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1.
Sci Total Environ ; 802: 149721, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34454154

RESUMO

The natural flow regime (i.e. magnitude, frequency, duration, timing and rate of change of flow events) is crucial for maintaining freshwater biodiversity and ecosystem services. Protecting instream flow from anthropogenic alterations first requires an understanding of the relationship between aquatic organisms and the flow regime. In this study, we used a unique framework based on random forest modeling to quantify effects of natural flow regime metrics on fish and macroinvertebrate assemblages across ecoregions and flow regime types in the state of South Carolina, USA. We found that all components of the natural flow regime affected both fish and benthic macroinvertebrate assemblages, suggesting that maintaining natural aspects of all flow regime components is critical for protecting freshwater diversity. We identified hydrologic metrics and flow regime components such as magnitude, frequency, and duration of flow events, that were associated with the greatest ecological responses for individual stream classes to help managers prioritize hydrologic and biological metrics of interest during environmental flow standard development. The response of aquatic organisms to hydrologic metrics varied across stream classifications and ecoregions, highlighting the importance of accounting for differences in flow regime and ecoregion when designing environmental flow standards. We provide a flexible framework based on statistical flow-ecology relationships that can be used to inform instream flow management and assess effects of flow alteration on riverine assemblages.


Assuntos
Ecossistema , Invertebrados , Animais , Monitoramento Ambiental , Rios , South Carolina
2.
J Hist Dent ; 69(2): 131, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34734795

RESUMO

We are pleased to publish the following postcard that was submitted by Dr. Robert (Bob) L. Koolkin from Beaufort, South Carolina, one or our long-time members. This is one of his favorite cards that was posted in 1903. He writes, "Please note the 'key' that the 'dentist' holds behind his back as well as both the two sets of initials, as well as the "Before" and "After" captions that the writer added. The brief note on the reverse also gives the reader a feel for the times (Figs. 1 A & B). Fig. B reads: "Am very sorry to hear you have such a bad face, hope you will soon be better. I wonder if you could send me a little green book from the cupboard in the top bedroom called Arnolds Handbook of Africa, also one of the British Isles, paper covers. Much Love, from Hilda".


Assuntos
Publicações , Editoração , Livros , Humanos , Masculino , South Carolina , Redação
4.
Bull Environ Contam Toxicol ; 107(5): 868-875, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34652459

RESUMO

Wastewater reclamation facilities are known sources of emerging contaminants associated with human health and sanitation. This study evaluated the contribution of trace organic contaminants to a previously unmonitored river by water resource reclamation facilities. Six sampling events were conducted on the Reedy River in South Carolina. Sampling locations included sites upstream and downstream of two WRRFs located on the river to examine potential contributions under drought conditions where WRRF effluents comprise a large proportion of total stream flow. Five target analytes were monitored including atrazine, carbamazepine, 17ß-estradiol, perfluorooctanoic acid, and sulfamethoxazole. On a mass basis, the WRRFs contributed additional loadings of carbamazepine ranging from 5.4 g/d to 7.2 g/d (mean: 6.3 ± 0.4 g/d), PFOA ranging from 8.6 to 31.9 g/d (mean: 20.0 ± 4.9), and sulfamethoxazole ranging from 49.4 g/d to 75.1 g/d (mean: 62.1 ± 4.8). 17ß-estradiol was detected once and atrazine was not detected.


Assuntos
Poluentes Químicos da Água , Monitoramento Ambiental , Humanos , Rios , South Carolina , Poluentes Químicos da Água/análise , Recursos Hídricos
5.
Matern Child Health J ; 25(12): 1960-1971, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34637063

RESUMO

OBJECTIVE: State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. METHODS: A retrospective cohort of women aged 15-45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. RESULTS: Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41-0.49 and APR = 0.13, 95% CI 0.10-0.17; Low income families APR = 0.82; 95% CI 0.77-0.88 and APR = 0.33, 95% CI 0.28-0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68-0.77 and APR = 0.35, 95% CI 0.30-0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. CONCLUSIONS FOR PRACTICE: The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women.


Assuntos
Anticoncepcionais , Medicaid , Adolescente , Criança , Anticoncepção , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , South Carolina , Estados Unidos
6.
J Am Med Dir Assoc ; 22(10): 2026-2031.e1, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34481792

RESUMO

OBJECTIVES: This study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). DESIGN: Longitudinal secondary data analysis. SETTING AND PARTICIPANTS: Adults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). METHODS: COVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. RESULTS: LTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. CONCLUSIONS AND IMPLICATIONS: Narrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.


Assuntos
COVID-19 , Idoso , Teste para COVID-19 , Humanos , Incidência , Assistência de Longa Duração , Casas de Saúde , SARS-CoV-2 , South Carolina/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-34574599

RESUMO

Disparities and their geospatial patterns exist in morbidity and mortality of COVID-19 patients. When it comes to the infection rate, there is a dearth of research with respect to the disparity structure, its geospatial characteristics, and the pre-infection determinants of risk (PIDRs). This work aimed to assess the temporal-geospatial associations between PIDRs and COVID-19 infection at the county level in South Carolina. We used the spatial error model (SEM), spatial lag model (SLM), and conditional autoregressive model (CAR) as global models and the geographically weighted regression model (GWR) as a local model. The data were retrieved from multiple sources including USAFacts, U.S. Census Bureau, and the Population Estimates Program. The percentage of males and the unemployed population were positively associated with geodistributions of COVID-19 infection (p values < 0.05) in global models throughout the time. The percentage of the white population and the obesity rate showed divergent spatial correlations at different times of the pandemic. GWR models fit better than global models, suggesting nonstationary correlations between a region and its neighbors. Characterized by temporal-geospatial patterns, disparities in COVID-19 infection rate and their PIDRs are different from the mortality and morbidity of COVID-19 patients. Our findings suggest the importance of prioritizing different populations and developing tailored interventions at different times of the pandemic.


Assuntos
COVID-19 , Humanos , Masculino , Pandemias , SARS-CoV-2 , South Carolina/epidemiologia , Regressão Espacial
8.
BMC Public Health ; 21(1): 1703, 2021 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-34537021

RESUMO

BACKGROUND: The inclusion of self-reported differential treatment by race/ethnicity in population-based public health surveillance and monitoring systems may provide an opportunity to address long-standing health inequalities. While there is a growing trend towards decreasing response rates and selective non-response in health surveys, research examining the magnitude of non-response related to self-reported discrimination warrants greater attention. This study examined the distribution of sociodemographic variables among respondents and non-respondents to the South Carolina Behavioral Risk Factor Surveillance System (SC-BRFSS) Reactions to Race module (6-question optional module capturing reports of race-based treatment). METHODS: Using data from SC-BRFSS (2016, 2017), we examined patterns of non-response to the Reactions to Race module and individual items in the module. Logistic regression models were employed to examine sociodemographic factors associated with non-response and weighted to account for complex sampling design. RESULTS: Among 21,847 respondents, 15.3% were non-responders. Significant differences in RTRM non-response were observed by key sociodemographic variables (e.g., age, race/ethnicity, labor market participation, and health insurance status). Individuals who were younger, Hispanic, homemakers/students, unreported income, and uninsured were over-represented among non-respondents. In adjusted analyses, Hispanics and individuals with unreported income were more likely to be non-responders in RTRM and across item, while retirees were less likely to be non-responders. Heterogeneity in levels of non-responses were observed across RTRM questions, with the highest level of non-response for questions assessing differential treatment in work (54.8%) and healthcare settings (26.9%). CONCLUSIONS: Non-responders differed from responders according to some key sociodemographic variables, which could contribute to the underestimation of self-reported discrimination and race-related differential treatment and health outcomes. While we advocate for the use of population-based measures of self-reported racial discrimination to monitor and track state-level progress towards health equity, future efforts to estimate, assess, and address non-response variations by sociodemographic factors are warranted to improve understanding of lived experiences impacted by race-based differential treatment.


Assuntos
Racismo , Sistema de Vigilância de Fator de Risco Comportamental , Grupos Étnicos , Hispano-Americanos , Humanos , South Carolina/epidemiologia , Estados Unidos
9.
Evol Anthropol ; 30(4): 242-252, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34388300

RESUMO

African-descended peoples of the Americas represent an amalgamation of West, Central, and Southeast African regional and ethnic groups with modest gene flow from specific non-African populations. Despite 16+ generations of residence in the Americas, there is a deficit of evolutionary knowledge about these populations. Focusing on Legacy African American, the African North American descendants of survivors of the transatlantic trade in enslaved Africans, we report on emic evolutionary perspectives of their self-identity gleaned from our interviews of 600 individuals collected over 2 years. Gullah-Geechee peoples of Carolina Coastal regions are a model case study due to their historical antiquity, substantial African retentions, relative geospatial isolation, and proposed progenitor status to other Legacy African American microethnic groups. We identify salient research questions for future studies that will begin to bridge the evolutionary gaps in our knowledge of these diverse peoples and the historical evidence for specific evolutionary processes.


Assuntos
Afro-Americanos/genética , Evolução Molecular , Antropologia Física , Grupos Étnicos/genética , Feminino , Variação Genética/genética , Humanos , Masculino , Racismo , South Carolina , Sudeste dos Estados Unidos
10.
J Health Care Poor Underserved ; 32(3): 1461-1474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421043

RESUMO

PURPOSE: Our primary aim was to determine if combined antiretroviral therapy (cART) increased the risk of poor infant outcomes among women with HIV. METHODS: Maternal antiretroviral regimens were classified as mono-(mARV), dual (dARV), cART, and no ARV. Differences in dichotomous outcomes were compared using χ2 tests and continuous outcomes were compared using Kruskal-Wallis tests. Predictors of preterm delivery (PTD), low birth weight, and perinatal HIV infection were determined using logistic regression. RESULTS: During the 11-year study period, 643 mother-baby pairs with HIV exposure were eligible for analysis. Non-Hispanic, Black women were more likely to report mARV or no ARV use (p=.03). Women not taking ARVs were more likely to have PTD (p=.01). Prenatal care was associated with a reduction in PTD [aOR 0.12 (95% CI 0.03-0.5)] and perinatal HIV infection [aOR 0.1 (95% CI 0.01-0.7)]. CONCLUSIONS: Maternal cART and race were not associated with PTD. Rather, absence of prenatal care and lack of ARV use during pregnancy increased the risk of PTD and perinatal HIV infection.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Estudos Retrospectivos , South Carolina/epidemiologia
11.
PLoS One ; 16(8): e0256178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432817

RESUMO

Coronavirus disease 2019 (COVID-19) has presented a global pandemic in 2020 and 2021, and has therefore spurred a flurry of research, whether related directly to the disease and its treatment or regarding its spread, containment, and effect on everyday lives. In particular, two pressing streams of research have investigated antecedents to COVID-19 preventative behaviors and vaccination intentions. This nascent research has led to many interesting and practically important findings, however, there remains many segmented, compartmentalized studies that address topics that, while certainly generative and meaningful, may not provide a full lens to possible antecedents. The current study takes an interdisciplinary approach that investigates commonly studied variables from biology and public health, political science, and psychology as they relate to COVID-19 preventative behaviors and vaccine intentions in a stratified sample of South Carolina residents (N = 1695). Results from correlations and multiple regression substantiated the findings of many previous studies, however, it was found that, when controlling for shared variance among predictors via relative weights analysis, COVID-19 knowledge, trust in science, age, and Trump approval were the strongest predictors of preventative behaviors. Alternatively, trust in science, gender, age, and conservatism were the strongest predictors of vaccine intentions. Understanding the variables that contribute to the practice of preventative behaviors and vaccine intentions can be used by public health officials to better target and tailor their educational campaign in the community.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Comportamentos Relacionados com a Saúde , Vacinação/psicologia , Adulto , Fatores Etários , COVID-19/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política , SARS-CoV-2/isolamento & purificação , Fatores Sexuais , South Carolina , Inquéritos e Questionários
12.
AIDS Behav ; 25(12): 3909-3921, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34173137

RESUMO

To ensure continuing HIV care services during the COVID-19 pandemic, telehealth has been recommended and implemented in numerous HIV-related facilities. This study aims to understand telehealth utilization for HIV care services in South Carolina (SC), identify barriers to telehealth during COVID-19, and investigate strategies to facilitate remote HIV care delivery. In-depth interviews with 11 management personnel from 8 HIV-related facilities in SC were analyzed using thematic analysis. Utilizations of telehealth were diverse in delivering medical and non-medical HIV care services. Barriers included technological challenges, digital literacy, client/provider experiences, low socio-economic status of client population, and reimbursement issues. Various strategies were mentioned for promoting telehealth utilization, from client empowerment, provider training to improved organizational readiness. For successful telehealth use during and after COVID-19, it is necessary to continue efforts to promote telehealth and remove barriers to telehealth by implementing inclusive multi-level strategies for non-technologically savvy or disadvantaged populations living with HIV.


Assuntos
COVID-19 , Infecções por HIV , Telemedicina , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , South Carolina/epidemiologia
13.
J Environ Manage ; 293: 112828, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062422

RESUMO

With population growth driving urban expansion in many cities in the United States, there is a need for a sustainable way to manage stormwater. Green stormwater infrastructure (GSI) is considered an innovative way to handle stormwater because of its potential to provide multiple ecosystem services (ES) beyond flooding reduction. However, there is limited research regarding the society's perceived value for GSI practices' co-benefits. This study utilized stated-preference data obtained from a choice experiment in an online survey of 1159 South Carolina (SC) residents to estimate a monetary value for the ES provided by wet detention ponds- the most widely adopted stormwater practice in coastal counties of SC. The benefits examined are flooding reduction, water quality, wildlife habitat, recreation, and scenic beauty. The data were analyzed using a Mixed logit formulation. Considering the differences across the state, the model was estimated separately for five counties. Findings indicate that residents are willing to pay $13.8 to $37.8 annually for a 50% improvement in pollutant removal efficiency of ponds in addition to their current stormwater fee. Also, they are willing to pay $12.5 to $42.9 per year for the nearest pond to have buffer vegetation and wildlife. They are also likely to pay $5 to $22.5 for ponds to contribute to their neighborhood's scenic beauty. Furthermore, the results indicate that respondents from three counties are willing to pay $5.4 to $13.2 for a 50% improvement in flooding reduction, while those from two counties are likely to pay $3.9 to $4.9 for ponds to have recreational benefits. The findings of the study could help stormwater managers in designing their stormwater management programs, especially for better evaluation of stormwater utility fees.


Assuntos
Ecossistema , Lagoas , Cidades , South Carolina , Qualidade da Água
14.
Environ Manage ; 68(1): 126-145, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961123

RESUMO

Regional frameworks enable bioassessment methods to detect anthropogenic effects on ecosystems amid natural variability. Conventional approaches to regionalization have used coarse geographical frameworks to separate sites similar in their ecological (ecoregion) or faunal (basin) characteristics. Expectations for individual streams are then adjusted for within-region variability in local environmental characteristics. Integrating regional frameworks and local variability may improve the sensitivity and performance of bioassessments. In this study, we used a biologically-informed stream classification to develop an integrated regional framework for bioassessment considering the effects of ecoregion, basin, and local environmental variables on wadeable stream fish communities of South Carolina, USA. Our integrated framework was compared against conventional regional frameworks indexing ecoregions or basins alone. Frameworks were evaluated by their ability to (1) efficiently partition community variation and (2) allow for the detection of anthropogenic effects on fish communities. We found an integrated framework better described natural variability in stream fish communities. In addition, we found highly regional relationships between fish metrics and anthropogenic disturbance among frameworks, suggesting appropriate bioassessment metrics will differ across regions in our study area. Differences in community response to disturbance among frameworks emphasize the importance of testing metrics for their hypothesized sensitivity before using them in bioassessment. This study ultimately supports the integration of regional frameworks across spatial scales to classify streams for bioassessment, and provides an analytical framework from which to evaluate biotic variation and metric utility in the context of bioassessment.


Assuntos
Ecossistema , Rios , Animais , Monitoramento Ambiental , Peixes , South Carolina
15.
Matern Child Health J ; 25(8): 1200-1208, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33948828

RESUMO

PURPOSE: School-based oral health programs (SBOHPs) provide opportunities to address oral health inequities by providing convenient access points for care. No published guidelines on SBOHP implementation existed. Our work describes how philanthropic, public, and academic organizations partnered to support dental safety net providers with designing comprehensive SBOHPs in North and South Carolina. DESCRIPTION: A multi-sector leadership team was established to manage a new SBOHP philanthropic-funded grant program organized into two phases, Readiness and Implementation, with the former a 6-month planning period in preparation of the latter. Readiness included technical assistance (TA) delivered through coaching and 15 online learning modules organized in four domains: operations, finance, enabling services, and impact. Organizations could apply for implementation grants after successful TA completion. Process evaluation was used including a Readiness Stoplight Report for tracking progression. ASSESSMENT: Ten Readiness grantees completed the TA. A variety of models resulted, including mobile, portable and fixed clinics. Descriptive analysis was conducted on the readiness stoplight reports. Components of the operation and finance domains required were the most time-intensive, specifically the development of policy manuals, production goals, and financial performance tracking. CONCLUSION: The program's structure resulted in (a) a two-state learning community, (b) SBOHP practice and policy alignment, and (c) coordinated program distribution. TA improvements are planned to account for COVID-19 threats, including school closures, space limitations, and transmission fears. Telehealth, non-aerosolizing procedures, and improved scheduling and communication can address concerns. Organizations considering SBOHPs should explore similar recommendations to navigate adverse circumstances.


Assuntos
Currículo , Assistência Odontológica para Crianças , Promoção da Saúde , Saúde Bucal , Serviços de Odontologia Escolar , Criança , Humanos , Instituições Acadêmicas , South Carolina
16.
Nat Commun ; 12(1): 2721, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035248

RESUMO

Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.


Assuntos
Exposição Ambiental/análise , Disparidades nos Níveis de Saúde , Transtornos de Estresse por Calor/etnologia , Temperatura Alta , Saúde da População Urbana/etnologia , Afro-Americanos/estatística & dados numéricos , Cidades , Exposição Ambiental/efeitos adversos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Geografia , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Maryland , Pobreza/estatística & dados numéricos , South Carolina , Estados Unidos
17.
J Stroke Cerebrovasc Dis ; 30(8): 105815, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34052785

RESUMO

BACKGROUND: Geographical and racial disparities in stroke outcomes are especially prominent in the Southeastern United States, which represents a region more heavily burdened with stroke compared to the rest of the country. While stroke is eminently preventable, particularly via blood pressure control, fewer than one third of patients with a stroke have their blood pressure controlled ≥ 75% of the time, and low consistency of blood pressure control is linked to higher stroke risk. OBJECTIVE: To demonstrate that a mHealth technology-centered, integrated approach can effectively improve sustained blood pressure control among stroke patients (half of whom will be Black). DESIGN: The Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor is a prospective randomized controlled trial, which will include a cohort of 200 patients with a stroke, encountered at two major safety net health care systems in South Carolina. The intervention comprises utilization of a Vaica electronic pill tray & blue-toothed UA-767Plus BT blood pressure device and a dedicated app installed on patients' smart phones for automatic relay of data to a central server. Providers will follow care protocols based on expert consensus practice guidelines to address optimal blood pressure management. STUDY OUTCOMES: Primary outcome is systolic blood pressure at 12-months, which is the major modifiable step to stroke event rate reduction. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. DISCUSSION: We anticipate that a successful intervention will serve as a scalable model of effective chronic blood pressure management after stroke, to bridge racial and geographic disparities in stroke outcomes in the United States. TRIAL REGISTRATION: ClinicalTrials.gov - NCT03401489.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Provedores de Redes de Segurança , Prevenção Secundária , Autocuidado , Acidente Vascular Cerebral/prevenção & controle , Telemedicina , Adolescente , Adulto , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Grupo com Ancestrais do Continente Europeu , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Aplicativos Móveis , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Smartphone , South Carolina , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
BMC Public Health ; 21(1): 919, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985467

RESUMO

BACKGROUND: Early childhood education (ECE) settings are critical intervention targets for obesity prevention. This study evaluated a pilot two-year community-based participatory research (CBPR) project designed to assist ECE center directors and caregivers in policy, systems and environmental (PSE) change for improving healthy eating (HE) and physical activity (PA). METHODS: A two-year CBPR study was conducted in 10 licensed ECE centers in Greenville, South Carolina. The intervention consisted of five steps: [1] baseline data collection and self-assessment using the Nutrition and Physical Activity Self-Assessment for Child Care (Go-NAP SACC), [2] tailored goal setting and action planning, [3] technical assistance and access to resources, [4] post intervention data collection and re-assessment, and [5] celebration of success. Main outcome measures (HE and PA environments, practices and policies) were assessed using the Environment and Policy Assessment and Observation (EPAO) tool at baseline and 24 months. One classroom of 3-5-year-olds was randomly selected for observation from each center (mean of 12 children per classroom). Means and standard deviations were calculated for total PA, total nutrition and each subscale of PA and nutrition. Paired sample t-tests were calculated to assess changes in EPAO scales from baseline to post intervention. RESULTS: Ten ECE centers enrolled in the pilot study and eight completed the two-year intervention. Center-based goals were accomplished across all 8 ECE centers over the two-year intervention: 16 child nutrition goals, 6 outdoor play goals, 11 physical activity goals and 8 screen time goals across the entire sample. Nutrition policy and PA policy significantly improved (p < 0.05), with greater improvements in PA (10.0 point increase, p = .048) as compared to nutrition (3.3 point increase, p = 0.02). CONCLUSIONS: Utilizing a CBPR approach, this two-year nutrition and PA PSE intervention in ECE centers improved ECE center HE and PA policies.


Assuntos
Creches , Exercício Físico , Criança , Pré-Escolar , Humanos , Estado Nutricional , Projetos Piloto , South Carolina
19.
Exp Appl Acarol ; 84(2): 407-418, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33970407

RESUMO

Tetranychus urticae Koch (Acari: Tetranychidae), twospotted spider mite, is a major secondary pest of strawberry and can cause significant yield loss. Tetranychus urticae is typically controlled using miticides, which has led to rapid resistance development. In South Carolina (USA), extension agents and growers have reported field failures of miticides (inadequate pest suppression), but resistance has not been quantitatively determined. In 2018, we determined the level of miticide resistance of six T. urticae populations found on strawberry across South Carolina. We examined efficacy of all miticides registered for use on US strawberry by conducting an initial diagnostic bioassay at 20% of the maximum labeled field rate. Any population × active ingredient combination resulting in < 55% mortality was identified as 'potentially resistant' and concentration-response bioassays were then conducted to calculate LC50 values for an individual population. These values were compared with those of a known-susceptible laboratory population to calculate resistance ratios (RR). Our results indicate that examined South Carolina populations of T. urticae from strawberry were highly resistant to bifenthrin (RR = 100-60,000) and there was reduced susceptibility to fenbutatin-oxide (RR = 25-123). The 'Sardinia' population had decreased abamectin susceptibility (RR = 25). No resistance to hexythiazox, etoxazole, acequinocyl, bifenazate, fenpyroximate, spiromesifen, or cyflumetofen was found. Based on available data, it appears that miticide resistance is not a likely cause of field failures and issues related to application error and coverage should be investigated. Overall, this work supports the need to reduce the use of broad-spectrum pesticides and older products, in favor of newer miticide chemistries due to resistance issues.


Assuntos
Acaricidas , Fragaria , Tetranychidae , Animais , Itália , Controle de Pragas , South Carolina
20.
Contraception ; 104(2): 155-158, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33894253

RESUMO

OBJECTIVE: Capacity building and training to improve contraceptive care is essential for patient-centered care and reproductive autonomy. This study assessed the feasibility of translating the knowledge and skills gained from contraception trainings into improvements in practice. STUDY DESIGN: Participants completed surveys following contraceptive care trainings provided to family planning clinic and hospital obstetric providers and staff as a part of the Choose Well contraceptive access initiative in South Carolina. Surveys assessed participants' intent to change their practice post-training and anticipated barriers to implementing change. A mixed-methods approach was utilized including descriptive analysis of Likert scale responses and thematic content analysis to synthesize open-ended, qualitative responses. RESULTS: Data were collected from 160 contraceptive training sessions provided to 4814 clinical and administrative staff between 2017 and 2019. Post-training surveys were completed by 3464 participants (72%), and of these, 2978 answered questions related to the study outcomes. Most respondents (n = 2390; 80.7%) indicated intent to change their practice and 35.5% (n = 1044) anticipated barriers to implementing intended changes. Across all training categories, organizational factors (time constraints, policies and practices, infrastructure/resources) were the most frequently perceived barrier to improving contraceptive services. Structural factors related to cost for patients were also identified as barriers to IUD and implant provision. CONCLUSION: The trainings were successful in influencing family planning staff and providers' intent to improve their contraceptive practices, yet some anticipated barriers in translating training into practice. Improvements in organizational and structural policies are critical to realizing the benefits of trainings in advancing quality contraceptive care. IMPLICATIONS: In addition to training, coordinated efforts to address organizational practices and resources, coupled with system-level policy changes are essential to facilitate the delivery and sustainability of patient-centered contraceptive care.


Assuntos
Anticoncepção , Anticoncepcionais , Dispositivos Anticoncepcionais , Serviços de Planejamento Familiar , Feminino , Humanos , Gravidez , South Carolina
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