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1.
Creat Nurs ; 28(3): 198-202, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35927005

RESUMO

Background: Students in the southeastern United States were affected by Hurricane Michael in 2018. The storm's devastation led to communication and education issues that transformed students' paths to completing their nursing degree program. Climate change will cause increased natural disasters, and educators must be prepared. Method: This qualitative study used a descriptive phenomenological design. A purposive sample of 10 graduate nursing students were recruited and interviewed. The data gathering ended when data saturation was achieved. Results: Five themes were generated: Devastation and no communication, survival mode, emotional impact, before and after, and forever changed. The rich data documented the resiliency of the students as they described events during and after the hurricane in relation to their personal and educational experiences. Conclusion: Universities and students need to be prepared for natural disasters; understanding graduate nursing students' prior experiences can benefit educators.


Assuntos
Tempestades Ciclônicas , Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Pesquisa Qualitativa , Sudeste dos Estados Unidos , Estudantes de Enfermagem/psicologia , Universidades
2.
Am J Public Health ; 112(S4): S433-S443, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35763751

RESUMO

Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).


Assuntos
Infecções por HIV , Saúde Mental , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Características da Vizinhança , Qualidade de Vida , Sudeste dos Estados Unidos/epidemiologia
3.
BMC Health Serv Res ; 22(1): 795, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725410

RESUMO

BACKGROUND: The purpose of SNAP Out Stigma (SOS) was to design and implement a community-based intervention to reduce HIV-related stigma for people living with HIV (PLWH) in the Deep South. This region is a subset of 9 states including Memphis, Tennessee (project site) driving the epidemic in the United States. The purpose of this paper is to explain how PLWH in the U.S. South used Photovoice to communicate stigmatizing lived experiences and contextualize their intersection with multi-level sources of support. METHODS: PLWH attended one-on-one and/or group sessions with other PLWH. In Session 1, PLWH received a project overview, met other participants, received a camera and camera training, completed a standardized internalized stigma scale, discussed experiences of internalized stigma, and were instructed to take 3-10 pictures that captured stigma. In Session 2, PLWH discussed the pictures and their meaning. In Session 3, PLWH expanded on what they shared in previous sessions in a one-on-one interview. Thematic analysis captured key patterns of how PLWH experienced stigma. RESULTS: Forty-seven PLWH attended Session 1 and were issued a camera. Of those, 35 completed sessions 2 and 3. Participants self-identified as cis man who has sex with men (n = 18), ciswoman (n = 5), transwoman (n = 10), and non-binary (n = 2). Four emergent themes intersecting with internalizations of stigma were identified including: medical, social support, church, and self. CONCLUSIONS: The SOS intervention created a safe space for PLWH to share lived experiences of stigmatization. Photovoice facilitated discussion topics ranging from healing and recovery to overcoming factors of social determinants of HIV. We identified trauma-informed growth as an area of future programs for PLWH.


Assuntos
Infecções por HIV , Fotografação , Estigma Social , Apoio Social , Feminino , Infecções por HIV/terapia , Humanos , Masculino , Sudeste dos Estados Unidos , Estereotipagem , Inquéritos e Questionários
4.
J Vet Diagn Invest ; 34(4): 654-661, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35686438

RESUMO

Listeria monocytogenes is a bacterium that can cause disease in many species, including humans, livestock, and wildlife. Increased interactions via shared habitats may promote pathogen transmission among these groups. Our objectives were to evaluate the Southeastern Cooperative Wildlife Disease Study diagnostic data to characterize and compare L. monocytogenes-induced lesions and comorbidities in gray foxes and wild turkeys, and to describe cases of listeriosis in 2 cervids. From 1991-2020, 8 gray foxes, 8 wild turkeys, a neonatal elk, and a white-tailed deer fawn from several eastern states in the United States were diagnosed with listeriosis. All 8 foxes had hepatitis and/or hepatic necrosis with intralesional gram-positive bacilli, and concurrent canine distemper virus (CDV) infection; 2 of the foxes had been vaccinated recently for CDV. L. monocytogenes was cultured from the liver (6 of 8) or lung (2 of 8) of foxes. Lesions in wild turkeys included hepatocellular necrosis (3 of 8), heterophilic hepatitis (1 of 8), heterophilic granulomas (1 of 8), intrasinusoidal gram-positive bacilli without hepatic lesions (1 of 8), granulomatous dermatitis (1 of 8), and/or granulomatous myocarditis (2 of 8). Lymphoproliferative disease viral DNA was detected in 5 of 6 turkeys tested; reticuloendotheliosis viral DNA was detected in 2 of 3 turkeys tested. Both cervids had systemic listeriosis, with L. monocytogenes isolated from liver. Immunohistochemistry for Listeria spp. on select cases revealed immunolabeling in affected organs. Listeriosis was thus established as a cause of morbidity and mortality in 3 wildlife species, which often suffered from concurrent infections and likely immunosuppression.


Assuntos
Coinfecção , Cervos , Vírus da Cinomose Canina , Cinomose , Doenças do Cão , Listeriose , Animais , Animais Selvagens , Coinfecção/veterinária , DNA Viral , Cães , Raposas , Listeriose/epidemiologia , Listeriose/veterinária , Necrose/veterinária , Sudeste dos Estados Unidos/epidemiologia , Perus/genética , Estados Unidos
5.
J Hosp Palliat Nurs ; 24(4): 232-239, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35766946

RESUMO

This preliminary qualitative study aimed to explore affordable housing specialists' perceptions of challenges and patterns of advance care planning behaviors among low-income older residents in affordable housing. Advance care planning rates among such residents are disproportionally lower than higher-income older adults. Individual telephone interviews were conducted with affordable housing specialists in a major urban area in the Southeastern United States (N = 5). Using thematic content analysis, 2 independent coders synthesized the 2 coding sets into a single codebook that was iteratively and individually reapplied to the transcripts. The Ecological Model of Active Living, a model that embeds individual behavior within a physical and social environment, was used to categorize prominent codes to visualize relationships among codes and create a cohesive, ecological picture of planning behavior in this population. Four themes emerged from the data and were plotted in an adapted ecological model. Residents' ongoing struggles despite obtaining housing prevent self-initiation and maintenance of advance care planning. Housing specialists possess the expertise and empathy to guide change efforts and provide advance care planning, but aid is required to ensure adequate resources to prevent role conflict and burnout. Recommendations for interprofessional collaboration, practice, policy, and research are discussed.


Assuntos
Planejamento Antecipado de Cuidados , Habitação , Idoso , Humanos , Pobreza , Pesquisa Qualitativa , Sudeste dos Estados Unidos
7.
J Fish Biol ; 101(1): 13-25, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35446438

RESUMO

Abundances of large sharks are reported to have declined worldwide, and in response various levels of fisheries management and conservation efforts have been established. For example, marine-protected areas have been suggested as a means to protect large expanses of ocean from fishing and other industrial activities (e.g., habitat destruction), and in 2011 The Commonwealth of The Bahamas established The Bahamas Shark Sanctuary. Nonetheless, assessing the effectiveness of conservation efforts is challenging because consistent long-term data sets of shark abundances are often lacking, especially throughout the Caribbean and The Bahamas. In this study, the authors investigated the catch rates and demographics of tiger sharks Galeocerdo cuvier caught in a fishery-independent survey near Bimini, The Bahamas, from 1984 to 2019 to assess relative abundance trends following the banning of longline fishing in 1993 and the subsequent establishment of the shark sanctuary. To contextualize the relative abundance trends near Bimini, the authors compared this to the relative abundance of tiger sharks in a fishery-dependent survey from the Southeastern USA (SE USA), conducted from 1994 to 2019. The data of this study suggest that local abundance of tiger sharks has been stable near Bimini since the 1980s, including after the ban of longline fishing and the implementation of the shark sanctuary. In comparison, the abundance near the SE USA has slowly increased in the past decade, following potential declines in the decade preceding the USA Shark Management Plan. The results of this study provide some optimism that current conservation efforts in The Bahamas have been effective to maintain local tiger shark abundance within the protected area. In addition, current fisheries management in the SE USA is allowing this species to recover within those waters.


Assuntos
Tubarões , Animais , Bahamas , Ecossistema , Pesqueiros , Tubarões/fisiologia , Sudeste dos Estados Unidos , Estados Unidos
8.
Int J Biometeorol ; 66(7): 1339-1348, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35378617

RESUMO

Wearable sensors have been used to collect information on individual exposure to excessive heat and humidity. To date, no consistent diurnal classification method has been established, potentially resulting in missed opportunities to understand personal diurnal patterns in heat exposure. Using individually experienced temperatures (IET) and heat indices (IEHI) collected in the southeastern United States, this work aims to determine whether current methods of classifying IETs and IEHIs accurately characterize "day," which is typically the warmest conditions, and "night," which is typically the coolest conditions. IET and IEHI data from four locations were compared with the closest hourly weather station. Different day/night classifications were compared to determine efficacy. Results indicate that diurnal IET and IEHI ranges are higher than fixed-site ranges. Maximum IETs and IEHIs are warmer and occur later in the day than ambient conditions. Minimum IETs are lower and occur earlier in the day than at weather stations, which conflicts with previous assumptions that minimum temperatures occur at night. When compared to commonly used classification methods, a method of classifying day and night based on sunrise and sunset times best captured the occurrence of maximum IETs and IEHIs. Maximum IETs and IEHIs are often identified later in the evening, while minimum IETs and IEHIs occur throughout the day. These findings support future research focusing on nighttime heat exposure, which can exacerbate heat-related health issues, and diurnal patterns of personal exposure throughout the entire day as individual patterns do not necessarily follow the diurnal pattern seen in ambient conditions.


Assuntos
Temperatura Alta , Tempo (Meteorologia) , Umidade , Sudeste dos Estados Unidos , Temperatura
9.
Am J Public Health ; 112(6): 923-930, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35446610

RESUMO

Objectives. To assess linkages of patient data from a health care system in the southeastern United States to microdata from the American Community Survey (ACS) with the goal of better understanding health disparities and social determinants of health in the population. Methods. Once a data use agreement was in place, a stratified random sample of approximately 200 000 was drawn of patients aged 25 to 74 years with at least 2 visits between January 1, 2016, and December 31, 2019. Information from the sampled electronic health records (EHRs) was transferred securely to the Census Bureau, put through the Census Person Identification Validation System to assign Protected Identification Keys (PIKs) as unique identifiers wherever possible. EHRs with PIKs assigned were then linked to 2001-2017 ACS records with a PIK. Results. PIKs were assigned to 94% of the sampled patients. Of patients with PIKs, 15.5% matched to persons sampled in the ACS. Conclusions. Linking data from EHRs to ACS records is feasible and, with adjustments for differential coverage, will advance understanding of social determinants and enhance the ability of integrated delivery systems to reflect and affect the health of the populations served. (Am J Public Health. 2022;112(6):923-930. https://doi.org/10.2105/AJPH.2022.306783).


Assuntos
Prestação Integrada de Cuidados de Saúde , Registros Eletrônicos de Saúde , Censos , Estudos de Viabilidade , Humanos , Sudeste dos Estados Unidos , Estados Unidos
10.
J Appl Gerontol ; 41(7): 1641-1650, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35412383

RESUMO

This study's aim was to determine nursing home (NH) and county-level predictors of COVID-19 outbreaks in nursing homes (NHs) in the southeastern region of the United States across three time periods. NH-level data compiled from census data and from NH compare and NH COVID-19 infection datasets provided by the Center for Medicare and Medicaid Services cover 2951 NHs located in 836 counties in nine states. A generalized linear mixed-effect model with a random effect was applied to significant factors identified in the final stepwise regression. County-level COVID-19 estimates and NHs with more certified beds were predictors of COVID-19 outbreaks in NHs across all time periods. Predictors of NH cases varied across the time periods with fewer community and NH variables predicting COVID-19 in NH during the late period. Future research should investigate predictors of COVID-19 in NH in other regions of the US from the early periods through March 2021.


Assuntos
COVID-19 , Casas de Saúde , Idoso , COVID-19/epidemiologia , Centers for Medicare and Medicaid Services, U.S. , Humanos , Medicare , Casas de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia , Estados Unidos
11.
Sci Total Environ ; 824: 153802, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35150681

RESUMO

Aboveground net primary productivity (ANPP) of an ecosystem is among the most important metrics of valued ecosystem services. Measuring the efficiency scores of ecological production (ESEP) based on ANPP using relevant variables is valuable for identifying inefficient sites. The efficiency scores computed by the Data Envelopment Analysis (DEA) may be influenced by the number of input variables incorporated into the models and two DEA settings-orientations and returns-to-scales (RTSs). Therefore, the objectives were threefold to: (1) identify soil-environmental variables relevant to ANPP, (2) assess the sensitivity of ESEP to the number of input variables and DEA settings, and (3) assess local management relations with ESEP. The ANPP rates were calculated for pine forests in the southeastern U.S. where 10 management types were used. This was followed by an all-relevant variable selection technique based on 696 variables that cover biotic, pedogenic, climatic, geological, and topographical factors. Five minimal-optimal variable selection techniques were further applied to create five parsimonious sets that contain a different number of variables used as DEA inputs. After setting ANPP as the output variable, two DEA orientations (input/output) and six RTS were applied to compute ESEP. The variable selection methods succeeded in objectively identifying the major factors relevant to ANPP variation. The site index showed the highest correlation with ANPP (r = 0.39), while various precipitation factors were negatively correlated (r = - 0.15~ - 0.29, p < 0.01). Parsimonious ESEP models observed a decrease in score variances as the number of input variables increased. Various RTS produced similar scores across orientations. Of the DEA settings, an output orientation with decreasing RTS produced the most progressive ESEP with large variation. Results also suggested that macro- and micronutrient fertilization is the best combination of management strategies to achieve high ESEP. This holistic benchmark approach can be applied to other ecological functions in diverse regions.


Assuntos
Ecossistema , Solo , Florestas , Sudeste dos Estados Unidos
12.
Glob Chang Biol ; 28(10): 3163-3187, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35100489

RESUMO

Climate change is transforming ecosystems and affecting ecosystem goods and services. Along the Gulf of Mexico and Atlantic coasts of the southeastern United States, the frequency and intensity of extreme freeze events greatly influence whether coastal wetlands are dominated by freeze-sensitive woody plants (mangrove forests) or freeze-tolerant grass-like plants (salt marshes). In response to warming winters, mangroves have been expanding and displacing salt marshes at varying degrees of severity in parts of north Florida, Louisiana, and Texas. As winter warming accelerates, mangrove range expansion is expected to increasingly modify wetland ecosystem structure and function. Because there are differences in the ecological and societal benefits that salt marshes and mangroves provide, coastal environmental managers are challenged to anticipate the effects of mangrove expansion on critical wetland ecosystem services, including those related to carbon sequestration, wildlife habitat, storm protection, erosion reduction, water purification, fisheries support, and recreation. Mangrove range expansion may also affect wetland stability in the face of extreme climatic events and rising sea levels. Here, we review the current understanding of the effects of mangrove range expansion and displacement of salt marshes on wetland ecosystem services in the southeastern United States. We also identify critical knowledge gaps and emerging research needs regarding the ecological and societal implications of salt marsh displacement by expanding mangrove forests. One consistent theme throughout our review is that there are ecological trade-offs for consideration by coastal managers. Mangrove expansion and marsh displacement can produce beneficial changes in some ecosystem services, while simultaneously producing detrimental changes in other services. Thus, there can be local-scale differences in perceptions of the impacts of mangrove expansion into salt marshes. For very specific local reasons, some individuals may see mangrove expansion as a positive change to be embraced, while others may see mangrove expansion as a negative change to be constrained.


Assuntos
Ecossistema , Áreas Alagadas , Sequestro de Carbono , Mudança Climática , Humanos , Sudeste dos Estados Unidos
13.
Cancer Causes Control ; 33(4): 515-524, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35088206

RESUMO

PURPOSE: To evaluate the association between obesity and the relative prevalence of tumor subtypes among Black women with breast cancer (BC). METHODS: We conducted a pooled case-only analysis of 1,793 Black women with invasive BC recruited through three existing studies in the southeastern US. Multivariable case-only polytomous logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between obesity, measured by pre-diagnostic body mass index (BMI), and human epidermal growth factor receptor 2 + (HER2 +) and triple negative BC (TNBC) subtype relative to hormone receptor (HR) + /HER2- status (referent). RESULTS: Among 359 premenopausal women, 55.4% of cases were HR + /HER2 -, 20.1% were HER2 + , and 24.5% were TNBC; corresponding percentages among 1,434 postmenopausal women were 59.3%, 17.0%, and 23.6%. Approximately, 50-60% of both pre- and postmenopausal women were obese (BMI > 30 kg/m2), regardless of BC subtype. We did not observe a significant association between obesity and BC subtype. Among postmenopausal women, class I obesity (BMI 35 + kg/m2) was not associated with the development of HER2 + BC (OR 0.69; 95% CI 0.42-1.14) or TNBC (OR 0.93; 95% CI 0.60-1.45) relative to HR + /HER2- tumors. Corresponding estimates among premenopausal women were 1.03 (95% CI 0.43-2.48) and 1.13 (95% CI 0.48-2.64). CONCLUSION: In this large study of Black women with BC, there was no evidence of heterogeneity of BMI by BC subtype.


Assuntos
Afro-Americanos , Neoplasias da Mama , Obesidade , Neoplasias de Mama Triplo Negativas , Afro-Americanos/estatística & dados numéricos , Índice de Massa Corporal , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/metabolismo , Feminino , Humanos , Pré-Menopausa , Receptor ErbB-2/metabolismo , Receptores de Progesterona/metabolismo , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Neoplasias de Mama Triplo Negativas/epidemiologia
14.
Am Surg ; 88(3): 368-371, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34974712

RESUMO

BACKGROUND: Venomous snakebites are a common clinical scenario in the Southeastern United States. CroFab® (Crotalidae Polyvalent Immune Fab (Ovine), BTG, Wales, UK) antivenom is indicated in cases involving pit vipers and is known to be expensive. The treatment protocol for snakebites is based on clinically subjective measures triggering the application, or escalation of, antivenom administration. The purpose of this study is to characterize the use of CroFab at our institution and to evaluate the impact of its use regarding cost and overall outcomes. We suspect that it is often used but potentially less often needed. We hypothesized that CroFab use was associated with increased length of stay (LOS) without an observed difference in patient outcomes. MATERIALS AND METHODS: A retrospective chart review of snakebite patients at our level-1 trauma center from 2000 to 2016 was performed. Snakebite location, snake species, number of vials of CroFab administered, hospital LOS, intensive care unit (ICU) LOS, and complications were identified for each patient. Patients were divided into CroFab (C) and no CroFab (NC) groups. RESULTS: One hundred ninety patients with venomous snakebites were included. 53.7% of patients received CroFab. There was no difference in the complication rate of C versus NC groups, (P = .1118). CroFab use was associated with longer hospital LOS (P < .0001) and ICU LOS (P < .0001). DISCUSSION: CroFab use was associated with increased LOS in our patient population. There was no difference in observed outcomes between the C and NC groups. These findings imply that CroFab is potentially over-used in our patient population.


Assuntos
Antivenenos/administração & dosagem , Antivenenos/economia , Hospitalização , Fragmentos Fab das Imunoglobulinas/administração & dosagem , Fragmentos Fab das Imunoglobulinas/economia , Tempo de Internação/estatística & dados numéricos , Mordeduras de Serpentes/terapia , Adulto , Agkistrodon , Animais , Antivenenos/efeitos adversos , Análise Custo-Benefício , Crotalus , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Mordeduras de Serpentes/complicações , Sudeste dos Estados Unidos , Centros de Atenção Terciária
15.
J Insect Sci ; 22(1)2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35066591

RESUMO

Stink bugs (Hemiptera: Pentatomidae) are ubiquitous, cryptic, phytophagous pests that are found in many crops. In agroecosystems, individuals disperse from adjacent noncrop hosts and tend to aggregate or cluster within fields. In this study, we characterized the distribution of Euschistus servus (Say) and Euschistus tristigmus (Say) (Hemiptera: Pentatomidae) over 2 yr at three southeastern United States farmscapes. Stink bugs were captured in pheromone-baited traps, and Spatial Analysis by Distance Indices (SADIE) used to identify the location of significant aggregations by habitat type and season. Euschistus servus adults were more likely to be captured in pecan orchards, cotton, other crops, or unmanaged habitats than in woodland habitats. Significant aggregations of E. servus were detected in a variety of habitats including pecan, corn, cotton, peanut, and tobacco, as well as fallow and hay fields, pastures, and hedgerows. Fewer adult E. tristigmus were captured than E. servus adults, and E. tristigmus adults were typically trapped and aggregated in woodland habitats. The resulting data provide an important understanding regarding the seasonal movement and relative abundance levels of stink bug populations, which are critical to the development of integrated pest management strategies.


Assuntos
Distribuição Animal , Heterópteros , Animais , Arachis , Produtos Agrícolas , Estações do Ano , Sudeste dos Estados Unidos , Análise Espaço-Temporal , Zea mays
16.
Sex Transm Dis ; 49(3): 208-215, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34535613

RESUMO

BACKGROUND: Little is known regarding human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing preferences for location, staffing, and hours of operation among Young Black men who have sex with men (YBMSM) in the Southeastern United States, a population at high risk for HIV/STIs. We used a discrete choice experiment to explore these preferences. METHODS: Young Black men who have sex with men ages 16 to 35 years in Birmingham, AL and Jackson, MS completed online surveys evaluating their preferences (best/worst) for HIV/STI testing locations, staffing, hours, method of results notification, and cost. They also selected preferred combinations of these variables through choice tasks. Results were analyzed using joint best/worst and discrete choice experiment models. RESULTS: Between June 2018 and December 2019, participants in Alabama (n = 54) and Mississippi (n = 159) completed online surveys. Both groups preferred stationary testing locations over mobile testing vans, with the most significant difference favoring STI testing-only clinics in Mississippi and local health departments in Alabama (P < 0.001). Technician-performed tests or self-testing were significantly less preferred compared with clinician-performed testing for both groups (P < 0.0001 and P < 0.0001, respectively). Free testing and phone results notification (versus text) were preferred by both groups. The most desirable combination among all participants was weekday clinician-performed testing at the health department for $5. CONCLUSIONS: Young Black men who have sex with men in the Southeastern United States prefer traditional testing locations staffed by experienced personnel. Combination choices are influenced by services that are low or no cost. More research is needed to inform the best way(s) to provide affordable, high-quality HIV/STI testing services for YBMSM, particularly in the post-COVID-19 era when sexual health care delivery models are evolving toward home-based and remote health-focused strategies.


Assuntos
COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adolescente , Adulto , HIV , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , SARS-CoV-2 , Infecções Sexualmente Transmissíveis/diagnóstico , Sudeste dos Estados Unidos , Adulto Jovem
17.
Ann Surg ; 275(2): 340-347, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32516232

RESUMO

OBJECTIVE: To define geographic variations in emergency general surgery (EGS) care, we sought to determine how much variability exists in the rates of EGS operations and subsequent mortality in the Northeastern and Southeastern United States (US). SUMMARY BACKGROUND DATA: While some geographic variations in healthcare are normal, unwarranted variations raise questions about the quality, appropriateness, and cost-effectiveness of care in different areas. METHODS: Patients ≥18 years who underwent 1 of 10 common EGS operations were identified using the State Inpatient Databases (2011-2012) for 6 states, representing Northeastern (New York) and Southeastern (Florida, Georgia, Kentucky, North Carolina, Mississippi) US. Geographic unit of analysis was the hospital service area (HSA). Age-standardized rates of operations and in-hospital mortality were calculated and mapped. Differences in rates across geographic areas were compared using the Kruskal-Wallis test, and variance quantified using linear random-effects models. Variation profiles were tabulated via standardized rates of utilization and mortality to compare geographically heterogenous areas. RESULTS: 227,109 EGS operations were geospatially analyzed across the 6 states. Age-standardized EGS operation rates varied significantly by region (Northeast rate of 22.7 EGS operations per 10,000 in population versus Southeast 21.9; P < 0.001), state (ranging from 9.9 to 29.1; P < 0.001), and HSA (1.9-56.7; P < 0.001). The geographic variability in age-standardized EGS mortality rates was also significant at the region level (Northeast mortality rate 7.2 per 1000 operations vs Southeast 7.4; P < 0.001), state-level (ranging from 5.9 to 9.0 deaths per 1000 EGS operations; P < 0.001), and HSA-level (0.0-77.3; P < 0.001). Maps and variation profiles visually exhibited widespread and substantial differences in EGS use and morality. CONCLUSIONS: Wide geographic variations exist across 6 Northeastern and Southeastern US states in the rates of EGS operations and subsequent mortality. More detailed geographic analyses are needed to determine the basis of these variations and how they can be minimized.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estudos de Coortes , Cirurgia Geral , Humanos , New England/epidemiologia , Estudos Retrospectivos , Sudeste dos Estados Unidos/epidemiologia
18.
J Anim Physiol Anim Nutr (Berl) ; 106(1): 205-219, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34120377

RESUMO

Loggerhead sea turtles (Caretta caretta) are opportunistic carnivores that feed primarily on benthic invertebrates and fish. Sea turtle rehabilitation requires provision of a species-specific, balanced diet that supplies nutrition similar to that of a wild diet; this can be challenging because free-ranging loggerheads' diets vary depending on their life stage and geographic location, with predominant prey species dictated by local availability. The goal of this study was to better understand the nutritional needs of subadult and adult loggerheads in rehabilitation. This was accomplished by conducting a retrospective survey of stomach contents identified during gross necropsy of 153 deceased loggerheads that stranded in coastal Georgia, USA. A total of 288 different forage items were identified; the most frequently observed prey items belong to the subphylum Crustacea (N = 131), followed by bony fish (Osteichthyes; N = 45), gastropod mollusks (N = 40), bivalve mollusks (N = 23), and Atlantic horseshoe crabs (Limulus polyphemus; N = 15). The proportions of certain prey items differed significantly with turtle size; adult turtles ate proportionately more gastropods (p = 0.001), and subadults ate proportionately more fish (p = 0.01). Stomach contents information was used to determine common local prey items (blue crab, cannonball jellyfish, horseshoe crab, whelk), which were evaluated for nutritional content. Additionally, we compared hematology and plasma biochemistry profiles (including proteins, trace minerals, and vitamins) between four cohorts of loggerhead turtles, including free-ranging subadults and adults, nesting females, and loggerheads undergoing rehabilitation. This information was applied to inform a regionally specific, formulated diet for tube feeding, and a supplement containing vitamins and minerals for captive loggerheads, to more closely approximate the nutritional content of their natural diet. Assessing the regional and temporal variability in loggerhead diets is an important component in their effective conservation because resultant data can be used to help understand the impacts of environmental perturbations on benthic food webs.


Assuntos
Oligoelementos , Tartarugas , Animais , Feminino , Conteúdo Gastrointestinal , Estudos Retrospectivos , Sudeste dos Estados Unidos
19.
Sex Transm Infect ; 98(1): 44-49, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33436506

RESUMO

ObjectivesThe southeastern US is a domestic epicentre for incident HIV with high prevalence of herpes simplex virus (HSV) coinfection. We estimated the incidence rates (IR) of symptomatic herpetic anogenital ulcer disease (HAUD) and assessed its associations with demographic and clinical characteristics, specifically with immunological markers using median, nadir and trajectory CD4 counts. METHODS: Electronic medical records (EMR) of over 7000 people living with HIV (PLWH) attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analysed. IR of HSV-related HAUD were estimated per 10 000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of IR. All IR and trends were stratified by gender and race. Six CD4 trajectory groups were constructed using the group-based trajectory modelling. Multivariable logistic models were conducted to assess the associations of CD4 counts (nadir, median CD4 and newly defined CD4 trajectory), separately with HAUD. RESULTS: Of the 4484 PLWH eligible individuals (3429 men, 1031 women and 24 transgender), we observed 425 patients with HSV-related HAUD. The mean log10viral load was higher in HAUD than HAUD-free groups, whereas the median nadir CD4 count (cells/uL) was higher in the non-cases than the case groups (p<0.05). HAUD were more frequent in women than men. Median CD4 (<200 cell/uL) was associated with HAUD (OR=2.1), but there were no significant associations with nadir CD4. Significant associations with declining and sustained low CD4 counts trajectory patterns were observed with HAUD. CONCLUSIONS: There were significant differences between men and women with incident HAUD among PLWH. EMR-based studies can provide innovative trajectory models that can potentially be helpful in guiding screening and clinical care of HAUD among high-risk PLWH.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Fissura Anal/virologia , Genitália/virologia , Herpes Genital/epidemiologia , Adulto , Contagem de Linfócito CD4/estatística & dados numéricos , Coinfecção/epidemiologia , Coinfecção/virologia , Feminino , Herpes Genital/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Simplexvirus/genética , Simplexvirus/imunologia , Simplexvirus/patogenicidade , Sudeste dos Estados Unidos/epidemiologia , Carga Viral
20.
J Med Entomol ; 59(1): 41-48, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-34734635

RESUMO

Eastern equine encephalitis virus (EEEV; family Togaviridae, genus Alphavirus) is a mosquito-borne pathogen found in eastern North America that causes severe disease in humans and horses. The mosquito Culiseta melanura (Coquillett) (Diptera: Culicidae) is the primary enzootic vector of EEEV throughout eastern North America while several mosquito species belonging to diverse genera serve as bridge vectors. The ecology of EEEV differs between northern and southern foci, with respect to phenology of outbreaks, important vertebrate hosts, and bridge vector species. Active transmission is limited to roughly half of the year in northern foci (New York, New Hampshire, Massachusetts, Connecticut), while year-round transmission occurs in the southeastern region (particularly Florida). Multiple phylogenetic analyses indicate that EEEV strains circulating in northern foci are likely transported from southern foci by migrating birds. Bird species that overwinter or migrate through Florida, are bitten by Cs. melanura in late spring, and arrive at northern breeding grounds in May are the most likely candidates to disperse EEEV northward. Available data indicate that common yellowthroat and green heron satisfy these criteria and could serve as virus dispersers. Understanding the factors that drive the phenology of Cs. melanura reproduction in the south and the timing of avian migration from southern foci could provide insight into how confluence of these biological phenomena shapes outbreaks of EEE throughout its range. This information could be used to develop models predicting the likelihood of outbreaks in a given year, allowing vector control districts to more efficiently marshal resources necessary to protect their stakeholders.


Assuntos
Vírus da Encefalite Equina do Leste , Encefalomielite Equina , Doenças dos Cavalos , Mosquitos Vetores , Animais , Vírus da Encefalite Equina do Leste/fisiologia , Encefalomielite Equina/epidemiologia , Encefalomielite Equina/transmissão , Encefalomielite Equina/veterinária , Encefalomielite Equina/virologia , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/transmissão , Doenças dos Cavalos/virologia , Cavalos , Sudeste dos Estados Unidos/epidemiologia , Tennessee
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