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1.
BMC Health Serv Res ; 24(1): 101, 2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38238697

RESUMO

BACKGROUND: Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a disproportionate burden of rural infections. To reverse growing infection rates, the state must increase its focus on prevention efforts, including novel strategies. One such approach is to utilize dashboards that visualize real-time data on the pre-exposure prophylaxis (PrEP) care continuum to assist in prioritizing evidence-based preventative care for those most vulnerable for HIV infection. METHODS: We conducted a mixed methods evaluation to ascertain stakeholders' perceptions on the acceptability, feasibility, appropriateness, and usability of a PrEP care continuum dashboard, as well as gain insight on ways to improve the activities necessary to sustain it. Clinicians, administrators, and data personnel from participating sites in Alabama completed surveys (n = 9) and participated in key informant interviews (n = 10) to better understand their experiences with the prototype data dashboard and to share feedback on how it can be modified to best fit their needs. RESULTS: Surveys and interviews revealed that all participants find the pilot data dashboard to be an acceptable, feasible, and appropriate intervention for clinic use. Overall, stakeholders find the pilot dashboard to be usable and helpful in administrative efforts, such as report and grant writing; however, additional refining is needed in order to reduce burden and optimize usefulness. Participants voiced concerns about their site's abilities to sustain the dashboard, including the lack of systematized PrEP protocols and limited funds and staff time dedicated to PrEP data collection, cleaning, and upload. CONCLUSION: Study participants from clinics providing HIV prevention services, including PrEP, in Alabama voiced interest in sustaining and refining a data dashboard that tracks clients across the PrEP care continuum. Despite viewing the platform itself as an acceptable, feasible, and appropriate intervention, participants agreed that efforts need to be focused on standardizing PrEP data collection protocols in order to ensure consistent, accurate data capture and that limited funds and staff time are barriers to the sustained implementation of the dashboard in practice.


Assuntos
Síndrome de Imunodeficiência Adquirida , Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Estudos de Viabilidade , Fármacos Anti-HIV/uso terapêutico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Sudeste dos Estados Unidos , Profilaxia Pré-Exposição/métodos
2.
Environ Sci Pollut Res Int ; 31(6): 9000-9010, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38183546

RESUMO

Many vulture species worldwide are declining at alarming rates due to a variety of anthropogenic causes, including exposure to pollutants and pharmaceuticals through consumption of contaminated carrion. However, little is known about the extent to which vultures are exposed to various contaminants as well as toxicity thresholds for trace elements and heavy metals. Our objective was to quantify levels of trace elements and heavy metals within black vulture (Coragyps atratus) and turkey vulture (Cathartes aura) tissues to determine the extent to which populations in the Southeastern United States are exposed to carrion that contains high levels of contaminants. We collected 34 black vulture liver samples and examined differences in trace element and heavy metal concentrations between sexes and age classes (adult and juvenile). Further, we collected 81 blood and 42 feather samples from additional black and turkey vultures and compared differences between species and age classes. We found similar element concentrations between juvenile and adult black vultures with the exception of Cu, where levels were higher in juveniles compared to adults. However, we did observe substantial differences in element concentrations between species for both blood and feather samples, with black vultures generally having higher concentrations of most elements. Our data revealed higher element levels in both species compared to toxicity thresholds found in other bird of prey species, such as blood and liver toxicity threshold suggestions for Pb poisoning in Falconiformes. Further, while average contaminant levels were generally low, extreme outliers were observed for some elements, including Pb, suggesting some individuals were exposed to high levels of potentially toxic elements. More research is needed to better understand contaminant exposure in black and turkey vultures across a broader geographic region, as well as elucidate toxicity thresholds and non-lethal impacts of contaminant exposure in these species.


Assuntos
Epilepsia , Falconiformes , Metais Pesados , Oligoelementos , Humanos , Animais , Chumbo , Aves , Sudeste dos Estados Unidos
3.
Anxiety Stress Coping ; 37(1): 100-113, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37075162

RESUMO

Guided by the Family Stress Model for minority families, the present study examined the potential buffering effect of resting respiratory sinus arrythmia (RRSA), cognitive reappraisal, and mindfulness on the association between political climate stress (PCS) and anxiety symptoms in a sample of Latina and Black mothers. Participants were 100 mothers living in the southeastern United States. Mothers reported on PCS, cognitive reappraisal, mindfulness, and symptoms of anxiety. RRSA were measured during a resting task. Moderation analyses tested the influence of these three factors (RRSA, cognitive reappraisal, mindfulness) on the relation between PCS and anxiety. Results showed that the relation between PCS and anxiety symptoms was strongest at low levels of RRSA and cognitive reappraisal. At high levels of these two factors, there was no association between PCS and anxiety symptoms. Mothers with high levels of RRSA and cognitive reappraisal may be able to interact with and evaluate environmental stimuli in such a way that allows for adaptive adjustment, buffering against the negative impact of PCS. RRSA and cognitive reappraisal may be important targets of interventions designed to address the rising rates of anxiety symptoms in Latina and Black mothers.


Assuntos
Ansiedade , Arritmias Cardíacas , Cognição , Mães , Política , Estresse Psicológico , Feminino , Humanos , Ansiedade/psicologia , Arritmias Cardíacas/epidemiologia , Hispânico ou Latino , Negro ou Afro-Americano , Sudeste dos Estados Unidos , Estresse Psicológico/epidemiologia
4.
Am J Surg ; 227: 132-136, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37865543

RESUMO

BACKGROUND: High-grade soft tissue sarcoma is rare and associated with poor prognosis. This study examines racial and ethnic variation in presentation and outcomes at a Southeastern US cancer center. METHODS: Among an institutional cohort of patients seen between January 2016-December 2021, racial and ethnic differences were evaluated using chi-squared tests, Kaplan Meier curves, and Cox proportional hazards models. RESULTS: There were 295 patients (71 â€‹% Non-Hispanic White, 24 â€‹% Black, 3 â€‹% Hispanic White, 2 â€‹% Other). Black representation was greater than national cohorts (24 â€‹% vs. 12 â€‹%). Histological subtype varied by race/ethnicity (p â€‹= â€‹0.007). Adjusting for histology and stage, survival was worse for Black vs. White patients (HR 1.71, 95 â€‹% CI 1.07-2.76) and those with metastatic disease (5.47, 3.54-8.44). In non-metastatic patients, survival differences for Black vs. White patients were attenuated by receipt of multi-modal treatment (1.53, 0.82-2.88). CONCLUSION: Observed racial disparities in survival of high-grade sarcoma may be addressed by early, multidisciplinary management.


Assuntos
Disparidades nos Níveis de Saúde , Sarcoma , Humanos , Etnicidade , Modelos de Riscos Proporcionais , Sarcoma/etnologia , Sarcoma/terapia , Sudeste dos Estados Unidos/epidemiologia , Estados Unidos/epidemiologia , Grupos Raciais
5.
Front Public Health ; 11: 1225686, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38045982

RESUMO

Emerging evidence confirms COVID-19's negative impact on college students' mental health; however, more research is needed to identify factors that promoted or hindered college students' mental health early in the pandemic. This exploratory study addressed this need. Participants were 697 students attending a large, state, urban university in the southeastern United States. Using a cross-sectional survey design, participants completed an anonymous, online survey assessing socio-demographic variables, mental health issues, and activities during the lockdown period in 2020. Findings suggest college students in the southeastern US who were women or transgender men and had pre-existing mental health conditions, fewer routine activities, and high exposure to COVID-19 news reported more mental health problems early in the pandemic. Students who exercised daily had fewer symptoms of anxiety and post-traumatic stress than students who exercised monthly, but there were no differences in emotional responses to COVID-19 based on exercise frequency. Tailored strategies to address college students' needs in response to the current or future pandemics are needed and should take into consideration factors that promote or hinder mental health. Patient or Public Contribution: College students were participants in this study. College students who were not participants in this study assisted with the implementation of this study.


Assuntos
COVID-19 , Masculino , Humanos , Feminino , COVID-19/epidemiologia , Saúde Mental , SARS-CoV-2 , Estudos Transversais , Controle de Doenças Transmissíveis , Sudeste dos Estados Unidos/epidemiologia , Estudantes/psicologia
6.
J Insect Sci ; 23(6)2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-38055939

RESUMO

A significant amount of researcher and practitioner effort has focused on developing new chemical controls for the parasitic Varroa destructor mite in beekeeping. One outcome of that has been the development and testing of "glycerol-oxalic acid" mixtures to place in colonies for extended periods of time, an off-label use of the otherwise legal miticide oxalic acid. The majority of circulated work on this approach was led by practitioners and published in nonacademic journals, highlighting a lack of effective partnership between practitioners and scientists and a possible failure of the extension mandate in beekeeping in the United States. Here, we summarize the practitioner-led studies we could locate and partner with a commercial beekeeper in the Southeast of the United States to test the "shop towel-oxalic acid-glycerol" delivery system developed by those practitioners. Our study, using 129 commercial colonies between honey flows in 2017 split into 4 treatment groups, showed no effectiveness in reducing Varroa parasitism in colonies exposed to oxalic acid-glycerol shop towels. We highlight the discrepancy between our results and those circulated by practitioners, at least for the Southeast, and the failure of extension to support practitioners engaged in research.


Assuntos
Mel , Varroidae , Estados Unidos , Animais , Abelhas , Ácido Oxálico/farmacologia , Glicerol/farmacologia , Sudeste dos Estados Unidos , Criação de Abelhas/métodos
7.
Environ Sci Technol ; 57(48): 19990-19998, 2023 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-37943716

RESUMO

As wildland fires become more frequent and intense, fire smoke has significantly worsened the ambient air quality, posing greater health risks. To better understand the impact of wildfire smoke on air quality, we developed a modeling system to estimate daily PM2.5 concentrations attributed to both fire smoke and nonsmoke sources across the contiguous U.S. We found that wildfire smoke has the most significant impact on air quality in the West Coast, followed by the Southeastern U.S. Between 2007 and 2018, fire smoke contributed over 25% of daily PM2.5 concentrations at ∼40% of all regulatory air monitors in the EPA's air quality system (AQS) for more than one month per year. People residing outside the vicinity of an EPA AQS monitor (defined by a 5 km radius) were subject to 36% more smoke impact days compared with those residing nearby. Lowering the national ambient air quality standard (NAAQS) for annual mean PM2.5 concentrations to between 9 and 10 µg/m3 would result in approximately 35-49% of the AQS monitors falling in nonattainment areas, taking into account the impact of fire smoke. If fire smoke contribution is excluded, this percentage would be reduced by 6 and 9%, demonstrating the significant negative impact of wildland fires on air quality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Incêndios , Incêndios Florestais , Estados Unidos , Humanos , Poluentes Atmosféricos/análise , Fumaça/análise , Poluição do Ar/análise , Sudeste dos Estados Unidos , Material Particulado
8.
PLoS One ; 18(11): e0293133, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37943745

RESUMO

The movement ecology of raccoons varies widely across habitats with important implications for the management of zoonotic diseases such as rabies. However, the spatial ecology of raccoons remains poorly understood in many regions of the United States, particularly in the southeast. To better understand the spatial ecology of raccoons in the southeastern US, we investigated the role of sex, season, and habitat on monthly raccoon home range and core area sizes in three common rural habitats (bottomland hardwood, upland pine, and riparian forest) in South Carolina, USA. From 2018-2022, we obtained 264 monthly home ranges from 46 raccoons. Mean monthly 95% utilization distribution (UD) sizes ranged from 1.05 ± 0.48 km2 (breeding bottomland females) to 5.69 ± 3.37 km2 (fall riparian males) and mean monthly 60% UD sizes ranged from 0.25 ± 0.15 km2 (breeding bottomland females) to 1.59 ± 1.02 km2 (summer riparian males). Males maintained home range and core areas ~2-5 times larger than females in upland pine and riparian habitat throughout the year, whereas those of bottomland males were only larger than females during the breeding season. Home ranges and core areas of females did not vary across habitats, whereas male raccoons had home ranges and core areas ~2-3 times larger in upland pine and riparian compared to bottomland hardwood throughout much of the year. The home ranges of males in upland pine and riparian are among the largest recorded for raccoons in the United States. Such large and variable home ranges likely contribute to elevated risk of zoonotic disease spread by males in these habitats. These results can be used to inform disease mitigation strategies in the southeastern United States.


Assuntos
Raiva , Guaxinins , Animais , Masculino , Feminino , Estados Unidos , Melhoramento Vegetal , Sudeste dos Estados Unidos , Ecologia , Zoonoses
9.
Sci Rep ; 13(1): 20889, 2023 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-38017141

RESUMO

Invasive wild pigs (Sus scrofa) are one of the most widespread, destructive vertebrate species globally. Their success can largely be attributed to their generalist diets, which are dominated by plant material but also include diverse animal taxa. Wild pigs are demonstrated nest predators of ground-nesting birds and reptiles, and likely pose a threat to amphibians given their extensive overlap in wetland use. DNA metabarcoding of fecal samples from 222 adult wild pigs culled monthly from 2017 to 2018 revealed a diverse diet dominated by plant material, with 166 plant genera from 56 families and 18 vertebrate species identified. Diet composition varied seasonally with availability for plants and was consistent between sexes. Amphibians were the most frequent vertebrate group consumed and represented the majority of vertebrate species detected, suggesting amphibians are potentially vulnerable to predation by wild pigs in our study region. Mammal, reptile, and bird species were also detected in pig diets, but infrequently. Our results highlight the need for research on the impacts of wild pigs on amphibians to better inform management and conservation of imperiled species.


Assuntos
Código de Barras de DNA Taxonômico , DNA , Humanos , Animais , Suínos , Anfíbios/genética , Aves , Sudeste dos Estados Unidos , Répteis , Plantas , Sus scrofa/genética
10.
Future Cardiol ; 19(12): 593-604, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37916575

RESUMO

Aim: We assessed self-reported efficacy in cardiovascular prevention practice among internal medicine, family medicine, endocrinology and cardiology clinicians. Patients & methods: We emailed a 21-item questionnaire to 956 physicians, nurse practitioners, physician assistants and pharmacists. Results: 264 clinicians responded (median age: 39 years, 55% women, 47.9% specialists). Most expressed high self-efficacy in lifestyle counselling, prescribing statins, metformin, and aspirin in primary prevention, but low self-efficacy in managing specialized conditions like elevated lipoprotein(a). Compared with specialists, PCPs expressed lower self-efficacy in managing advanced lipid disorders and higher self-efficacy in prescribing sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Conclusion: Self-efficacy in cardiovascular prevention varied across specialties. Future research should explore relevant provider, clinic and system level factors to optimize cardiovascular prevention.


Assuntos
Doenças Cardiovasculares , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Feminino , Estados Unidos , Adulto , Masculino , Autorrelato , Autoeficácia , Padrões de Prática Médica , Sudeste dos Estados Unidos , Doenças Cardiovasculares/prevenção & controle
11.
Environ Sci Technol ; 57(43): 16255-16264, 2023 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-37856836

RESUMO

Carbon capture, utilization, and storage (CCUS) are a critical set of strategies to decarbonize the industrial and power sectors and to mitigate global climate change. Pipeline infrastructure connecting CO2 sources and sinks, if not planned strategically, can cause environmental and social impacts by disturbing local landscapes. We investigated the impacts of these considerations on optimal CO2 pipeline routing and sink locations by modifying and leveraging an open-source CCUS infrastructure model, SimCCS. We expanded SimCCS from a cost-minimizing to a multiobjective framework, explicitly incorporating environmental protection objectives. We estimated trade-offs between private costs and environmental and social impacts. Using a version of the model focused on the southeastern United States, we modeled seven scenarios with varying weights given to environmental impacts to evaluate how the pipeline network responds to the multiobjective optimization. We found that the optimal path is sensitive to environmental and social impact considerations in that a small increase in pipeline length (and cost) significantly avoids large environmental and social impacts. We hope such a tool can be used to improve the pipeline permitting and siting processes and contribute to the achievement of decarbonization goals with minimal environmental impacts.


Assuntos
Dióxido de Carbono , Conservação dos Recursos Naturais , Dióxido de Carbono/análise , Indústrias , Carbono , Sudeste dos Estados Unidos
12.
Soc Sci Med ; 338: 116319, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37871395

RESUMO

RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function. OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment. METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects. RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment. CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.


Assuntos
Cognição , Dessegregação , Idoso , Humanos , Pessoa de Meia-Idade , Negro ou Afro-Americano , Brancos , Estados Unidos , Sudeste dos Estados Unidos
13.
PLoS One ; 18(10): e0293270, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37878654

RESUMO

Coyotes (Canis latrans) colonized the eastern United States over the last century and formed a 3-species predator guild with bobcats (Lynx rufus) and gray foxes (Urocyon cinereoargenteus) across much of the southeastern United States. Diets among the three species vary along with respective impacts on game species such as white-tailed deer (Odocoileus virginianus) and wild turkeys (Meleagris gallopavo). To determine predation impacts on vertebrate prey and dietary overlap in consumption of prey items, we assessed diets of coyote, bobcat, and gray fox during spring, coinciding with white-tailed deer fawning and wild turkey nesting and brood rearing. We sampled across three sites along the Savannah River in South Carolina from mid-May through mid-June of 2020-2021. We collected 180 scat samples along 295.9 kilometers (71.1-122.4 km/site) of unpaved secondary roads and used DNA metabarcoding to determine vertebrate diet items. We identified predator species of scat using DNA metabarcoding and species-specific mtDNA fragment analysis (153 were coyote, 20 bobcat, and seven gray fox). Overall, we found evidence that two species, coyote and bobcat, consumed deer while all three consumed turkeys. Frequency of deer in the diet varied across sites for coyotes from 62-86% and wild turkey was present with a frequency of occurrence of 9% for coyotes, 5% for bobcats, and 14% for gray fox. Vertebrate diet specialization was evident across predator species with high frequency of deer in coyote diets, rabbits and small mammals in bobcat diets, and herpetofauna in gray fox diets. During deer fawning and wild turkey nesting and brood rearing, dietary overlap appears to be mediated by disparate selection of prey items, which reduced competition among coyotes, bobcats, and gray foxes. Use of DNA metabarcoding may augment our understanding of dietary preferences within this predator guild by providing increased resolution of diet composition among important game species.


Assuntos
Coiotes , Cervos , Lynx , Animais , Coelhos , Raposas , Sudeste dos Estados Unidos
14.
Sci Rep ; 13(1): 16810, 2023 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-37798365

RESUMO

The health of older populations in the Southeastern U.S. receives threats from recurrent tropical cyclones and extreme heat, which may exacerbate the mortality caused by heart diseases and strokes. Such threats can escalate when these extremes form compound disasters, which may be more frequent under climate change. However, a paucity of empirical evidence exists concerning the health threats of compound disasters, and anticipations regarding the health risks of older populations under future compound disaster scenarios are lacking. Focusing on Florida, which has 67 counties and the second-largest proportion of older populations among U.S. states, we calibrate Poisson regression models to explore older populations' mortality caused by heart diseases and strokes under single and compound disasters. The models are utilized to estimate the mortality across future disaster scenarios, the changing climate, and the growing population. We identify that under multiple hurricanes or heat, current-month hurricanes or heat can affect mortality more heavily than previous-month hurricanes or heat. Under future scenarios, co-occurring hurricanes and extreme heat can exacerbate the mortality more severely than other disaster scenarios. The same types of compound disasters can coincide with an average of 20.5% higher mortality under RCP8.5-SSP5 than under RCP4.5-SSP2. We assess older populations' future health risks, alerting health agencies to enhance preparedness for future "worst-case" scenarios of compound disasters and proactively adapt to climate change.


Assuntos
Desastres , Cardiopatias , Humanos , Florida/epidemiologia , Temperatura Alta , Sudeste dos Estados Unidos , Mudança Climática
15.
Arch Psychiatr Nurs ; 46: 127-132, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37813495

RESUMO

PURPOSE: This study examined perceived substance use, opioid knowledge, and barriers to Black people accessing treatment for substance and opioid use disorder (SUD/OUD). METHODS: Thirty-nine participants completed the community survey and The Brief Opioid Overdose Knowledge questionnaire. Qualitative interviews were conducted with 18 stakeholders and 9 people with SUD/OUD. FINDINGS: Out of 39 participants, <50 % knew where to refer someone for treatment and fewer knew where to access naloxone. Majority of the stakeholders and people with SUD/OUD reported stigma as a treatment barrier. CONCLUSION: Studies related to provider anti-stigma trainings and psychoeducation for Black people living in the rural South are warranted.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Estigma Social , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Inquéritos e Questionários , Negro ou Afro-Americano , População Rural , Sudeste dos Estados Unidos
17.
PLoS One ; 18(9): e0290375, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37656705

RESUMO

Staphylococcus aureus (S. aureus) is known to cause human infections and since the late 1990s, community-onset antibiotic resistant infections (methicillin resistant S. aureus (MRSA)) continue to cause significant infections in the United States. Skin and soft tissue infections (SSTIs) still account for the majority of these in the outpatient setting. Machine learning can predict the location-based risks for community-level S. aureus infections. Multi-year (2002-2016) electronic health records of children <19 years old with S. aureus infections were queried for patient level data for demographic, clinical, and laboratory information. Area level data (Block group) was abstracted from U.S. Census data. A machine learning ecological niche model, maximum entropy (MaxEnt), was applied to assess model performance of specific place-based factors (determined a priori) associated with S. aureus infections; analyses were structured to compare methicillin resistant (MRSA) against methicillin sensitive S. aureus (MSSA) infections. Differences in rates of MRSA and MSSA infections were determined by comparing those which occurred in the early phase (2002-2005) and those in the later phase (2006-2016). Multi-level modeling was applied to identify risks factors for S. aureus infections. Among 16,124 unique patients with community-onset MRSA and MSSA, majority occurred in the most densely populated neighborhoods of Atlanta's metropolitan area. MaxEnt model performance showed the training AUC ranged from 0.771 to 0.824, while the testing AUC ranged from 0.769 to 0.839. Population density was the area variable which contributed the most in predicting S. aureus disease (stratified by CO-MRSA and CO-MSSA) across early and late periods. Race contributed more to CO-MRSA prediction models during the early and late periods than for CO-MSSA. Machine learning accurately predicts which densely populated areas are at highest and lowest risk for community-onset S. aureus infections over a 14-year time span.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Humanos , Criança , Adulto Jovem , Adulto , Staphylococcus aureus , Sudeste dos Estados Unidos/epidemiologia , Aprendizado de Máquina , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia
18.
Soc Sci Med ; 335: 116213, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37717468

RESUMO

The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.


Assuntos
Negro ou Afro-Americano , Mortalidade , Adulto , Idoso , Criança , Humanos , Recém-Nascido , Fatores Raciais , Acidente Vascular Cerebral/mortalidade , Brancos , Sudeste dos Estados Unidos , Agricultura , Entorno do Parto
19.
J Wound Ostomy Continence Nurs ; 50(6): 463-473, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37698422

RESUMO

PURPOSE: This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management. DESIGN: A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project. PARTICIPANTS AND SETTING: The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center. Both institutions are located in the Southeastern United States (Mobile, Alabama). METHODS: The A-P council used a participatory action research approach and developed a practice-informed active learning program incorporating Melnyk's evidence-based practice (EBP) steps, the Donabedian Model and the Patient-Centered Outcomes Research Institute (PCORI) Stakeholder Engagement in Question Development and Prioritization (SEED). METHOD: Hospital-acquired pressure injuries were selected as the quality outcome to address. To identify HAPI prevention/management evidenced-based practices, the A-P council conducted an integrative literature review and developed a concept map and the Pressure Injury Prevention Gap Analysis Instrument. The gap analysis identified significant gaps between EBP and current pressure injury prevention practices, with priority ranking of gaps for action by key stakeholders. OUTCOME: Following the practice-informed active learning program objectives, the A-P council identified 79 HAPI best EBPs organized by Donabedian domains of structure, process, and outcome and prioritized 3 gaps for action. Actions to address the HAPI gaps included: restructuring the hospital HAPI program, incorporating appropriate leadership to guide the HAPI program, modifying the HAPI reporting process, hiring specialized experts (WOC nurses) with emphasis on pressure injury prevention, establishing a standardized HAPI prevalence survey, improving electronic documentation, increasing transparency of HAPI reporting, improving HAPI accountability at the unit level, and exploring technology to enhance skin assessment. While HAPIs increased by 6.3% from 2019 (n = 104) to 2021 (n = 111), HAPI severity (Stages 3 and 4) decreased by 9.9% from 2019 (n = 14, or 13.46%) to 2021 (n = 4, or 3.6%). IMPLICATIONS FOR PRACTICE: Our experience with this quality improvement initiative indicates that an A-P partnership can provide a model to address complex clinical problems, quality indicators, and quality improvement while advancing a culture of inquiry and scholarship and building nursing capacity.


Assuntos
Cuidados de Enfermagem , Lesão por Pressão , Humanos , Lesão por Pressão/prevenção & controle , Lesão por Pressão/epidemiologia , Melhoria de Qualidade , Sudeste dos Estados Unidos
20.
J Parasitol ; 109(5): 464-479, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37713534

RESUMO

The northern cottonmouth, Agkistrodon piscivorus (Lacépède, 1789) (Viperidae: Crotalinae), occurs in the southeastern United States and is one of the few semiaquatic vipers in the world. Three proteocephalid tapeworms of the genus OphiotaeniaLa Rue, 1911 (Cestoda), have been described from this venomous snake. A critical evaluation of type specimens and tapeworms recently collected from A. piscivorus has revealed that only 2 species, Ophiotaenia marenzelleri (Barrois, 1898) and Ophiotaenia grandisLa Rue, 1911 (new synonym Ophiotaenia agkistrodontis [Harwood, 1933]), are specific parasites of this crotaline viper; both species are redescribed here. Ophiotaenia grandis was originally described from a mixture of 2 species: 'true' O. grandis, which is indistinguishable from O. agkistrodontis described 22 yr later and thus considered to be a junior synonym of O. grandis, and O. marenzelleri. Ophiotaenia marenzelleri, also reported from the pygmy rattlesnake, Sistrurus miliarius (Linnaeus, 1766), is a larger tapeworm with a massive scolex, a large cirrus sac, a very large, annular vaginal sphincter near the equatorial gonopore, and an oval, 3-layered embryophore surrounded by a nearly square hyaline outer membrane. Ophiotaenia grandis is much smaller and more slender and has a narrower scolex, a smaller cirrus sac and vaginal sphincter, a 2-layered embryophore, and a distinctly pre-equatorial gonopore. In addition to O. marenzelleri and O. grandis, other Ophiotaenia species typical of semiaquatic snakes (Colubridae: Natricinae) may be present in the northern cottonmouth, which serves only as a postcyclic or occasional host. There is also a tabular summary of 18 species of Ophiotaenia from semiaquatic snakes worldwide, with information on their hosts, distribution, and taxonomically important characters, including key measurements.


Assuntos
Agkistrodon , Cestoides , Feminino , Animais , Cavidade Peritoneal , Sudeste dos Estados Unidos
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