,000 ng/mL. The results from our study from a pre-COVID-19 patient population suggest that ultra-high plasma D-dimer levels indicate the presence of severe underlying disease. This should be considered when using the plasma D-dimer level as a screening tool or prognostic indicator for COVID-19 infection.


Assuntos
COVID-19/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Tromboembolia Venosa/sangue , Idoso , Biomarcadores/sangue , COVID-19/sangue , COVID-19/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Ohio/epidemiologia , Pandemias , Estudos Retrospectivos , Fatores de Tempo , Tromboembolia Venosa/etiologia
13.
Ann Epidemiol ; 67: 50-60, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34921991

RESUMO

Purpose To estimate the prevalence of current and past COVID-19 in Ohio adults. Methods We used stratified, probability-proportionate-to-size cluster sampling. During July 2020, we enrolled 727 randomly-sampled adult English- and Spanish-speaking participants through a household survey. Participants provided nasopharyngeal swabs and blood samples to detect current and past COVID-19. We used Bayesian latent class models with multilevel regression and poststratification to calculate the adjusted prevalence of current and past COVID-19. We accounted for the potential effects of non-ignorable non-response bias. Results The estimated statewide prevalence of current COVID-19 was 0.9% (95% credible interval: 0.1%-2.0%), corresponding to ∼85,000 prevalent infections (95% credible interval: 6,300-177,000) in Ohio adults during the study period. The estimated statewide prevalence of past COVID-19 was 1.3% (95% credible interval: 0.2%-2.7%), corresponding to ∼118,000 Ohio adults (95% credible interval: 22,000-240,000). Estimates did not change meaningfully due to non-response bias. Conclusions Total COVID-19 cases in Ohio in July 2020 were approximately 3.5 times as high as diagnosed cases. The lack of broad COVID-19 screening in the United States early in the pandemic resulted in a paucity of population-representative prevalence data, limiting the ability to measure the effects of statewide control efforts.


Assuntos
COVID-19 , Adulto , Teorema de Bayes , COVID-19/epidemiologia , Humanos , Ohio/epidemiologia , Prevalência , SARS-CoV-2 , Estados Unidos
15.
Nature ; 602(7897): 481-486, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34942632

RESUMO

Humans have infected a wide range of animals with SARS-CoV-21-5, but the establishment of a new natural animal reservoir has not been observed. Here we document that free-ranging white-tailed deer (Odocoileus virginianus) are highly susceptible to infection with SARS-CoV-2, are exposed to multiple SARS-CoV-2 variants from humans and are capable of sustaining transmission in nature. Using real-time PCR with reverse transcription, we detected SARS-CoV-2 in more than one-third (129 out of 360, 35.8%) of nasal swabs obtained from O. virginianus in northeast Ohio in the USA during January to March 2021. Deer in six locations were infected with three SARS-CoV-2 lineages (B.1.2, B.1.582 and B.1.596). The B.1.2 viruses, dominant in humans in Ohio at the time, infected deer in four locations. We detected probable deer-to-deer transmission of B.1.2, B.1.582 and B.1.596 viruses, enabling the virus to acquire amino acid substitutions in the spike protein (including the receptor-binding domain) and ORF1 that are observed infrequently in humans. No spillback to humans was observed, but these findings demonstrate that SARS-CoV-2 viruses have been transmitted in wildlife in the USA, potentially opening new pathways for evolution. There is an urgent need to establish comprehensive 'One Health' programmes to monitor the environment, deer and other wildlife hosts globally.


Assuntos
Animais Selvagens/virologia , COVID-19/veterinária , Cervos/virologia , Filogenia , SARS-CoV-2/isolamento & purificação , Zoonoses Virais/transmissão , Zoonoses Virais/virologia , Sequência de Aminoácidos , Substituição de Aminoácidos , Animais , COVID-19/epidemiologia , COVID-19/transmissão , Evolução Molecular , Humanos , Masculino , Ohio/epidemiologia , Saúde Única/tendências , SARS-CoV-2/química , SARS-CoV-2/classificação , SARS-CoV-2/genética , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Zoonoses Virais/epidemiologia
16.
JAMA Netw Open ; 4(12): e2140352, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34940865

RESUMO

Importance: More than 50 000 youths are incarcerated in the United States on any given day, and youth incarceration has been linked to lasting adverse outcomes, including early mortality. Improving our understanding of the factors associated with early mortality among incarcerated youths can inform appropriate prevention strategies. Objective: To examine mortality rates and causes of death among youths previously incarcerated in the juvenile legal system. Design, Setting, and Participants: This retrospective longitudinal population-based cohort study compared mortality rates between youths aged 11 to 21 years incarcerated from 2010 to 2017 with same-aged nonincarcerated Medicaid-enrolled youths in the state of Ohio. Data from January 2017 to December 2019 were collected from juvenile incarceration, Medicaid, and death certificate information in Ohio. Exposure: Incarceration in the state of Ohio's juvenile legal system. Main Outcomes and Measures: Number, characteristics, and causes of deaths. Poisson regression incidence rate ratios (IRRs) compared mortality rates between previously incarcerated and Medicaid-enrolled youths. Results: Among 3645 incarcerated youths, 3398 (93.2%) were male, 2155 (59.1%) Black, 1307 (35.9%) White, and 183 (5.0%) other race and ethnicity. Overall, 113 youths (3.1%) died during the study period. Homicide was the leading cause of death in formerly incarcerated youths (homicide: 63 [55.8%]; legal intervention [ie, death due to injuries inflicted by law enforcement]: 3 [2.7%]). All-cause mortality rates were significantly higher among previously incarcerated youths than Medicaid-enrolled youths (adjusted IRR [aIRR], 5.91; 95% CI, 4.90-7.13) in every demographic subgroup. Compared with Medicaid-enrolled youths, mortality rates for previously incarcerated youths were highest for homicide (aIRR, 11.02; 95% CI, 8.54-14.22), overdose (aIRR, 4.32; 95% CI, 2.59-7.20), and suicide (aIRR, 4.30; 95% CI, 2.22-8.33). Formerly incarcerated Black youths had a significantly higher risk of homicide (aIRR, 14.24; 95% CI, 4.45-45.63) but a lower risk of suicide (aIRR, 0.18; 95% CI, 0.04-0.89) and overdose (aIRR, 0.31; 95% CI, 0.10-0.99) than White youths who were incarcerated. Previously incarcerated youths aged 15 to 21 years were significantly more likely to die than youths aged 22 to 29 years, irrespective of cause of death (aIRR for youths aged 22-29 years, 0.09; 95% CI, 0.06-0.14). Conclusions and Relevance: In this study, youths with a history of incarceration were significantly more likely to experience early mortality compared with nonincarcerated Medicaid-enrolled youths. Delinquency and violence prevention strategies that incorporate a culturally informed approach and consider sex and developmental level are critical.


Assuntos
Causas de Morte , Delinquência Juvenil , Mortalidade/tendências , Adolescente , Feminino , Homicídio/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Medicaid , Ohio/epidemiologia , Prisioneiros , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
17.
J Diabetes Res ; 2021: 6590431, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34761006

RESUMO

Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellitus. This paper outlines the unique enrollment challenges of the TEAM Study and preliminary analysis of the association between exposure to diabetes in pregnancy and adverse metabolic outcomes. The TEAM Study enrolls offspring of women who participated in a Diabetes in Pregnancy (DiP) Program Project Grant between 1978 and 1995. The DiP Study collected medical and obstetric data across pregnancy. The first 96 eligible offspring of women with pregestational diabetes were age-, sex-, and race-matched to adults from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 with an OGTT. Descriptive and regression analyses were employed to compare TEAM participants to NHANES participants. Among a subset of TEAM participants, we compared the metabolic outcomes across maternal glucose profiles using a longitudinal data clustering technique that characterizes level and variability, in maternal glucose across pregnancy. By comparing categories of BMI, TEAM Study participants had over 2.0 times the odds of being obese compared to matched NHANES participants (for class III obesity, OR = 2.81; 95% confidence interval (CI): 1.15, 6.87). Increasing levels of two-hour glucose were also associated with in utero exposure to pregestational diabetes in matched analyses. Exposure to pregestational diabetes in utero may be associated with an increased risk of metabolic impairment in the offspring with clinical implications.


Assuntos
Crianças Adultas/estatística & dados numéricos , Efeito de Coortes , Diabetes Mellitus/diagnóstico , Adulto , Crianças Adultas/etnologia , Antropometria/métodos , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Ohio/epidemiologia , Gravidez , Gravidez em Diabéticas/fisiopatologia
18.
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
19.
Obstet Gynecol ; 138(5): 732-737, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34619694

RESUMO

OBJECTIVE: To assess the rate of immediate postpartum long-acting reversible contraceptive (LARC) use in a multihospital health care system 2 years before and after the policy was implemented, and to assess factors associated with LARC use and repeat pregnancy rates within 12 months after delivery. METHODS: We conducted a retrospective chart review of all patients giving birth at three Cleveland Clinic Ohio hospitals from July 1, 2015, to June 30, 2019. We reviewed the inpatient medication reconciliation to identify the LARC initiation rate. We compared all patients who received inpatient postpartum LARC to a 1:3 matched sample of patients who did not receive LARC, matched by delivery date and location, to identify patient characteristics associated with LARC use. The electronic medical record (Epic) was reviewed to identify new pregnancies occurring within 12 months postdelivery. RESULTS: We identified 17,848 deliveries prepolicy and 18,555 deliveries postpolicy. Immediate postpartum LARC was used by 0.5% (monthly range 0-2.1%) of patients prepolicy and 11.6% (monthly range 8.3-15.4%) of patients postpolicy. Levonorgestrel intrauterine devices (IUDs) were used by 56.5%, implants by 29.1%, and copper IUDs by 14.5% of LARC users. Characteristics associated with LARC use included younger age, public insurance, non-White race, Hispanic or Latina ethnicity, higher body mass index, sexually transmitted infection in pregnancy, and tobacco use. Long-acting reversible contraceptive users had a lower rate of repeat pregnancy at 12 months postpartum compared with the non-LARC group (1.9% vs 3.6%, P<.001). CONCLUSION: Immediate postpartum LARC use increased after a state policy change mandated universal access and was associated with decreased pregnancy rates in the first year postdelivery.


Assuntos
Política de Saúde , Pacientes Internados/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Período Pós-Parto , Adulto , Anticoncepcionais Femininos/uso terapêutico , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Levanogestrel/uso terapêutico , Ohio/epidemiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
20.
Sci Rep ; 11(1): 19934, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620898

RESUMO

Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76-94%] in study (N = 60) vs. 63% [50-77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.


Assuntos
Cuidado da Criança , Comportamento de Escolha , Transtornos de Deglutição/epidemiologia , Métodos de Alimentação , Pais , Cuidado da Criança/métodos , Pré-Escolar , Transtornos de Deglutição/diagnóstico , Feminino , Fluoroscopia , Trânsito Gastrointestinal , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Manometria , Ohio/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...