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1.
J Med Microbiol ; 70(9)2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34542396

RESUMO

To the best of our knowledge to date there are no scientific studies specifically investigating whether the SARS-CoV-2 virus is present in the air or on the various surfaces in the school environment. The aim of this study was to determine if SARS-CoV-2 is present on various high touch surfaces and in the air across the elementary, middle and high schools in the Chester County of Pennsylvania, USA. One hundred and fifty surface swab samples and 45 air samples were analysed for the presence of the virus. All the samples tested were negative for the presence of SARS-CoV-2. The results indicate that the spread of the virus through contact and through air in the school buildings across the USA is highly unlikely.


Assuntos
Microbiologia do Ar , COVID-19 , Pandemias/prevenção & controle , SARS-CoV-2/isolamento & purificação , Instituições Acadêmicas , COVID-19/transmissão , COVID-19/virologia , Humanos , Pennsylvania/epidemiologia
2.
Am J Phys Med Rehabil ; 100(11): 1031-1032, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34483264

RESUMO

ABSTRACT: This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Pessoal de Saúde , Controle de Infecções/normas , Pneumonia Viral/prevenção & controle , Centros de Reabilitação , Adulto , COVID-19/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Fidelidade a Diretrizes , Humanos , Pacientes Internados , Masculino , Programas de Rastreamento , Pennsylvania/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
4.
Obstet Gynecol ; 138(1): 6-15, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259458

RESUMO

OBJECTIVE: To evaluate differences in short-term perinatal outcomes between the two prominent screening strategies for gestational diabetes mellitus, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan. METHODS: In this single-site, blinded, randomized, comparative effectiveness trial, participants received a nonfasting 50-g oral glucose tolerance test and, if less than 200 mg/dL (less than 11.1 mmol/L), were randomized to further screening with either IADPSG or Carpenter-Coustan criteria. Gestational diabetes treatment occurred per routine clinical care. The primary outcome was incidence of large-for-gestational-age (LGA) neonates. Prespecified secondary outcomes included small-for-gestational-age (SGA) neonates, cesarean birth, and neonatal and maternal composites of adverse perinatal outcomes. Assuming a 15% incidence of LGA neonates in the Carpenter-Coustan group, 782 participants provided more than 80% power to detect a 7% absolute risk reduction with the use of IADPSG; planned recruitment was 920 for anticipated attrition. RESULTS: From June 2015 to February 2019, 1,016 participants were enrolled and 921 were randomized to IADPSG (n=461) or Carpenter-Coustan (n=460) groups. Gestational diabetes incidence (14.4% vs 4.5%, P<.001) and diabetes medication use (9.3% vs 2.4%; P<.001) were more common in the IADPSG group; there were no differences in LGA neonates, either overall (risk reduction 0.90, 97.5% CI 0.53-1.52) or among women without gestational diabetes (risk reduction 0.85, 97.5% CI 0.49-1.48). Those screened with IADPSG had higher rates of neonatal morbidity but fewer study-related adverse events. Rates of SGA neonates, cesarean birth, and maternal morbidity composite did not differ significantly between study groups. CONCLUSIONS: The IADPSG screening criteria resulted in more women diagnosed and treated for gestational diabetes than Carpenter-Coustan without reducing the incidence of LGA birth weight or maternal or neonatal morbidity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02309138.


Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adulto , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Programas de Rastreamento/métodos , Pennsylvania/epidemiologia , Gravidez , Adulto Jovem
5.
Obstet Gynecol ; 138(1): 59-65, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259464

RESUMO

OBJECTIVE: To explore whether two-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy is associated with a lower rate of postoperative complications compared with a standard one-layer cuff closure. METHODS: A retrospective cohort study of total laparoscopic hysterectomies performed by fellowship-trained minimally invasive gynecologic surgeons between 2011 and 2017 was performed. Surgeons sutured the vaginal cuff laparoscopically, either in a two- or one-layer closure. The primary outcome was a composite of total postoperative complications, including all medical and surgical complications within 30 days and vaginal cuff complications within 180 days. Factors known to influence laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, and immunosuppressant medications were examined and controlled for, while surgeon skill, colpotomy technique, and suture material remained standardized. We conducted statistical analyses including χ2, Fisher exact test, logistic regression, and post hoc power calculations. RESULTS: Of the 2,973 women who underwent total laparoscopic hysterectomies, 40.8% (n=1,213) of vaginal cuffs were closed with a two-layer closure and 59.2% (n=1,760) with a one-layer technique. Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications (3.5% vs 5.7%; P<.01). The primary difference stemmed from lower vaginal cuff complications within 180 days (0.9% vs 2.6%; P<.01); no differences in 30-day medical and surgical postoperative complications were observed between the two groups (2.6% vs 3.1%; P=.77). No patients in the two-layer vaginal cuff closure cohort experienced a vaginal cuff dehiscence or mucosal separation compared with 1.0% in the one-layer group (P<.01). Compared with a one-layer closure, a two-layer closure was protective from postoperative complications (adjusted odds ratio 0.38, 95% CI 0.19-0.74). CONCLUSION: Although postoperative complications with laparoscopic hysterectomies are rare, two-layer laparoscopic vaginal cuff closure is associated with lower total postoperative complications compared with a one-layer closure. The difference was primary driven by cuff complications.


Assuntos
Histerectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Técnicas de Sutura/estatística & dados numéricos , Vagina/cirurgia , Adulto , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Laparoscopia , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
7.
J Am Heart Assoc ; 10(15): e020425, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34320844

RESUMO

Background Readmissions in patients with congestive heart failure are common and often preventable. Limited data suggest that patients discharged to a less intensive postacute care setting than recommended are likely to readmit. We examined whether postacute setting discordance (discharge to a less intensive postacute setting than recommended by a physical and occupational therapist) was associated with hospital readmission in patients with congestive heart failure. We also assessed sociodemographic and clinical predictors of setting discordance. Methods and Results Retrospective analysis of administrative claims and electronic health record data was conducted on 25 500 adults with a discharge diagnosis of congestive heart failure from 12 acute care hospitals in Western Pennsylvania. Generalized linear mixed models were estimated to examine the association between postacute setting discordance and 30-day hospital readmission and to identify predictors of setting discordance. The 30-day readmission and postacute setting discordance rates were high (23.7%, 20.6%). While controlling for demographic and clinical covariates, patients in discordant postacute settings were more likely to be readmitted within 30 days (adjusted odds ratio [OR], 1.12; 95% CI, 1.04-1.20). The effect was also seen in the subgroup of patients with low mobility scores (adjusted OR, 1.20; 95% CI, 1.08-1.33). Factors associated with setting discordance were lower-income, higher comorbidity burden, therapist recommendation disagreement, and midrange mobility limitations. Conclusions Postacute setting discordance was associated with an increased readmission risk in patients hospitalized with congestive heart failure. Maximizing concordance between therapist recommended and actual postacute discharge setting may decrease readmissions. Understanding factors associated with post-acute setting discordance can inform strategies to improve the quality of the discharge process.


Assuntos
Assistência ao Convalescente , Continuidade da Assistência ao Paciente/normas , Insuficiência Cardíaca , Readmissão do Paciente/estatística & dados numéricos , Cuidados Semi-Intensivos , Cooperação e Adesão ao Tratamento , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Idoso , Causalidade , Comorbidade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Limitação da Mobilidade , Alta do Paciente , Pennsylvania/epidemiologia , Cuidados Semi-Intensivos/métodos , Cuidados Semi-Intensivos/estatística & dados numéricos
8.
J Am Heart Assoc ; 10(13): e020466, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34212757

RESUMO

Background Assessment of the social determinants of post-hospital cardiac care is needed. We examined the association and predictive ability of neighborhood-level determinants (area deprivation index, ADI), readmission risk, and mortality for heart failure, myocardial ischemia, and atrial fibrillation. Methods and Results Using a retrospective (January 1, 2011-December 31, 2018) analysis of a large healthcare system, we assess the predictive ability of ADI on 30-day and 1-year readmission and mortality following hospitalization. Cox proportional hazards models analyzed time-to-event. Log rank analyses determined survival. C-statistic and net reclassification index determined the model's discriminative power. Covariates included age, sex, race, comorbidity, number of medications, length of stay, and insurance. The cohort (n=27 694) had a median follow-up of 46.5 months. There were 14 469 (52.2%) men and 25 219 White (91.1%) patients. Patients in the highest ADI quintile (versus lowest) were more likely to be admitted within 1 year of index heart failure admission (hazard ratio [HR], 1.25; 95% CI, 1.03‒1.51). Patients with myocardial ischemia in the highest ADI quintile were twice as likely to be readmitted at 1 year (HR, 2.04; 95% CI, 1.44‒2.91]). Patients with atrial fibrillation living in areas with highest ADI were less likely to be admitted within 1 year (HR, 0.79; 95% CI, 0.65‒0.95). As ADI increased, risk of readmission increased, and risk reclassification was improved with ADI in the models. Patients in the highest ADI quintile were 25% more likely to die within a year (HR, 1.25 1.08‒1.44). Conclusions Residence in socioeconomically disadvantaged communities predicts rehospitalization and mortality. Measuring neighborhood deprivation can identify individuals at risk following cardiac hospitalization.


Assuntos
Fibrilação Atrial/epidemiologia , Registros Eletrônicos de Saúde , Insuficiência Cardíaca/epidemiologia , Isquemia Miocárdica/epidemiologia , Readmissão do Paciente , Características de Residência , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/terapia , Pennsylvania/epidemiologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
Sci Total Environ ; 795: 148697, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34252768

RESUMO

How weather affects tick development and behavior and human Lyme disease remains poorly understood. We evaluated relations of temperature and humidity during critical periods for the tick lifecycle with human Lyme disease. We used electronic health records from 479,344 primary care patients in 38 Pennsylvania counties in 2006-2014. Lyme disease cases (n = 9657) were frequency-matched (5:1) by year, age, and sex. Using daily weather data at ~4 km2 resolution, we created cumulative metrics hypothesized to promote (warm and humid) or inhibit (hot and dry) tick development or host-seeking during nymph development (March 1-May 31), nymph activity (May 1-July 30), and prior year larva activity (Aug 1-Sept 30). We estimated odds ratios (ORs) of Lyme disease by quartiles of each weather variable, adjusting for demographic, clinical, and other weather variables. Exposure-response patterns were observed for higher cumulative same-year temperature, humidity, and hot and dry days (nymph-relevant), and prior year hot and dry days (larva-relevant), with same-year hot and dry days showing the strongest association (4th vs. 1st quartile OR = 0.40; 95% confidence interval [CI] = 0.36, 0.43). Changing temperature and humidity could increase or decrease human Lyme disease risk.


Assuntos
Ixodes , Doença de Lyme , Animais , Humanos , Umidade , Doença de Lyme/epidemiologia , Pennsylvania/epidemiologia , Temperatura
10.
J Health Commun ; 26(6): 402-412, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34292858

RESUMO

As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.


Assuntos
COVID-19/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
MMWR Morb Mortal Wkly Rep ; 70(30): 1040-1043, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34324479

RESUMO

The School District of Philadelphia reopened for in-school instruction the week of March 21, 2021, and required weekly testing for SARS-CoV-2, the virus that causes COVID-19, for all employees returning to in-school responsibilities. The resumption of in-school instruction followed a mass vaccination program using the Pfizer-BioNTech 2-dose vaccine offered under a partnership between the Philadelphia Department of Public Health and Children's Hospital of Philadelphia to all 22,808 School District of Philadelphia employees during February 23-April 3, 2021.* The subsequent mandatory testing program provided an opportunity to assess the percentage of positive BinaxNow point-of-care antigen tests (Abbott Laboratories) identified among school staff members based on their self-reported vaccination status (i.e., received zero, 1, or 2 vaccine doses) at the time of testing. During the initial 5 weeks after schools reopened, 34,048 screening tests were performed. Overall, 0.70% of tests returned a positive result. The percentage of positive test results was lower among persons who reported receipt of 2 vaccine doses (0.09%) compared with those who reported receipt of 1 dose (1.21%) or zero doses (1.76%) (p<0.001) representing a 95% reduction in percentage of positive SARS-CoV-2 test results among persons reporting receipt of 2 compared with zero doses of Pfizer-BioNTech vaccine. Vaccination of school staff members has been highlighted as an important strategy to maximize the safety of in-person education of K-12 students this fall (1). These findings reinforce the importance of promoting COVID-19 vaccination among school staff members before commencement of the 2021-22 school year.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Programas de Imunização , Professores Escolares/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Instituições Acadêmicas , Adulto Jovem
12.
J Trauma Acute Care Surg ; 91(1): 206-211, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144564

RESUMO

INTRODUCTION: Benzodiazepines (BZDs) modulate peripheral γ-amino-butyric acid type A on macrophages causing immunomodulation. They inhibit proinflammatory cytokines increasing infections. Prior studies have also shown that infections can increase thrombotic complications. We sought to examine this relationship in trauma patients. We hypothesized that the presence of BZDs on admission urine drug screen (UDS) would increase rates of both complications. METHODS: All patients submitted to the Pennsylvania Trauma Outcome Study database from 2003 to 2018 were queried. Those with a positive UDS for BZDs were analyzed. Infectious complications were defined as pneumonia, urinary tract infection, sepsis, wound, and soft tissue infection, and thrombotic complications were defined as presence of pulmonary embolism or deep vein thrombosis. Logistic regressions controlling for demographic and injury covariates assessed the adjusted impact of BZDs on infectious and thrombotic complications. RESULTS: A total of 3,393 patients (2.08%) had infectious complications, and 3,048 (1.87%) had thrombotic complications. Furthermore, 33,260 patients (20.4%) had a positive UDS for BZDs on admission. Univariate analysis showed that those positive for BZDs had higher rates of infectious (3.33% vs. 1.76%, p < 0.001) and thrombotic (2.84% vs. 1.62%, p < 0.001) complications. Multivariate analysis revealed that BZDs significantly increased the odds of infectious and thrombotic complications. Patients who tested positive for BZDs and subsequently developed infection had increased odds (adjusted odds ratio, 1.65; p < 0.001) of developing thrombotic complications. CONCLUSION: Trauma patients with a positive UDS for BZDs had higher odds of both infectious and thrombotic complications. Moreover, odds of thrombotic complications were higher in those with infections. LEVEL OF EVIDENCE: Epidemiological, level III.


Assuntos
Benzodiazepinas/efeitos adversos , Infecções/epidemiologia , Trombose/epidemiologia , Ferimentos e Lesões/complicações , Adulto , Idoso , Benzodiazepinas/urina , Bases de Dados Factuais , Feminino , Humanos , Infecções/urina , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Admissão do Paciente , Pennsylvania/epidemiologia , Fatores de Risco , Trombose/urina , Adulto Jovem
13.
Vaccine ; 39(31): 4291-4295, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34172330

RESUMO

BACKGROUND: This investigation sought to determine whether early season rates of pediatric influenza vaccination changed in a season when there was a concurrent COVID-19 pandemic. METHODS: This study used cohort and cross sectional data from an academic primary care division in Southcentral Pennsylvania that serves approximately 17,500 patients across 4 practice sites. Early season (prior to November 1) vaccination rates in 2018, 2019 and 2020 were recorded for children, age 6 months to 17 years. To explore the impact of COVID-19 on vaccination, we fit a model with a logit link (estimated via generalized estimating equations to account for clustering by patient over time) on calendar year, adjusted for race, ethnicity, age, and insurance type. We examined interaction effects of demographic covariates with calendar year. RESULTS: Early vaccination rates were lower in 2020 (29.7%) compared with 2018 and 2019 (34.2% and 33.3%). After adjusting for covariates and accounting for clustering over time, the odds of early vaccination in 2020 were 19% lower compared to 2018 (OR 0.81, 95% CI: 0.78-0.85). In 2020, children with private insurance were more likely to receive early vaccination than in 2018 (OR 1.51, 95% CI: 1.04-1.15), whereas children with public insurance were less likely to receive early vaccination in 2020 than in 2018 (OR 0.62, 95% CI: 1.38-1.65). CONCLUSIONS: Early influenza vaccination rates declined in a year with a concurrent COVID-19 pandemic. Modeling that accounts for individual trends and demographic variables identified specific populations with lower odds of early vaccination in 2020. Additional research is needed to investigate whether the COVID-19 pandemic impacted parental intent to obtain the influenza vaccine, or introduced barriers to healthcare access.


Assuntos
COVID-19 , Vacinas contra Influenza , Influenza Humana , Criança , Estudos Transversais , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pandemias , Pennsylvania/epidemiologia , SARS-CoV-2 , Vacinação
14.
J Trauma Acute Care Surg ; 91(3): 559-565, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074996

RESUMO

BACKGROUND: The COVID-19 pandemic reshaped the health care system in 2020. COVID-19 infection has been associated with poor outcomes after orthopedic surgery and elective, general surgery, but the impact of COVID-19 on outcomes after trauma is unknown. METHODS: We conducted a retrospective cohort study of patients admitted to Pennsylvania trauma centers from March 21 to July 31, 2020. The exposure of interest was COVID-19 (COV+) and the primary outcome was inpatient mortality. Secondary outcomes were length of stay and complications. We compared demographic and injury characteristics between positive, negative, and not-tested patients. We used multivariable regression with coarsened exact matching to estimate the impact of COV+ on outcomes. RESULTS: Of 15,550 included patients, 8,170 (52.5%) were tested for COVID-19 and 219 (2.7%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in terms of age and sex, but were less often white (53.5% vs. 74.7%, p < 0.0001), and more often uninsured (10.1 vs. 5.6%, p = 0.002). Injury severity was similar, but firearm injuries accounted for 11.9% of COV+ patients versus 5.1% of COV- patients (p < 0.001). Unadjusted mortality for COV+ was double that of COV- patients (9.1% vs. 4.7%, p < 0.0001) and length of stay was longer (median, 5 vs. 4 days; p < 0.001). Using coarsened exact matching, COV+ patients had an increased risk of death (odds ratio [OR], 6.05; 95% confidence interval [CI], 2.29-15.99), any complication (OR, 1.85; 95% CI, 1.08-3.16), and pulmonary complications (OR, 5.79; 95% CI, 2.02-16.54) compared with COV- patients. CONCLUSION: Patients with concomitant traumatic injury and COVID-19 infection have elevated risks of morbidity and mortality. Trauma centers must incorporate an understanding of these risks into patient and family counseling and resource allocation during this pandemic. LEVEL OF EVIDENCE: Level II, Prognostic Study.


Assuntos
COVID-19/epidemiologia , Tempo de Internação/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/etnologia , Teste para COVID-19/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Ferimentos e Lesões/complicações , Ferimentos por Arma de Fogo/epidemiologia
15.
PLoS One ; 16(6): e0252804, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125848

RESUMO

Streptococcus equi subsp. equi (SEE) is a host-restricted bacterium that causes the common infectious upper respiratory disease known as strangles in horses. Perpetuation of SEE infection appears attributable to inapparent carrier horses because it neither persists long-term in the environment nor infects other host mammals or vectors, and infection results in short-lived immunity. Whether pathogen factors enable SEE to remain in horses without causing clinical signs remains poorly understood. Thus, our objective was to use next-generation sequencing technologies to characterize the genome, methylome, and transcriptome of isolates of SEE from horses with acute clinical strangles and inapparent carrier horses-including isolates recovered from individual horses sampled repeatedly-to assess pathogen-associated changes that might reflect specific adaptions of SEE to the host that contribute to inapparent carriage. The accessory genome elements and methylome of SEE isolates from Sweden and Pennsylvania revealed no significant or consistent differences between acute clinical and inapparent carrier isolates of SEE. RNA sequencing of SEE isolates from Pennsylvania demonstrated no genes that were differentially expressed between acute clinical and inapparent carrier isolates of SEE. The absence of specific, consistent changes in the accessory genomes, methylomes, and transcriptomes of acute clinical and inapparent carrier isolates of SEE indicates that adaptations of SEE to the host are unlikely to explain the carrier state of SEE. Efforts to understand the carrier state of SEE should instead focus on host factors.


Assuntos
Portador Sadio/diagnóstico , Epigenoma/genética , Genoma/genética , Doenças dos Cavalos/diagnóstico , Streptococcus/genética , Transcriptoma/genética , Animais , Portador Sadio/microbiologia , DNA Bacteriano/análise , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Diagnóstico Diferencial , Surtos de Doenças , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/microbiologia , Cavalos , Pennsylvania/epidemiologia , RNA Bacteriano/análise , RNA Bacteriano/genética , RNA Bacteriano/isolamento & purificação , RNA-Seq/métodos , Especificidade da Espécie , Streptococcus/classificação , Streptococcus/fisiologia , Suécia/epidemiologia , Sequenciamento Completo do Genoma/métodos
16.
J Subst Abuse Treat ; 126: 108465, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34116815

RESUMO

BACKGROUND: The prevalence of injection drug use (IDU)-related skin and soft tissue infections (SSTI) in Philadelphia has been steadily increasing since 2013. Patients seeking treatment for these infections are more likely to be discharged against medical advice (AMA), increasing the likelihood that they will end antibiotic treatment prematurely and require additional medical interventions. METHODS: The research team performed a nested case-control study using the Pennsylvania Health Care Cost Containment Council database for Philadelphia residents hospitalized for SSTI and substance use-related diagnoses between 2013 and 2018. The primary outcome was readmission in the same or following quarter. The study examined the impact of discharge AMA on readmission along with clinical characteristics including diagnoses for anxiety, bipolar disorder, depression, schizophrenia, diabetes, and polydrug use. RESULTS: There were 8265 hospitalizations for IDU-related SSTI and 316 (6%) were readmitted to the hospital at least once in the same or following quarter. In total, 23.4% of cases and 13% of controls left AMA. In the final multivariable regression model, AMA discharge (AOR 2.04, 95% CI 1.46-2.86), anxiety (AOR 1.44, 95% CI 1.01-2.05), diabetes (AOR 2.02, 95% CI 1.46-2.81), and polydrug use (AOR 2.11, 95% CI 1.52-2.92) were associated with higher odds of readmission. CONCLUSIONS: Our study demonstrates that readmissions for IDU-related SSTI are associated with recent discharge AMA. As IDU-related SSTI and polydrug use continue to rise, premature antibiotic treatment completion will impact more people, leading to worse health outcomes and additional strain on the health care system.


Assuntos
Preparações Farmacêuticas , Infecções dos Tecidos Moles , Estudos de Casos e Controles , Humanos , Alta do Paciente , Readmissão do Paciente , Pennsylvania/epidemiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia
17.
J Prim Care Community Health ; 12: 21501327211017780, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34009062

RESUMO

BACKGROUND: Despite declining lead exposure among U.S. children, childhood blood lead level (BLL) undertesting and elevation remains a public health issue. This study explores the impacts of maternal, infant, and neighborhood characteristics on the receipt of lead testing and having elevated BLLs (EBLLs) among children under age two. METHODS: Pennsylvania infants born in 2015 and 2016 were followed to 24 months. Birth certificate data were linked to 2015 through 2018 blood lead surveillance data and neighborhood data on household income, poverty, and the burden of houses built before 1970. Generalized linear mixed models were used to examine the individual and neighborhood characteristics independently and/or interactively affecting the likelihood of lead testing and of having EBLLs. RESULTS: A total of 48.6% of children were tested for BLLs, and 2.6% of them had confirmed EBLLs. The likelihood of lead testing and of having EBLLs among non-Hispanic black children was respectively 7% and 18% higher than white children. Children born to mothers with the lowest educational attainment (

Assuntos
Intoxicação por Chumbo , Chumbo , Criança , Estudos de Coortes , Estudos Transversais , Humanos , Lactente , Chumbo/análise , Intoxicação por Chumbo/diagnóstico , Intoxicação por Chumbo/epidemiologia , Pennsylvania/epidemiologia , Características de Residência
18.
Med Sci Sports Exerc ; 53(6): 1245-1251, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33986230

RESUMO

INTRODUCTION: Repetitive head impacts in soccer have been linked to short-term neurophysiological deficits, and female soccer players have higher concussion rates than males. These findings have inspired investigation into gender differences in head impact exposure and how head impact rate contributes to the cumulative effect of head impact exposure on neurological outcomes. Various periods of exposure have been used to calculate head impact rates, including head impacts per season, game, and player-hour. PURPOSE: The aim of this study was to apply different methodological approaches to quantify and compare head impact rates by gender for two seasons of high school varsity soccer. METHODS: Video review was used to confirm all events recorded by a headband-mounted impact sensor and calculate playing time for all players. Impact rates were calculated per athlete exposure (presence and participation) and per player-hour (scheduled game time, individual play time, and absolute time). RESULTS: Impact rates per athlete exposure ranged from 2.5 to 3.2 for males and from 1.4 to 1.6 for females, and impact rates per player-hour ranged from 2.7 to 3.8 for males and from 1.0 to 1.6 for females. The exposure calculation method significantly affected head impact rates; however, regardless of approach, the head impact rate for males was higher, up to threefold, than for females. Individual head impact exposure varied substantially within a team with one in five players experiencing no impacts. CONCLUSIONS: Overall, the gender differences found in this study indicate that males experience higher head impact exposure compared with females. Future studies are needed to understand potential clinical implications of variability in head impact exposure and reconcile higher female concussion rates with the reduced head impact rates presented herein.


Assuntos
Cabeça/fisiologia , Futebol/fisiologia , Concussão Encefálica/epidemiologia , Concussão Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Pennsylvania/epidemiologia , Estudos Prospectivos , Instituições Acadêmicas , Distribuição por Sexo , Fatores Sexuais , Futebol/lesões , Fatores de Tempo , Estudos de Tempo e Movimento
19.
J Med Virol ; 93(9): 5582-5587, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34042189

RESUMO

Identify factors associated with readmission after an index hospital admission for coronavirus disease 2019 (COVID-19) infection in a single center serving an underserved and predominantly minority population. This retrospective descriptive study included 275 patients who tested COVID-19 positive via reverse transcriptase-polymerase chain reaction assay at our institution and who survived the index hospitalization. The main outcomes were 1- and 6-month readmission rates after an index hospitalization for COVID-19. The mortality rate among the readmitted patients was also determined. Factors independently associated with readmission were investigated using multivariable logistic regression. A final sample of 275 patients was included. The mean age was 64.69 ± 14.64 (SD), 133 (48%) were female and 194 (70%) were African American. Their chronic medical conditions included hypertension 203 (74%) and diabetes mellitus 121 (44%). After the hospitalization, 1-month readmission rate was 7.6%, while 6-month readmission rate was 24%. Nine percent of patients who were readmitted subsequently died. Coronary artery disease (CAD) was significantly associated with 6-month readmission odds ratio (OR), 2.15 (95% confidence interval [CI]: 1.04-4.44; p = 0.039) after adjustment for age, gender, ethnicity, and comorbidities. Readmissions were due to cardiac, respiratory, and musculoskeletal symptoms. Hispanic ethnicity was associated with increased readmission OR, 3.16 (95% CI: 1.01-9.88; p = 0.048). No significant difference was found between inflammatory markers or clinical outcomes during the index hospitalization among patients who were readmitted compared to those who were not. A significant number of patients hospitalized for COVID-19 may be readmitted. The presence of CAD is independently associated with high rates of 6-month readmission.


Assuntos
COVID-19/terapia , Readmissão do Paciente/estatística & dados numéricos , SARS-CoV-2 , Idoso , COVID-19/mortalidade , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pennsylvania/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
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