Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.477
Filtrar
1.
R I Med J (2013) ; 104(3): 22-26, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33789404

RESUMO

Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with three major goals: 1) establish a center of scientific excellence on opioids and overdose; 2) train the next generation of scientists to become independent investigators and address the opioid and overdose crises; and 3) contribute to the scientific progress and solutions to combat these epidemics. To date, we have made substantial progress. While the opioid and overdose crises continue to evolve, the COBRE on Opioid and Overdose and its team of investigators are well poised to address the daunting task of understanding and meaningfully addressing these deadly epidemics, with the ultimate goal of saving lives.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/epidemiologia , Educação em Saúde/organização & administração , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , /epidemiologia , Overdose de Drogas/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Rhode Island/epidemiologia
2.
J Subst Abuse Treat ; 124: 108283, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33771282

RESUMO

Despite its proven efficacy, buprenorphine remains dramatically underutilized for management of opioid use disorder largely due to onerous barriers to treatment initiation. During the COVID-19 pandemic, many substance use disorder treatment facilities have reduced their hours and services, exacerbating existing barriers. To this end, the U.S. Drug Enforcement Administration and Substance Abuse Mental Health Services Administration adjusted their guidelines to allow for new buprenorphine prescriptions following audio-only telehealth encounters, no longer requiring an in-person evaluation prior to treatment initiation. Under this new guidance, we established a 24/7 telephone hotline to function as a "tele-bridge" clinic where people with opioid use disorder can be linked with a buprenorphine prescriber in real-time for OUD assessment and unobserved buprenorphine initiation with connection to follow-up if appropriate. Additionally, we developed an ED callback protocol to reach patients recently seen for opioid overdose and facilitate their entry into care if interested. In this commentary we describe our hotline and ED callback protocols, discuss theoretical and anecdotal benefits to this approach, and advocate for continuation of current regulatory changes post-COVID-19 to maintain expanded access to novel treatment approaches.


Assuntos
Buprenorfina/uso terapêutico , Acesso aos Serviços de Saúde , Metadona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Telemedicina , Buprenorfina/provisão & distribução , Serviço Hospitalar de Emergência , Humanos , Metadona/provisão & distribução , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Rhode Island
4.
Emerg Infect Dis ; 27(3): 823-834, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33622481

RESUMO

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.


Assuntos
/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , /transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Razão de Chances , Equipamento de Proteção Individual/estatística & dados numéricos , Rhode Island/epidemiologia , /isolamento & purificação , Estudos Soroepidemiológicos , Adulto Jovem
5.
Am J Public Health ; 111(4): 700-703, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33600249

RESUMO

Objectives. To characterize statewide seroprevalence and point prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Rhode Island.Methods. We conducted a cross-sectional survey of randomly selected households across Rhode Island in May 2020. Antibody-based and polymerase chain reaction (PCR)-based tests for SARS-CoV-2 were offered. Hispanics/Latinos and African Americans/Blacks were oversampled to ensure adequate representation. Seroprevalence estimations accounted for test sensitivity and specificity and were compared according to age, race/ethnicity, gender, housing environment, and transportation mode.Results. Overall, 1043 individuals from 554 households were tested (1032 antibody tests, 988 PCR tests). The estimated seroprevalence of SARS-CoV-2 antibodies was 2.1% (95% credible interval [CI] = 0.6, 4.1). Seroprevalence was 7.5% (95% CI = 1.3, 17.5) among Hispanics/Latinos, 3.8% (95% CI = 0.0, 15.0) among African Americans/Blacks, and 0.8% (95% CI = 0.0, 2.4) among non-Hispanic Whites. Overall PCR-based prevalence was 1.5% (95% CI = 0.5, 3.1).Conclusions. Rhode Island had low seroprevalence relative to other settings, but seroprevalence was substantially higher among African Americans/Blacks and Hispanics/Latinos. Rhode Island sits along the highly populated northeast corridor, making our findings broadly relevant to this region of the country. Continued monitoring via population-based sampling is needed to quantify these impacts going forward.


Assuntos
Estudos Soroepidemiológicos , Adolescente , Adulto , Idoso , /etnologia , Criança , Pré-Escolar , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Rhode Island/epidemiologia , Adulto Jovem
6.
R I Med J (2013) ; 104(1): 55-60, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33517602

RESUMO

OBJECTIVE: To describe characteristics of children undergoing SARS-CoV-2 testing during the initial wave of infections in Rhode Island. METHODS: This is a descriptive study of 729 children tested for SARS-CoV-2 at four emergency departments April 9 to May 7, 2020 in Rhode Island. Demographic information and symptoms were cataloged for those tested. RESULTS: 81 (11%) children tested positive for SARS-CoV-2. 94% of positive children were symptomatic. 74% of positive cases had constitutional symptoms and 72% had upper respiratory symptoms. While only 34% of those tested were Hispanic, 68% of the SARS-CoV-2- positive cases occurred in Hispanic children. CONCLUSION: This study details the pediatric population's experience during the first wave of the pandemic in Rhode Island. It could inform testing allocation strategies in healthcare settings. It also highlights vulnerable populations in need of further public health support in our state.


Assuntos
/diagnóstico , Adolescente , Doenças Assintomáticas , /patologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Rhode Island/epidemiologia , Adulto Jovem
7.
Pediatr Infect Dis J ; 40(3): 175-181, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399431

RESUMO

BACKGROUND: The objective was to evaluate patterns of pediatric coronavirus disease 2019 testing in a large health system throughout the pandemic, before and after school reopening. METHODS: This was a cross-sectional time-series study of clinical virology results from children tested for severe acute respiratory syndrome coronavirus 2 in Southern Connecticut and areas of New York and Rhode Island. Data collected include demographics, hospital admission, changes in percent positive tests over time, detection intervals in persistently positive children and cycle threshold values. The setting was the Yale New Haven Health System has 6 hospitals at 4 Connecticut locations, 1 hospital in Rhode Island and ambulatory locations in Connecticut, Rhode Island and New York. Participants included twenty-three-thousand one-hundred thirty-seven children ≤ 18 years of age, tested for coronavirus disease 2019 at an ambulatory testing site, the emergency department or on an inpatient unit within the Yale New Haven Health System. RESULTS: Among all tests, 3.2% were positive. Older children consistently made up the larger portion of positive pediatric cases, regardless of community prevalence. Increased pediatric cases later in the pandemic when prevalence in adults was relatively low correlates with a higher number of tests performed in children and not with an increased positivity rate. No significant changes in trends of positivity were detected after the reopening of schools. Symptomatic and asymptomatic children had similar cycle threshold values regardless of age, and a subset of children demonstrated persistent viral detection, some for as long as 6 weeks. CONCLUSION: An increase in pediatric cases documented in the late summer was predominately due to increased access to testing for children. The percent positivity in children did not change in the first 3 weeks after school opened. A subset of children has detectable severe acute respiratory syndrome coronavirus 2 RNA in the upper respiratory tract for weeks after the initial infection.


Assuntos
/epidemiologia , Pandemias , /isolamento & purificação , Adolescente , Criança , Pré-Escolar , Connecticut/epidemiologia , Estudos Transversais , Demografia , Feminino , Hospitalização , Humanos , Pacientes Internados , Masculino , New York/epidemiologia , Prevalência , Rhode Island/epidemiologia , /genética
8.
J Subst Abuse Treat ; 120: 108163, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33298301

RESUMO

Historically, federal and state policies have narrowly defined treatment models that have resulted in limited access to and engagement in counseling for individuals receiving medications for opioid use disorder (MOUD; e.g., methadone and buprenorphine). In response to the coronavirus pandemic, outpatient MOUD treatment providers rapidly transitioned from traditional, in-person care delivery models to revised COVID-19 protocols that prioritized telehealth counseling to protect the health of patients and staff and ensure continuity in MOUD care. These telehealth innovations appear to mitigate many of the longstanding barriers to counseling in the traditional system and have the potential to forever alter MOUD care delivery. Drawing on data from a Rhode Island-based clinic, we argue that MOUD counseling is achievable via telehealth and outline the need for, and anticipated benefits of, hybrid telehealth/in-person MOUD treatment models moving forward.


Assuntos
Aconselhamento/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Telemedicina/organização & administração , Buprenorfina/administração & dosagem , Continuidade da Assistência ao Paciente/organização & administração , Assistência à Saúde/organização & administração , Humanos , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Rhode Island
9.
R I Med J (2013) ; 103(8): 14-17, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003675

RESUMO

The COVID-19 pandemic challenges safe and equitable voting in the United States' 2020 elections, and in response, several states including Rhode Island (RI) have made significant changes to election policy. In addition to increasing accessibility of mail-in voting by mailing applications to all registered voters, RI has suspended their notary/witness requirement for both the primary and general election. However, RI's "emergency" voting process still plays a crucial role in allowing voters who missed the mail-in ballot application deadline, such as those unexpectedly hospitalized in the days leading up to the election, to still cast their ballot. COVID-19 has also forced RI to modify its emergency voting procedures, most notably allowing healthcare workers to serve on bipartisan ballot delivery teams. This commentary highlights these salient updates to voting procedures and serves as a primer as to how interested health care workers may navigate this process alongside patients and lead in the arena of patient voting rights.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Política , Serviços Postais , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Rhode Island
10.
R I Med J (2013) ; 103(8): 59-61, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003682

RESUMO

BACKGROUND AND STUDY OBJECTIVE: The COVID-19 pandemic has forced assisted living facilities (ALF) to implement strict social isolation for residents. Social isolation in the geriatric population is known to negatively impact health. Here, we describe how ALFs in Rhode Island utilized device donations received from Connect for COVID-19, a nationwide nonprofit organization which has mobilized medical students to gather devices for donations to care centers. METHODS: Rhode Island ALFs were contacted to determine if they were interested in receiving smart device donations. After donations were made, an impact survey was electronically administered. Primary Results: A total of 11 facilities completed the survey with a response rate of 24% (11/46). The facilities were located throughout all five counties in Rhode Island, with the majority located in Providence County. All but one of the facilities that responded to the survey (n=10, 90.9%) have used the devices to allow residents to video-call their family members. Seven responses (63.6%) indicated that devices were used for more than one purpose. Primary Conclusions: Smart devices were well received by Rhode Island ALFs and used for purposes beyond video conference calls. ALFs should consider advertising the need for devices to encourage community donations. Future studies should investigate the direct impact that digital connectivity has had on Rhode Island ALF residents.


Assuntos
Moradias Assistidas , Betacoronavirus , Comunicação , Infecções por Coronavirus/epidemiologia , Relações Familiares/psicologia , Pneumonia Viral/epidemiologia , Smartphone , Computadores de Mão , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Rhode Island
11.
R I Med J (2013) ; 103(9): 41-46, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33126788

RESUMO

The COVID-19 pandemic has exacerbated the effects of existing health disparities throughout the United States. While Hispanic/Latino individuals account for only 16% of the Rhode Island (RI) population, Rhode Island Department of Health (RIDOH) data show that 45% of COVID-19 cases and 36% of individuals who have been hospitalized identify as Hispanic/Latino. Clínica Esperanza/Hope Clinic (CEHC) mobilized a comprehensive effort to offer telehealth visits, health education and accessible, walk-up COVID-19 testing for low-income, uninsured and Spanish-speaking individuals living in Rhode Island. With support from CEHC volunteers, the City of Providence, the State of Rhode Island, and local foundations, CEHC has administered 1,649 individual COVID-19 tests as of October 2020. The overall COVID-19 test positivity rate at CEHC was 23%, peaking in April at 48%. Additionally, CEHC has distributed more than 1,600 meal boxes to patients experiencing food insecurity, provided emergency financial resources, while rapidly scaling up healthcare services for the increasing numbers of uninsured individuals in RI.


Assuntos
Instituições de Assistência Ambulatorial , Infecções por Coronavirus/diagnóstico , Apoio Financeiro , Abastecimento de Alimentos , Educação em Saúde , Hispano-Americanos , Pessoas sem Cobertura de Seguro de Saúde , Pneumonia Viral/diagnóstico , Telemedicina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Técnicas de Laboratório Clínico , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Rhode Island , Populações Vulneráveis , Adulto Jovem
13.
West J Emerg Med ; 21(5): 1048-1053, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970553

RESUMO

INTRODUCTION: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19-April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. RESULTS: A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. CONCLUSION: SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Política de Saúde , Inquéritos Epidemiológicos , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevalência , Rhode Island/epidemiologia , Adulto Jovem
14.
Environ Health ; 19(1): 97, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917231

RESUMO

BACKGROUND: Organophosphate esters (OPEs)-used as flame retardants and plasticizers-are associated with adverse pregnancy outcomes such as reduced fecundity and live births and increased preterm delivery. OPEs may interfere with growth and metabolism via endocrine-disruption, but few studies have investigated endocrine-related outcomes. The objective of this pilot study (n = 56 mother-infant pairs) was to evaluate associations of OPEs with gestational weight gain (GWG), gestational age at delivery, infant anthropometry, and infant feeding behaviors. METHODS: We quantified OPE metabolites (bis-2-chloroethyl phosphate [BCEP], bis (1,3-dichloro-2-propyl) phosphate [BDCPP], diphenyl phosphate [DPHP]) in pooled maternal spot urine collected throughout pregnancy (~ 12, 28, and 35 weeks' gestation). We obtained maternal sociodemographic characteristics from questionnaires administered at enrollment and perinatal characteristics from medical record abstraction. Trained research assistants measured infant weight, length, head and abdominal circumferences, and skinfold thicknesses at birth and 6 weeks postpartum. Mothers reported infant feeding behavior via the Baby Eating Behavior Questionnaire (BEBQ). Using multiple linear regression, we assessed associations of log2-transformed maternal urinary OPE metabolites with GWG, gestational age at delivery, infant anthropometry at birth, weekly growth rate, and BEBQ scores at 6 weeks postpartum. We used linear mixed effects (LME) models to analyze overall infant anthropometry during the first 6 weeks of life. Additionally, we considered effect modification by infant sex. RESULTS: We observed weak positive associations between all OPE metabolites and GWG. In LME models, BDCPP was associated with increased infant length (ß = 0.44 cm, 95%CI = 0.01, 0.87) and weight in males (ß = 0.14 kg, 95%CI = 0.03, 0.24). BDCPP was also associated with increased food responsiveness (ß = 0.23, 95%CI = 0.06, 0.40). DPHP was inversely associated with infant abdominal circumference (ß = - 0.50 cm, 95%CI = - 0.86, - 0.14) and female weight (ß = - 0.19 kg, 95%CI = - 0.36, - 0.02), but positively associated with weekly growth in iliac skinfold thickness (ß = 0.10 mm/wk., 95%CI = 0.02, 0.19). Further, DPHP was weakly associated with increased feeding speed. BCEP was associated with greater infant thigh skinfold thickness (ß = 0.34 mm, 95%CI = 0.16, 0.52) and subscapular skinfold thickness in males (ß = 0.14 mm, 95%CI = 0.002, 0.28). CONCLUSIONS: Collectively, these findings suggest that select OPEs may affect infant anthropometry and feeding behavior, with the most compelling evidence for BDCPP and DPHP.


Assuntos
Antropometria , Poluentes Ambientais/urina , Idade Gestacional , Ganho de Peso na Gestação/efeitos dos fármacos , Recém-Nascido/fisiologia , Exposição Materna , Organofosfatos/urina , Adulto , Composição Corporal/efeitos dos fármacos , Tamanho Corporal/efeitos dos fármacos , Ésteres/urina , Comportamento Alimentar/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido/crescimento & desenvolvimento , Gravidez , Rhode Island , Adulto Jovem
16.
PLoS One ; 15(8): e0220219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813699

RESUMO

The location of defunct environmentally hazardous businesses like gas stations has many implications for modern American cities. To track down these locations, we present the directoreadr code (github.com/brown-ccv/directoreadr). Using scans of Polk city directories from Providence, RI, directoreadr extracts and parses business location data with a high degree of accuracy. The image processing pipeline ran without any human input for 94.4% of the pages we examined. For the remaining 5.6%, we processed them with some human input. Through hand-checking a sample of three years, we estimate that ~94.6% of historical gas stations are correctly identified and located, with historical street changes and non-standard address formats being the main drivers of errors. As an example use, we look at gas stations, finding that gas stations were most common early in the study period in 1936, beginning a sharp and steady decline around 1950. We are making the dataset produced by directoreadr publicly available. We hope it will be used to explore a range of important questions about socioeconomic patterns in Providence and cities like it during the transformations of the mid-1900s.


Assuntos
Diretórios de Sinalização e Localização/estatística & dados numéricos , Cidades , Análise de Dados , Diretórios como Assunto , Gasolina/provisão & distribução , História do Século XX , Humanos , Rhode Island , Software/estatística & dados numéricos
17.
R I Med J (2013) ; 103(6): 8-13, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32752556

RESUMO

Field hospitals have long been used to extend health care capabilities in times of crisis. In response to the pandemic and an anticipated surge in patients, Rhode Island Gov. Gina Raimondo announced a plan to create three field hospitals, or "alternate hospital sites" (AHS), totaling 1,000 beds, in order to expand the state's hospital capacity. Following China's Fangcang shelter hospital model, the Lifespan AHS (LAHS) planning group attempted to identify existing public venues that could support rapid conversion to a site for large numbers of patients at a reasonable cost. After discussions with many stakeholders - pharmacy, laboratory, healthcare providers, security, emergency medical services, and infection control - design and equipment recommendations were given to the architects during daily teleconferencing and site visits. Specific patient criteria for the LAHS were established, staffing was prioritized, and clinical protocols were designed to facilitate care. Simulations using 4 different scenarios were practiced in order to assure proper patient care and flow, pharmacy utilization, and staffing.


Assuntos
Infecções por Coronavirus , Planejamento em Desastres , Hospitais de Isolamento , Unidades Móveis de Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Abrigo de Emergência , Humanos , Rhode Island
18.
Medicine (Baltimore) ; 99(31): e21412, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756140

RESUMO

We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.


Assuntos
Demência/psicologia , Transtorno Depressivo/psicologia , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Psicometria , Rhode Island , Inquéritos e Questionários
19.
MMWR Morb Mortal Wkly Rep ; 69(34): 1170-1172, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853185

RESUMO

On June 1, 2020, with declines in coronavirus disease 2019 (COVID-19) cases and hospitalizations in Rhode Island,* child care programs in the state reopened after a nearly 3-month closure implemented as part of mitigation efforts. To reopen safely, the Rhode Island Department of Human Services (RIDHS) required licensed center- and home-based child care programs to reduce enrollment, initially to a maximum of 12 persons, including staff members, in stable groups (i.e., staff members and students not switching between groups) in physically separated spaces, increasing to a maximum of 20 persons on June 29. Additional requirements included universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.† As of July 31, 666 of 891 (75%) programs were approved to reopen, with capacity for 18,945 children, representing 74% of the state's January 2020 child care program population (25,749 children).


Assuntos
Cuidado da Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adulto , Betacoronavirus/isolamento & purificação , Criança , Cuidado da Criança/organização & administração , Pré-Escolar , Técnicas de Laboratório Clínico , Busca de Comunicante , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Rhode Island/epidemiologia , Adulto Jovem
20.
BMC Public Health ; 20(1): 1289, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32843002

RESUMO

BACKGROUND: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. METHODS: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. RESULTS: Eight unique themes centered on health literacy, sources of health information, organizational culture's impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients' health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. CONCLUSIONS: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Saúde Pública/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Rhode Island
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...