Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 864
Filtrar
1.
BMJ ; 367: l5837, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666218

RESUMO

OBJECTIVE: To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction. DESIGN: Quasi-experimental longitudinal study. SETTING: Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018. PARTICIPANTS: 104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period. MAIN OUTCOME MEASURES: Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census). RESULTS: The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81). CONCLUSIONS: A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.


Assuntos
Ingestão de Energia/fisiologia , Fast Foods/efeitos adversos , Rotulagem de Alimentos , Obesidade/prevenção & controle , Restaurantes/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Ensaios Clínicos Controlados não Aleatórios como Assunto , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Sudeste dos Estados Unidos/epidemiologia
2.
AIDS Behav ; 23(Suppl 3): 224-232, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473847

RESUMO

HIV prevention goals in the United States include reducing new HIV infections among people in the South Census region (commonly referred as the South). Using data reported to the National HIV Surveillance System, we examined trends in HIV diagnoses in the South, including the Deep South and Other South, during 2012-2017. Although diagnosis rates declined in all regions during the time period, declines were greater in all other regions compared to the Deep South, with the exception of the West region. Moreover, the South continues to have a diagnosis rate 50% higher (65% higher in the Deep South) than that of any other region. Diagnoses in the Deep South increased among some groups, including men who have sex with men, persons aged 25-34 years and Hispanics/Latinos. These findings highlight the need to further strengthen interventions in the South, particularly among communities of color and young adults.


Assuntos
Sorodiagnóstico da AIDS/tendências , Infecções por HIV/diagnóstico , Vigilância da População , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Hispano-Americanos , Homossexualidade Masculina , Humanos , Masculino , Sudeste dos Estados Unidos/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
3.
Res Vet Sci ; 125: 370-373, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31377419

RESUMO

It is no secret that the rigors of professional medical programs are creating an immense strain on mental health, and studies show that students are coping poorly. It is becoming more widely known that this problem especially exists in veterinary medicine. Veterinary colleges are starting to make changes to address the mental health crisis among their student (and practitioner) population, however, in order to solve a problem you must first understand your audience. There are still questions regarding who is more often affected and why? In this study, the prevalence and correlates of stress, anxiety, and depression among veterinary students in the Southeastern US is the primary focus. Three hundred and forty two participants answered survey questions addressing socio-demographics, as well as, completed a perceived stress scale and patient health questionnaire (PHQ-4) to measure anxiety and depression. Chi-square, independent samples t-test, and ANOVA were conducted to assess demographic correlates of stress, anxiety, and depression. High levels of stress, anxiety, and depression were identified among veterinary students participating in the study. Stress level was significantly associated with sex and Grade Point Average (GPA): females and those with GPA <3.0 exhibited higher levels of stress. While it is good that veterinary colleges are already making changes, the question remains if these changes are significant enough. Based on this study's results, transitioning to a pass/fail grading system and implementing regular mindfulness practice are proposed changes that may aid in promoting a positive mental health culture for students and future veterinary professionals.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Estresse Psicológico/epidemiologia , Estudantes de Medicina/psicologia , Adulto , Ansiedade/psicologia , Depressão/psicologia , Educação em Veterinária/estatística & dados numéricos , Feminino , Humanos , Masculino , Prevalência , Fatores Socioeconômicos , Sudeste dos Estados Unidos/epidemiologia , Estresse Psicológico/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
4.
Orthop Nurs ; 38(4): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343631

RESUMO

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.


Assuntos
/normas , Pacotes de Assistência ao Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/normas , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/normas , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
5.
Ecotoxicol Environ Saf ; 182: 109387, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31302332

RESUMO

A spatiotemporal analysis of benzene was performed in east of the USA and in a representative station in Baltimore County, in order to assess its trend over a 25-year time span between 1993 and 2018. A novel time series analysis technique known as TBATS (an ensemble of Trigonometric seasonal models, Box-Cox transformation, ARMA error plus Trend and Seasonal components) was applied for the first time on an air contaminant. The results demonstrated an annual seasonality and a continuously declining trend in this respect. The success of Reformulated Gasoline Program (RFG), initiated in 1995, was obviously detected in time series data since the daily benzene concentrations reduced to one-sixth of its original level in 1995. In this regard, the respective values of mean absolute scaled error (MASE) were 0.35 and 0.45 for training and test series. Given the observed concentrations of benzene, the hot spot areas in east of the US were identified by spatial analysis, as well. A chronic cancer risk was followed along the study area, by both a deterministic and probabilistic risk assessment (PRA) techniques. It was indicated that children are at higher risk than that of adults. The range of estimated risk values for PRA was higher and varied between 6.45 × 10-6 and 1.68 × 10-4 for adults and between 8.13 × 10-6 and 8.29 × 10-4 for children. According to the findings of PRA, and referring to the threshold level of 1 × 10-4, only 1.2% of the adults and 28.77% of the children were categorized in an immediate risk group.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Benzeno/análise , Monitoramento Ambiental/métodos , Neoplasias/epidemiologia , Adulto , Criança , Pré-Escolar , Gasolina/análise , Humanos , Masculino , Mid-Atlantic Region/epidemiologia , Probabilidade , Medição de Risco , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Análise Espaço-Temporal
6.
Gynecol Oncol ; 154(2): 379-382, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31196574

RESUMO

OBJECTIVE: To compare referral patterns, genetic testing and pathogenic variant rates in Black women (BW) and White women (WW) in a large academic Gynecologic Cancer Risk Assessment Clinic (GCRAC). METHODS: Cross sectional study of an IRB-approved prospective, cohort study from a GCRAC. Data evaluated included: age, race, referral provider specialty and indication, genetic testing frequency, as well as frequency and types of pathogenic variants. RESULTS: 588 WW and 57 BW were evaluated from 1/2010-12/2015. Although approximately one-third of BW and WW were referred for family history alone, referral indications varied. BW were more likely referred for a known pathogenic variant (20.0% vs. 6.2%) although less likely referred for a personal history of ovarian cancer (24.0% vs. 46.8%; p = 0.0023). While gynecologic oncologists referred most patients (BW 43.6% vs. WW 63.0%), BW were more likely to be referred by surgical oncologist (23.0% vs. 12.8%) or genetic counselor (12.8% vs. 5.9%) than WW (p = 0.0234). Referral from non-OBGYN primary care providers was <3% in both groups. Genetic testing rates were similar in both races (82.4% vs. 85.5%). Rates of BRCA1 mutations (12.7% vs. 11.5%) were similar; however, BW had more BRCA2 mutations (21.3% vs. 9.5%; p = 0.0194). CONCLUSIONS: Since BW are more likely to be referred by surgical oncology or genetics counselor, breast clinics might be an entry point to ensure genetic counseling and testing. Continued efforts to increase awareness regarding the importance of patient referral at the primary care level may help identify the subset of women not currently undergoing counseling and testing.


Assuntos
Predisposição Genética para Doença , Testes Genéticos/estatística & dados numéricos , Neoplasias Ovarianas , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/etnologia , Estudos Prospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
7.
J Wound Ostomy Continence Nurs ; 46(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083063

RESUMO

PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting. DESIGN: Mixed methods, pre-/posttest design. SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States. METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant. RESULTS: System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology. CONCLUSIONS: Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.


Assuntos
Monitorização Fisiológica/métodos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Casas de Saúde/organização & administração , Postura , Lesão por Pressão/epidemiologia , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia
8.
Geospat Health ; 14(1)2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31099526

RESUMO

Lyme disease is the most significant vector-borne disease in the United States, and its southward advance over several decades has been quantified. Previous research has examined the potential role of climate change on the disease's expansion, but no studies have considered the role of future land cover upon its distribution. This research examines Lyme disease risk in the south-eastern U.S. based on projected land cover developed under four Intergovernmental Panel on Climate Change Scenarios: A1B, A2, B1, and B2. Land cover types and edge indices significantly associated with Lyme disease in Virginia were incorporated into a spatial Poisson regression model to quantify potential land cover suitability for Lyme disease in the south-eastern U.S. under each scenario. Our results indicate an intensification of potential land cover suitability for Lyme disease under the A scenarios and a decrease of potential land cover suitability under the B scenarios. The decrease under the B scenarios is a critical result, indicating that Lyme disease risk can be decreased by making different land cover choices. Additionally, health officials can focus efforts in projected high incidence areas.


Assuntos
Meio Ambiente , Doença de Lyme/epidemiologia , Carrapatos/crescimento & desenvolvimento , Animais , Humanos , Análise de Regressão , Sudeste dos Estados Unidos/epidemiologia , Análise Espacial
9.
Psychiatry Res ; 275: 61-70, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30878858

RESUMO

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.


Assuntos
Emoções , Frustração , Análise de Classes Latentes , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Emoções/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/epidemiologia , Sudeste dos Estados Unidos/epidemiologia , Estudantes/psicologia , Inquéritos e Questionários
10.
Am J Clin Dermatol ; 20(3): 465-475, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877492

RESUMO

OBJECTIVES: Depression may occur in up to 30% of individuals with cutaneous lupus erythematosus (CLE), many of whom may also have systemic manifestations. Chronic cutaneous lupus erythematosus (CCLE) conditions are less likely to present systemic involvement than acute and subacute conditions but more often cause permanent scarring and dyspigmentation. However, little is known about depression in those who have CCLE confined to the skin (primary CCLE). As African Americans are at high risk for primary CCLE and depression, we aimed to investigate the prevalence of and explore the risk factors for depression in a population-based cohort of predominantly Black patients with primary CCLE. METHODS: This was a cross-sectional analysis of a cohort of individuals with a documented diagnosis of primary CCLE, established in metropolitan Atlanta, GA, USA. Participants were recruited from the Centers for Disease Control and Prevention (CDC) population-based Georgia Lupus Registry, multicenter dermatology clinics, community practices, and self-referrals. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the primary outcome: depressive symptoms. Stand-alone questions were used to assess sociodemographics and healthcare utilization. Emotional, informational, and instrumental support were measured with PROMIS short forms, interpersonal processes of care with the IPC-29 survey, and skin-related quality of life with the Skindex-29+ tool. RESULTS: Of 106 patients, 92 (86.8%) were female, 91 (85.8%) were Black, 45 (42.9%) were unemployed or disabled, and 28 (26.4%) reported moderate to severe depressive symptoms. Depression severity was lower in patients who were aged ≥ 60 years, were married, or had graduated from college. Univariate analysis showed that being employed (odds ratio [OR] 0.24; 95% confidence interval [CI] 0.10-0.61), insured (OR 0.23; 95% CI 0.09-0.60), reporting higher instrumental, informational, and emotional support (OR 0.75; 95% CI 0.60-0.94; OR 0.62; 95% CI 0.49-0.78; and OR 0.48; 95% CI 0.35-0.65, respectively), visiting a primary care physician in the last year (OR 0.16; 95% CI 0.04-0.61) and reporting better physician-patient interactions (OR 0.56; 95% CI 0.37-0.87) were negatively associated with depression. Patient's perception of staff disrespect (OR 2.30; 95% CI 1.19-4.47) and worse skin-related quality of life (OR 1.04; 95% CI 1.02-1.06) rendered higher risk. In multivariate analysis, only perception of staff disrespect (OR 2.35; 95% CI 1.06-5.17) and lower emotional support (OR 0.48; 95% CI 0.35-0.66) remained associated with depression. CONCLUSION: Over one-quarter of a predominantly Black population-based cohort of individuals with primary CCLE reported moderate to severe depression, a rate three to five times higher than described previously in the general population from the same metropolitan Atlanta area. Our findings suggest that, while patient's perception of discrimination in the healthcare setting may play a role as a determinant of depression, social support may be protective. In addition to routine mental health screening and depression treatment, interventions directed at providing emotional support and improving office staff interpersonal interactions may contribute to reduce the risk of depression in patients with CCLE.


Assuntos
Efeitos Psicossociais da Doença , Depressão/epidemiologia , Lúpus Eritematoso Cutâneo/psicologia , Qualidade de Vida , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Doença Crônica/psicologia , Estudos de Coortes , Estudos Transversais , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Disparidades em Assistência à Saúde , Humanos , Lúpus Eritematoso Cutâneo/diagnóstico , Masculino , Programas de Rastreamento , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Relações Profissional-Paciente , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Apoio Social , Sudeste dos Estados Unidos/epidemiologia
11.
J Agromedicine ; 24(2): 121-124, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712502

RESUMO

Non-timber forest products in the southeastern United States are rich and varied and contribute millions of dollars to the economies of timber producing states. They include medicinals, specialty wood products, floral greens, and edibles. However, little is known about the safety and health outcomes of those workers that harvest non-timber forest products. We stress the need for research to assess the burden of injury and fatalities in this work group.


Assuntos
Fazendeiros/estatística & dados numéricos , Saúde do Trabalhador/estatística & dados numéricos , Agricultura Florestal , Humanos , Traumatismos Ocupacionais/epidemiologia , Sudeste dos Estados Unidos/epidemiologia
12.
Psychol Serv ; 16(1): 58-66, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30714808

RESUMO

Youth are commonly exposed to potentially traumatic events (PTEs). Following exposure, approximately 25% develop persistent mental and behavioral health (M/BH) symptoms, yet many go untreated or are misdiagnosed and suffer adverse outcomes. Primary care is an ideal setting for detection of trauma-related symptoms. The current article uses archival data to (1) examine the prevalence of posttraumatic stress symptoms that are unlikely, possible, and likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD) and the M/BH and physical health concerns that co-occur with PTSD symptoms among adolescents (n = 133, mean age = 15.1 years, 67% female, 60% White) referred for brief, integrated M/BH services within primary care and (2) identify the prevalence of referred adolescents with elevated symptoms of PTSD that would not be identified for services by traditional depression screening. M/BH providers assessed referred patients for PTSD, M/BH, and physical health symptoms as a routine part of services. Fifty-eight percent screened positive for PTSD (PTSD-possible or PTSD-likely range). The subset of adolescents in the PTSD-likely range (29%) reported significantly greater stress, depression, anxiety, anger, and externalizing symptoms than those categorized as PTSD-possible or PTSD-unlikely. Adolescents in the PTSD-possible or PTSD-unlikely ranges did not differ on any M/BH variables; PTSD groups' physical health did not differ. Of note, 15% of adolescents reporting symptoms likely to meet PTSD criteria did not report elevated depressive symptoms and would have been overlooked by depression screening alone. Given the prevalence of PTEs among M/BH patients, trauma-informed care is necessary for quality patient care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Sintomas Comportamentais/diagnóstico , Serviços de Saúde Mental , Atenção Primária à Saúde , Trauma Psicológico/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adolescente , Sintomas Comportamentais/epidemiologia , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Trauma Psicológico/epidemiologia , Sudeste dos Estados Unidos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
13.
J Parasitol ; 105(1): 11-16, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30807729

RESUMO

The life cycle of Sarcocystis species is heteroxenous (2-host), with carnivores being the definitive host and herbivores serving as intermediate hosts in predator-prey relationships. Raptors (eagles, hawks, falcons, and owls) are apex predators and are not consumed routinely by other carnivores, making the occurrence of sarcocysts in their muscles unusual. Recent reports of sarcocysts in eagles and owls with Sarcocystis encephalitis suggests that this condition may be becoming more frequent, and Sarcocystis falcatula has been implicated as the agent of encephalitis in golden ( Aquila chrysaetos) and bald eagles ( Haliaeetus leucocephalus) as well as great horned owls ( Bubo virginianus). The present study was done to determine the prevalence of sarcocysts of Sarcocystis species in the muscles of raptors from the southeastern United States. Pectoral and heart muscle from 204 raptor patients from the Carolina Raptor Center, Huntersville, North Carolina were tested for the presence of Sarcocystis species using histology. Only a few sarcocysts were seen in sections of pectoral muscle from 39 of 204 raptors (19.1%) and heart muscle from 9 that also had sarcocysts in their pectoral muscle. Two structural types of sarcocysts, thin-walled (1 µm; 62%) or thick-walled (>2 µm, 38%), were seen. Statistical analysis of raptor age and gender was done by Fisher's exact test on samples from raptors with 20 or more samples per group. The prevalence of sarcocysts by age (2 yr or more) was significant for red-shouldered hawks ( Buteo lineatus) ( P = 0.022) and Cooper's hawks ( Accipiter cooperii) ( P = 0.028). Sarcocyst prevalence in male raptors from these groups evaluated statistically were always less than in females. Prevalence in female red-tailed hawks ( Buteo jamaicensis) (42.1%) was significantly greater than in males (6.7%) using Fisher's exact test ( P = 0.047). Examination of case histories from the 39 sarcocyst-positive raptors did not reveal an association with sarcocysts in raptor pectoral or heart muscle and in a diagnosis of encephalitis. Additional studies are needed to determine the epidemiology and relationships of Sarcocystis spp. that use raptors as intermediate hosts and the importance of Sarcocystis spp. in the overall wellbeing of raptors in their natural environments.


Assuntos
Doenças das Aves/parasitologia , Músculo Esquelético/parasitologia , Aves Predatórias/parasitologia , Sarcocystis/isolamento & purificação , Sarcocistose/veterinária , Animais , Doenças das Aves/epidemiologia , Falconiformes/parasitologia , Feminino , Falcões/parasitologia , Masculino , North Carolina/epidemiologia , Prevalência , Centros de Reabilitação , Sarcocistose/epidemiologia , Sarcocistose/parasitologia , Fatores Sexuais , Sudeste dos Estados Unidos/epidemiologia , Estrigiformes/parasitologia
14.
Lung Cancer ; 127: 90-95, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30642558

RESUMO

OBJECTIVES: Previous studies have suggested that poor oral health might increase the risk of lung cancer among European- and Asian- descendants. The association has not been investigated among African Americans or socially disadvantaged populations. In this nested case-control study, we investigated whether oral health was associated with lung cancer risk among a low-income population of African Americans and European Americans in the Southeastern United States. MATERIALS AND METHODS: A total of 403 incident lung cancer cases and 1612 matched controls from the Southern Community Cohort Study were included. Multivariate conditional logistic regression models were fitted to evaluate the risk of lung cancer linked to tooth loss, tooth decay, and history of periodontal disease. RESULTS: Tooth loss was significantly associated with an increased risk of lung cancer: the odds ratio (OR) of more than 10 teeth lost was 1.64 (95% CI: 1.00, 2.69). Tooth decay was also significantly associated with increased lung cancer risk; those with ≥ 6 decaying teeth had an OR of 1.65 (1.18, 2.31). An increased lung cancer risk was significantly associated with a history of periodontal disease among African Americans (OR = 1.56, 95% CI: 1.05, 2.31) and heavy smokers (OR = 2.05, 95% CI: 1.38, 3.05). CONCLUSION: Poor oral health is associated with increased lung cancer risk, and this association appears to vary by race and smoking behavior among a low-income population of African Americans and European Americans in the Southeastern United States.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Neoplasias Pulmonares/epidemiologia , Saúde Bucal/estatística & dados numéricos , Doenças Periodontais/epidemiologia , Pobreza , Idoso , Fumar Cigarros , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Sudeste dos Estados Unidos/epidemiologia
15.
Sleep Health ; 5(1): 72-77, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30670170

RESUMO

OBJECTIVES: Immediately after experiencing a concussion, many will report the presence of a variety of symptoms, which may include disturbances in sleep. It is possible that these symptoms and other resulting quality of life (QOL) disturbances may persist for some time following a concussion. The purpose of this study was to determine if a history of concussions was related to ongoing sleep disturbances, symptoms, and changes in QOL. METHODS: Eighty-two student-athletes (club and varsity) completed an online survey to determine concussion history, sleep disturbances, concussion symptoms, and QOL dysfunctions. Separate analyses of variance were performed to determine if sleep disturbances, symptoms, and QOL dysfunctions were related and if they differed based on concussion history (0, 1-2, 3+). RESULTS: Those with no concussion history reported fewer sleep disturbances (P = .028), symptoms (P = .029), symptom severity (P = .014), QOL dysfunctions (P = .003), and QOL severity (P = .011) than those who self-reported having had a previous concussion(s). Additionally, the number of sleep disturbances was found to positively correlate with symptoms (P < .001), symptom severity (P < .001), QOL dysfunctions (P = .001), and severity of QOL dysfunctions (P = .002). CONCLUSIONS: The results of the current study demonstrate that concussion history is related to persistent changes in sleep, ongoing symptoms, and QOL dysfunctions and should be considered in concussion management protocols even after return to play and academics has occurred.


Assuntos
Atletas/psicologia , Concussão Encefálica/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Estudantes/psicologia , Adolescente , Adulto , Atletas/estatística & dados numéricos , Feminino , Humanos , Masculino , Sudeste dos Estados Unidos/epidemiologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
16.
J Acquir Immune Defic Syndr ; 80(5): 527-532, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30649036

RESUMO

BACKGROUND: Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. SETTING AND METHODS: We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women's Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. RESULTS: Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. CONCLUSIONS: Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.


Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Profilaxia Pré-Exposição , Adulto , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Sexo sem Proteção/estatística & dados numéricos
17.
Subst Use Misuse ; 54(6): 899-907, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30618337

RESUMO

BACKGROUND: College student substance use has been a problem for many years. In particular, heavy alcohol consumption can create issues with academics, social relationships, and overall functioning. Unitary measures of generic alcohol consumption (e.g., drinking frequency) are important predictors of alcohol-related negative consequences, but the small amount of specific-beverage research available suggests that assessing beverage type consumed may enhance prediction. OBJECTIVES: The purpose of the present study was to expand knowledge of alcoholic beverage preference in relation to negative consequences and confirm the factor structure of the RAPI proposed by Martens et al. ( 2007 ) in a college student sample. METHODS: In addition, the present study expanded current knowledge by assessing beverage preference type in relation to specific negative consequences on the RAPI. RESULTS: Results replicated the three-factor structure originally found by Martens et al. ( 2007 ). Moreover, results found that individuals consuming shots of liquor or alcohol mixed with caffeine reported higher overall RAPI scores and higher scores on the Abuse/Dependence and Personal Consequences factors but not the Social Consequences factor than those consuming mixed drinks, beer, or wine. Conclusions/Importance: This research might inform discussions with incoming college freshman about not only alcohol consumption and negative consequences but the dangers of drinking specific types of alcohol beverages such as shots and/or alcohol mixed with caffeine.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Bebidas Alcoólicas/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Sudeste dos Estados Unidos/epidemiologia , Universidades , Adulto Jovem
18.
Biol Res Nurs ; 21(2): 166-172, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30514103

RESUMO

Despite adequate insulin regimens and concurrent treatments for Type 1 diabetes (T1D), many children have trouble achieving glycemic control, as evidenced by elevated HbA1c levels. Maternal and child depressive symptoms, as well as child perceived stress, are associated with less optimal glycemic control. Cortisol, a stress hormone, may mediate the relationships among depressive symptoms, perceived stress, and glycemic control. The purposes of this pilot study were to (1) examine the feasibility of collecting salivary samples to measure cortisol change in prepubertal school-age children diagnosed with T1D and (2) determine effect sizes for the relationships among maternal depressive symptoms and child depressive symptoms, perceived stress, cortisol levels, and glycemic control. Participants were recruited using convenience sampling from a pediatric endocrinology clinic in the southeastern United States. All data, including surveys, salivary samples, HbA1c, height, and weight, were collected the same day as a clinic visit. The study included 30 children, ages 6.9-12.2 years, and their mothers. Most children were female (70%) and Caucasian (76.7%), but the sample was socioeconomically diverse. HbA1c values ranged from 6.1% to 12.2%. Of the children, 18 showed normal declines in cortisol over 3 hr, while 12 had increases in cortisol. Results show recruitment, participation, and data collection are feasible in school-age children with T1D. Examination of relevancy thresholds for effect sizes between variables of interest supports the need for future research in a larger, more representative sample on research questions that include the role cortisol plays as a potential mediator among examined variables.


Assuntos
Glicemia , Transtorno Depressivo/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Índice Glicêmico , Hidrocortisona/sangue , Estresse Psicológico/fisiopatologia , Adolescente , Criança , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Masculino , Projetos Piloto , Sudeste dos Estados Unidos/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários
19.
J Natl Med Assoc ; 111(3): 320-327, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30527966

RESUMO

OBJECTIVE: Examining cultural differences in assessment of cognitive/functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men. METHODS: Design- Cross-sectional. SETTING: Homes of community-dwelling older adults. Participants- 893 Medicare beneficiaries >65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups. RESULTS: After controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (ß = -0.205, P = 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (ß = -0.118, P = 0.001, and ß = -0.180, P < 0.001, respectively); for ADL, significant associations were seen for AA men and nHW women (ß = -0.203, P = 0.004, and ß = -0.139, P = 0.02, respectively) and, for IADL, in AA women and men (ß = -0.156, P = 0.03, and ß = -0.24, P < 0.001, respectively). CONCLUSION: While African American women reported the highest difficulty with ADLs and IADLs among all race/sex groups, CLOX1 scores were correlated with ADL for AA men only. CLOX1 may have limitations to identify functional disability for older AA women. [Word Count = 234].


Assuntos
Atividades Cotidianas , Afro-Americanos/estatística & dados numéricos , Disfunção Cognitiva/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Função Executiva , Atividades Cotidianas/psicologia , Afro-Americanos/psicologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Testes Neuropsicológicos , Prevalência , Fatores Sexuais , Sudeste dos Estados Unidos/epidemiologia
20.
Eur Urol ; 75(3): 399-407, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30237027

RESUMO

BACKGROUND: Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men. OBJECTIVE: To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men. DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40-64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA. RESULTS AND LIMITATIONS: Median PSA among controls was 0.72, 0.80, 0.94, and 1.03ng/ml for age groups 40-49, 50-54, 55-59, and 60-64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2-539) for 40-54 yr and 71.7 (95% CI, 23.3-288) for 55-64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3-infinity) for 40-54 yr and 51.8 (95% CI, 11.0-519) for 55-64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation. CONCLUSIONS: PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies. PATIENT SUMMARY: Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.


Assuntos
Afro-Americanos , Calicreínas/sangue , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Adulto , Fatores Etários , Estudos de Casos e Controles , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/patologia , Medição de Risco , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA