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2.
Am J Public Health ; 110(4): 580-586, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078355

RESUMO

Objectives. To describe and report initial outcomes of a low-threshold, group-based primary care medication for opioid use disorder (OUD) program in a federally qualified health center.Methods. We performed a retrospective chart review of patients enrolled in the program from October 4, 2017, to October 3, 2018, in Philadelphia, Pennsylvania. The main outcome measure was time retained in treatment, defined as time from treatment initiation to unplanned treatment termination. Secondary outcomes were the relationships between treatment retention and cocaine use or housing status. We analyzed retention in treatment using Kaplan-Meier survival estimates.Results. The 3- and 6-month retention rates were 82% and 63%, respectively. The log-rank test showed no significant differences for comparisons between homeless versus not homeless (P = .25) and cocaine use versus no cocaine use (P = .12).Conclusions. The medication for OUD program engaged a large number of patients from marginalized groups. Three- and 6-month retention rates were comparable with those reported of other federally qualified health center populations.Public Health Implications. Integrating treatment of OUD into primary care shows promise for increasing access to and retention in medication for OUD services. The federally qualified health center payment structure supports the sustainability of the group visit model.


Assuntos
Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia , Atenção Primária à Saúde/métodos , Estudos Retrospectivos , Resultado do Tratamento , Populações Vulneráveis
3.
Am J Public Health ; 110(4): 540-546, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078356

RESUMO

Objectives. To identify the effect of a Breakfast in the Classroom (BIC) initiative on the foods and drinks students consume in the morning.Methods. Sixteen public schools in Philadelphia, Pennsylvania, that provide universal breakfast participated in a group randomized trial to examine the effects of BIC with complementary nutrition promotion between 2013 and 2016. Control schools (n = 8) offered breakfast in the cafeteria before school. Baseline data were collected from 1362 students in grades 4 to 6. Endpoint data were collected after 2.5 years. Students self-reported the foods and drinks they consumed in the morning.Results. At endpoint, there was no effect of the intervention on breakfast skipping. Nearly 30% of intervention students consumed breakfast foods or drinks from multiple locations, as compared with 21% of control students. A greater proportion of intervention students than control students consumed 100% juice, and a smaller proportion consumed sugar-sweetened beverages and foods high in saturated fat and added sugar.Conclusions. A BIC initiative led to improvements in the types of foods and drinks students consumed in the morning. However, the program did not reduce breakfast skipping and increased the number of locations where students ate.


Assuntos
Desjejum , Serviços de Alimentação/organização & administração , Instituições Acadêmicas , Bebidas/classificação , Criança , Feminino , Alimentos/classificação , Assistência Alimentar , Humanos , Masculino , Philadelphia , Avaliação de Programas e Projetos de Saúde
4.
Am J Public Health ; 110(4): 547-553, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078358

RESUMO

Objectives. To evaluate changes in licensed tobacco retailers and retailer density 5 years before and 3 years after novel tobacco retailer licensing regulations were implemented in a large, urban area.Methods. We used administrative tobacco license data (n = 23 806 licenses, 2012-2019) to calculate (1) annual retailer density by district (n = 18), (2) density by district and school income status, and (3) retailers within 500 feet of schools (n = 673) before and after regulations.Results. Observed tobacco retailer density declined by 20.3% (from 1.97 to 1.57 per 1000 daytime residents) 3 years after regulation implementation. Regression results showed a decline in the trend of retailers per 1000 daytime population (b = -0.19; 95% confidence interval[CI] = -0.23, -0.14) that was modestly but significantly greater in low-income districts (interaction b = -0.18; 95% CI = -0.25, -0.11) and a 12% decline in the rates of retailers near schools (rate ratio = 0.88; 95% CI = 0.85, 0.92) following implementation of the regulations. We did not observe similar density changes in comparable cities.Conclusions. Tobacco retailer licensing strategies can be an effective policy approach to reduce the availability of tobacco and tobacco marketing, lessen socioeconomic disparities in tobacco retailer density, and decrease the number of tobacco outlets near schools.


Assuntos
Comércio/legislação & jurisprudência , Licenciamento/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Comércio/estatística & dados numéricos , Philadelphia , Instituições Acadêmicas , Fatores Socioeconômicos , Produtos do Tabaco/estatística & dados numéricos
5.
PLoS One ; 15(2): e0228471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023310

RESUMO

BACKGROUND: Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients' experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection. METHODS: The Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments. RESULTS: The revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss. CONCLUSIONS: The 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.


Assuntos
Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/psicologia , Psicometria , Estigma Social , Inquéritos e Questionários/normas , Adolescente , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Infecções por HIV/epidemiologia , Hepacivirus , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Reprodutibilidade dos Testes , Estereotipagem , Adulto Jovem
7.
AIDS Patient Care STDS ; 34(1): 7-15, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31944853

RESUMO

Young black and Latinx men who have sex with men (YBLMSM) and transgender women (YBLTW) are disproportionately impacted by HIV. Structural and social marginalization, the social barriers, and structures that unevenly distribute benefits and burdens to different groups, may contribute to inability for youth to access prevention and treatment care services. Yet, few reports have examined the community and health care experiences of social marginalization among youth service providers who have multiple roles in the community (i.e., serve as a service provider and are a member or prior member of the YBLMSM and YBLTW population). Eighteen key informants (KIs), defined as youth, young adults, or adults who were members of or connected to the YBLMSM and young black and Latinx transgender (YBLTG) community, participated in a one-time, face-to-face, or telephone key informant interview (KII) lasting ∼45 min. KIs were defined as youth service providers because they described working with the target population and either being a member of or closely connected to the target population. KIs described key themes related to marginalization: lack of competent care among health care providers and both clinical and community spaces that left out key populations. HIV stigma and medical mistrust continues to create a barrier to care in this population and for interventions to be effective interventions will need to use an intersectional approach that simultaneously address all identities, and the social and structural needs of youth.


Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Homossexualidade Masculina/psicologia , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Pessoas Transgênero/psicologia , Confiança , Adolescente , Adulto , Afro-Americanos , Baltimore , District of Columbia , Grupo com Ancestrais do Continente Europeu , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Acesso aos Serviços de Saúde , Hispano-Americanos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Philadelphia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Transexualidade , Adulto Jovem
8.
Occup Environ Med ; 77(2): 84-93, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31896615

RESUMO

OBJECTIVES: To update the mortality experience of a previously studied cohort of 29 992 US urban career firefighters compared with the US general population and examine exposure-response relationships within the cohort. METHODS: Vital status was updated through 2016 adding 7 years of follow-up. Cohort mortality compared with the US population was evaluated via life table analyses. Full risk-sets, matched on attained age, race, birthdate and fire department were created and analysed using the Cox proportional hazards regression to examine exposure-response associations between select mortality outcomes and exposure surrogates (exposed-days, fire-runs and fire-hours). Models were adjusted for a potential bias from healthy worker survivor effects by including a categorical variable for employment duration. RESULTS: Compared with the US population, mortality from all cancers, mesothelioma, non-Hodgkin's lymphoma (NHL) and cancers of the oesophagus, intestine, rectum, lung and kidney were modestly elevated. Positive exposure-response relationships were observed for deaths from lung cancer, leukaemia and chronic obstructive pulmonary disease (COPD). CONCLUSIONS: This update confirms previous findings of excess mortality from all cancers and several site-specific cancers as well as positive exposure-response relations for lung cancer and leukaemia. New findings include excess NHL mortality compared with the general population and a positive exposure-response relationship for COPD. However, there was no evidence of an association between any quantitative exposure measure and NHL.


Assuntos
Bombeiros , Neoplasias/mortalidade , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Ocupações , Adolescente , Adulto , Idoso , Causas de Morte , Chicago/epidemiologia , Estudos de Coortes , Feminino , Humanos , Leucemia/mortalidade , Neoplasias Pulmonares/mortalidade , Linfoma não Hodgkin/mortalidade , Masculino , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/mortalidade , São Francisco/epidemiologia , Adulto Jovem
10.
Am J Public Health ; 110(2): 189-195, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855483

RESUMO

OBJECTIVE: To quantify the association between heat and infant mortality and identify factors that influence infant vulnerability to heat. METHODS: We conducted a time-stratified case-crossover analysis of associations between ambient temperature and infant mortality in Philadelphia, Pennsylvania, during the warm months of 2000 through 2015. We used conditional logistic regression models to estimate associations of infant mortality with daily temperatures on the day of death (lag 0) and for averaging periods of 0 to 1 to 0 to 3 days before the day of death. We explored modification of associations by individual and census tract-level characteristics and by amounts of green space. RESULTS: Risk of infant mortality increased by 22.4% (95% confidence interval [CI] = 5.0%, 42.6%) for every 1°C increase in minimum daily temperature over 23.9°C on the day of death. We observed limited evidence of effect modification across strata of the covariates. CONCLUSIONS: Our results contribute to a growing body of evidence that infants are a subpopulation that is particularly vulnerable to climate change effects. Further research using large data sets is critically needed to elucidate modifiable factors that may protect infants against heat vulnerability.


Assuntos
Calor Extremo/efeitos adversos , Mortalidade Infantil/tendências , Pobreza , População Urbana , Estudos Cross-Over , Feminino , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Masculino , Philadelphia , Estações do Ano
12.
J Cross Cult Gerontol ; 35(1): 85-98, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31848885

RESUMO

This study examined how aspects of culture, social support, isolation, and loneliness are perceived as influences in chronic illness management by pre-diabetic (Glycated hemoglobin A1c levels between 5.7 and 6.4) or Type 2 diabetic patients (A1c levels between 6.4 and 8). Twenty-eight Middle Eastern immigrants in the greater Philadelphia area were interviewed using a semi-structured approach. Results were consistent with other research which suggests that patients benefit from family and community support in the management of their illness. However, findings also suggest that even in the presence of strong family and social support, patients report increased feelings of isolation and loneliness because they have to manage a complex illness that requires many lifestyle changes. For immigrant suffering from chronic illnesses, social gatherings, especially those that center on the consumption of traditional ethnic food, can be highly stressful because they need to avoid such foods as part of their daily treatment regimen. The results of this study have significant implications for patients, physicians, and psychologists who can benefit from an increased sensitivity to patients' challenges in illness management by understanding how cultural factors affect compliance in diabetes treatment regimens.


Assuntos
Características Culturais , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Emigrantes e Imigrantes/psicologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Solidão , Masculino , Pessoa de Meia-Idade , Oriente Médio/etnologia , Philadelphia , Pesquisa Qualitativa , Apoio Social
13.
Ann Vasc Surg ; 62: 70-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207398

RESUMO

BACKGROUND: The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. METHODS: A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. RESULTS: In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P = 0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P = 0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P = 1.0) with full recovery to normal function. CONCLUSIONS: Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/anormalidades , Descompressão Cirúrgica/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Frênico/anormalidades , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Maryland , Traumatismos dos Nervos Periféricos/fisiopatologia , Philadelphia , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento
14.
Environ Pollut ; 255(Pt 1): 113195, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31622955

RESUMO

Mobile monitoring is a useful approach for measuring intra-urban variation of air pollution in urban environments. In this study, we used a mobile monitoring approach to study the spatial-temporal variability of air and noise pollution in urban neighborhoods of Philadelphia. During summer 2017, we used portable instruments to measure PM2.5, black carbon (BC), and noise levels along 5 km paths in four residential neighborhoods (Tioga, Mill Creek, Chestnut Hill, and Northern Liberties) and one commercial district (Center City) in Philadelphia, Pennsylvania, USA. A total of 62 sets of measurements were made at three different times of day (during morning rush hour, mid-afternoon, and during afternoon rush hour) from June 5 to July 7, 2017. Spatially, there was a significant difference in PM2.5 concentrations among the four residential neighborhoods. Overall, the Chestnut Hill neighborhood had the highest PM2.5 concentrations (13.25 ±â€¯6.89 µg/m3), followed by Tioga (9.58 ±â€¯4.83 µg/m3), Northern Liberties (7.02 ±â€¯4.17 µg/m3), and Mill Creek (3.9 ±â€¯4.5 µg/m3). There was temporal variability of pollutants depending on the neighborhood; Northern Liberties demonstrated the highest temporal variability in these data. The highest PM2.5 (18.86 ±â€¯3.17 mg/m3) was measured in the Chestnut Hill neighborhood during mid-afternoon. Mean PM2.5, BC, and noise levels based on mobile measurements at Philadelphia during summer 2017 were 8.41 ±â€¯4.31 µg/m3, 0.99 ±â€¯0.44 µg C/m3, and 62.01 ±â€¯3.20 dBA, respectively. Environmental noise showed the highest temporal variation of the monitored components for 3 time periods. In general, tree cover showed a weak and inconclusive association with particulate pollution levels.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental/métodos , Ruído , Fuligem/análise , Philadelphia , Estações do Ano
15.
Artigo em Inglês | MEDLINE | ID: mdl-31581461

RESUMO

Slowing traffic speed in urban areas has been shown to reduce pedestrian injuries and fatalities due to automobile accidents. This research aims to measure how brick and granite block paving materials, which were widely used historically prior to the use of asphalt paving in many cities, may influence free flow traffic speed. Traffic speeds for 690 vehicles traversing street blocks paved with asphalt, granite block, and brick materials were measured using a radar gun on a sample of 18 matched pair (asphalt and historic paving material) street blocks in Philadelphia, Pennsylvania. Fixed effects linear regression was used to estimate the effect of paving material on vehicle speed after controlling for the street class (e.g., arterial versus local road) and the matched pair. Results indicate that brick reduced speeds by approximately 3 mph (~5 km/h) and granite block reduced speeds by approximately 7 mph (~11 km/h), as compared to asphalt paved city streets, which we attribute to drivers intentionally slowing due to road roughness. This research suggests that brick and granite block paving materials may be an effective traffic calming strategy, having implications for reducing negative health outcomes associated with pedestrian-automobile collisions.


Assuntos
Acidentes de Trânsito/prevenção & controle , Condução de Veículo/estatística & dados numéricos , Pedestres , Dióxido de Silício , Adulto , Cidades , Humanos , Modelos Lineares , Philadelphia , Segurança
17.
Waste Manag ; 100: 278-286, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563841

RESUMO

Predicting waste disposal of a given municipality could be complicated and expensive for government agencies. Lack of a uniform modeling approach, the gap between the scientific community and the government, inaccessibility to the forecasts of variables used in the waste management literature, and budget deficiencies could all result in over-simplification and possibly employing inaccurate modeling approaches for decision makers. This paper portrays the trend of Total Solid Waste (TSW) and Municipal Solid Waste (MSW) disposal of Philadelphia (Pennsylvania, US) with respect to the rate of population change, unemployment rate change, and the current recycling policies. The objective is to develop satisfactory predictive models for the TSW disposal using the same number of variables as currently used by the City of Philadelphia. It is crucial to include an economic factor such as unemployment rate in modeling the waste disposal, especially during economic downturns when economic factors can dominate the effects of population change on waste generation and therefore disposal. Two predictive models are developed using time series analysis and stationary multiple linear regression. The stationary multiple linear regression model yields more accurate predictions for both TSW and MSW disposal of Philadelphia with an approximate level of 8.8% Root Mean Square Percentage Error (RMSPE) and R2 of 0.7. Even the VAR model, with RMSE of 0.15 million tons (RMSPE = 10.7%), provides better estiamtions than does the City of Philadelphia's current working model.


Assuntos
Eliminação de Resíduos , Gerenciamento de Resíduos , Cidades , Philadelphia , Resíduos Sólidos , Desemprego
18.
J Pediatr Orthop ; 39(9): e698-e702, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503227

RESUMO

BACKGROUND: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE: Level II-prognostic study.


Assuntos
Osteogênese por Distração/efeitos adversos , Costelas/cirurgia , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Philadelphia/epidemiologia , Próteses e Implantes/efeitos adversos , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Doenças Torácicas/cirurgia
19.
Artigo em Inglês | MEDLINE | ID: mdl-31480420

RESUMO

Current objective data on aircraft noise effects on sleep are needed in the US to inform policy. In this pilot field study, heart rate and body movements were continuously measured during sleep of residents living in the vicinity of Philadelphia International Airport (PHL) and in a control region without aircraft noise with sociodemographic characteristics similar to the exposed region (N = 40 subjects each). The primary objective was to establish the feasibility of unattended field measurements. A secondary objective was to compare objective and subjective measures of sleep and health between control and aircraft noise exposed groups. For all measurements, there was less than 10% of data loss, demonstrating the feasibility of unattended home measurements. Based on 2375 recorded aircraft noise events, we found a significant (unadjusted p = 0.0136) exposure-response function between the maximum sound pressure level of aircraft noise events and awakening probability inferred from heart rate increases and body movements, which was similar to previous studies. Those living near the airport reported poorer sleep quality and poorer health than the control group in general, but when asked in the morning about their last night's sleep, no significant difference was found between groups. Neither systolic nor diastolic morning blood pressures differed between study regions. While this study demonstrates the feasibility of unattended field study measurements, for a national study around multiple US airports refinements of the study design are necessary to further lower methodological expense and increase participation rates.


Assuntos
Aeroportos , Ruído dos Transportes , Distúrbios do Início e da Manutenção do Sono , Sono/fisiologia , Adulto , Idoso , Aeronaves , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia , Projetos Piloto , Adulto Jovem
20.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501233

RESUMO

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Assuntos
Desenvolvimento Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Arkansas/epidemiologia , Baltimore/epidemiologia , Boston/epidemiologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Inquéritos Nutricionais , Philadelphia/epidemiologia , Pobreza , Análise de Regressão
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