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1.
Am J Epidemiol ; 190(2): 295-304, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33524122

RESUMO

Socioeconomic status has been associated with cardiovascular disease risk factors. However, few studies have examined this relationship among populations in the US Gulf Coast region. We assessed neighborhood deprivation in relation to obesity and diabetes in 9,626 residents participating in the Gulf Long-Term Follow-Up Study (2011-present) who completed a home visit (2011-2013) with height, weight, waist, and hip measurements. Obesity was categorized as body mass index of at least 30, and diabetes was defined by doctor's diagnosis or prescription medication. Participant home addresses were linked to an established Area Deprivation Index and categorized into 4 levels (1 = least deprived). In adjusted, modified Poisson regression models, participants with greatest deprivation were more likely to have obesity compared with those with least deprivation (adjusted prevalence ratio (aPR) = 1.21, 95% confidence interval (CI): 1.08, 1.35), central obesity (aPR = 1.11, 95% CI: 1.04, 1.19), and diabetes (aPR = 1.49, 95% CI: 1.03, 2.14). Repeated analyses among a subgroup of participants (n = 3,016) whose hemoglobin A1C values were measured 3 years later indicated the association with diabetes (defined as diagnosis, medications, or hemoglobin A1C ≥ 6.5) was similar (aPR = 1.46, 95% CI: 1.14, 1.86). Results suggest neighborhood deprivation is associated with obesity and diabetes in a US region with high baseline prevalence.


Assuntos
Diabetes Mellitus/epidemiologia , Obesidade/epidemiologia , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Fumar Cigarros/epidemiologia , Feminino , Hemoglobina A Glicada , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Classe Social , Fatores Socioeconômicos , Sudeste dos Estados Unidos/epidemiologia , Texas/epidemiologia
3.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32859735

RESUMO

OBJECTIVES: Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP. METHODS: We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions. RESULTS: Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10). CONCLUSIONS: In larger and longer studies, researchers should examine food security and adiposity in young children.


Assuntos
Adiposidade/fisiologia , Características da Família , Abastecimento de Alimentos/economia , Inquéritos Nutricionais/economia , Obesidade Pediátrica/economia , Obesidade Pediátrica/epidemiologia , Adulto , Estudos de Coortes , Feminino , Assistência Alimentar/economia , Assistência Alimentar/tendências , Humanos , Lactente , Masculino , Inquéritos Nutricionais/tendências , Obesidade Pediátrica/diagnóstico , Sudeste dos Estados Unidos/epidemiologia
4.
South Med J ; 113(5): 240-249, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358619

RESUMO

Leptospirosis is a zoonotic disease with symptoms in humans and animals, ranging from subclinical to serious and fatal. The disease occurs worldwide, but there is limited recognition of the public and animal health risks it poses in the southern United States. A systematic review of the frequency of animal leptospirosis in 17 states and jurisdictions covering the southern continental United States was performed to advance our understanding of the pathogen's distribution and identify transmission patterns that could be targeted for prevention efforts. Fifty-two articles, spanning >100 years, met the analysis criteria. A wide range of techniques were used to measure seroprevalence and isolate the bacteria. The assessment identified exposure to Leptospira spp and Leptospira spp infection among a diverse range of species, spanning 22 animal families within 14 states, suggesting that the pathogen is distributed throughout the southern region. Disease frequency trends were assessed among animals in various habitats (all habitats, nonwild habitats, and wild habitats). The frequency of Leptospira spp detection in animals in wild habitats increased slightly over time (<0.2%/year). We identified reports of 11 human leptospirosis illness clusters and outbreaks in the southern United States. Exposure to potentially contaminated surface waters were documented for at least seven of the events, and interactions with infected or likely infected animals were documented for at least six of the events. This analysis highlights the need for stronger partnerships across the public and animal health fields to enhance diagnostics, surveillance, and reporting. The early identification of leptospirosis in animals may serve as an indicator of environmental contamination and trigger prevention measures, such as vaccinating companion animals and livestock, use of potable water, and the wearing of waterproof protective clothing near water that may be contaminated.


Assuntos
Leptospirose/epidemiologia , Leptospirose/veterinária , Zoonoses/epidemiologia , Animais , Animais Selvagens/microbiologia , Gatos/microbiologia , Bovinos/microbiologia , Cervos/microbiologia , Cães/microbiologia , Humanos , Gado/microbiologia , Mephitidae/microbiologia , Animais de Estimação/microbiologia , Roedores/microbiologia , Estudos Soroepidemiológicos , Sudeste dos Estados Unidos/epidemiologia , Suínos/microbiologia
5.
N C Med J ; 81(3): 149-156, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32366621

RESUMO

BACKGROUND Trauma-emotional, physical, and psychological-is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). This article presents the results of 15 in-depth, semi-structured interviews with PLWH in the Southeastern United States in which participants identified a trauma and described its long-lasting impact on their lives. Participants' trauma narratives described a wide range of traumas, including childhood sexual abuse, the loss of a loved one, and their HIV diagnosis.METHODS Systematic qualitative analysis was used to delineate beliefs about causes, symptoms, treatments, quality of life, and health implications of trauma.RESULTS: Fifteen participants completed semi-structured interviews that lasted on average 32 minutes. Participants described a wide spectrum of personal trauma that occurred both prior and subsequent to their HIV diagnosis. The types of trauma identified included physical, sexual, and psychological abuse inflicted by intimate partners, family members, and/or strangers.LIMITATIONS A chief limitation of this study is selection bias. Additionally, the participant selection and content of the trauma narratives might have been affected by the surrounding context of the parent study centered on HIV, aging, and psychosocial stress. It is also difficult to interpret the distinction between discrete trauma experiences and the diagnosis of HIV, leading to potential information bias.CONCLUSION This study highlights the importance of social support in coping with trauma and the effect of trauma on health-related behaviors. It also illustrates the need for additional research on the topic of trauma and trauma-informed care for PLWH. Understanding how different types of trauma affect individuals' lives is necessary to inform recommendations to provide better care for PLWH.


Assuntos
Infecções por HIV/psicologia , Trauma Psicológico , Infecções por HIV/epidemiologia , Humanos , Narração , Pesquisa Qualitativa , Sudeste dos Estados Unidos/epidemiologia
7.
BMC Infect Dis ; 20(1): 144, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059635

RESUMO

BACKGROUND: The southeastern US is an epicenter for incident HIV in the US with high prevalence of human papillomavirus (HPV) co-infections. However, epidemiologies of HPV-associated clinical conditions (CC) among people living with HIV-1 infection (PLWH) are not fully known. METHODS: Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested within the University of Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWH's clinical and sociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical, and vaginal/vulvar low- and high-grade squamous intraepithelial lesions (LSIL and HSIL) were estimated per 10,000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All rates and trends were stratified by gender and race. RESULTS: Of the 4484 PLWH included in the study (3429 men, 1031 women, and 24 transgender), we observed 1038 patients with HPV-related CC. The median nadir CD4 count (cells/uL) was higher in the HPV-condition free group than the case groups (P < 0.0001). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among HIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than black men (P < 0.03). White women were also more likely to be diagnosed with cervical HSIL (P = 0.023) and cancer (P = 0.037) than black women. CONCLUSIONS: There were significant differences between gender and race with incidence of HPV-related CC among HIV patients. EMR-based studies provide insights on understudied HPV-related anogenital conditions in PLWH; however, large-scale studies in other regions are needed to generalize current findings and draw public health attention to co-infection induced non-AIDS defining comorbidities among PLWH.


Assuntos
Infecções por HIV/epidemiologia , Infecções por Papillomavirus/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Canal Anal/virologia , Contagem de Linfócito CD4 , Estudos de Coortes , Comorbidade , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/virologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Infecções por HIV/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Prevalência , Estudos Retrospectivos , Sudeste dos Estados Unidos/epidemiologia
8.
BMC Pulm Med ; 20(1): 32, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024493

RESUMO

BACKGROUND: Chronic hypersensitivity pneumonitis (cHP) is a disease caused by exposure to inhaled environmental antigens. Diagnosis of cHP is influenced by the awareness of the disease prevalence, which varies significantly in different regions, and how clinicians utilize relevant clinical information. We conducted a retrospective study to evaluate how clinicians in the Southeast United States, where the climate is humid favoring mold growth, diagnosed cHP using items identified in the international modified Delphi survey of experts, i.e., environmental exposure, CT imaging and lung pathology, METHODS: We searched Duke University Medical Center database for patients over the age of 18 with a diagnosis of cHP (ICD-9 code: 495) between Jan. 1, 2008 to Dec. 31, 2013 using a query tool, Duke Enterprise Data Unified Content Explorer (DEDUCE). RESULTS: Five hundred patients were identified and 261 patients had cHP confirmed in clinic notes by a pulmonologist or an allergist. About half of the patients lived in the Research Triangle area where our medical center is located, giving an estimated prevalence rate of 6.5 per 100,000 persons. An exposure source was mentioned in 69.3% of the patient. The most common exposure sources were environmental molds (43.1%) and birds (26.0%). We used Venn diagram to evaluate how the patients met the three most common cHP diagnostic criteria: evidence of environmental exposures (history or precipitin) (E), chest CT imaging (C) and pathology from lung biopsies (P). Eighteen patients (6.9%) met none of three criteria. Of the remaining 243 patients, 135 patients (55.6%) had one (E 35.0%, C 3.3%, P 17.3%), 81 patients (33.3%) had two (E + C 12.3%, E + P 17.3%, C + P 4.9%), and 27 patients (11.1%) had all three criteria (E + C + P). Overall, 49.4% of patients had pathology from lung biopsy compared to 31.6% with CT scan. CONCLUSIONS: Environmental mold was the most common exposure for cHP in the Southeast United States. Lung pathology was available in more than half of cHP cases in our tertiary care center, perhaps reflecting the complexity of referrals. Differences in exposure sources and referral patterns should be considered in devising future diagnostic pathways or guidelines for cHP.


Assuntos
Alveolite Alérgica Extrínseca/diagnóstico , Exposição Ambiental/estatística & dados numéricos , Pulmão/patologia , Adulto , Idoso , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Animais , Aves , Doença Crônica , Bases de Dados Factuais , Exposição Ambiental/efeitos adversos , Feminino , Fungos , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sudeste dos Estados Unidos/epidemiologia , Tomografia Computadorizada por Raios X
10.
AIDS Care ; 32(1): 89-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31129981

RESUMO

Retention in care (RiC) is crucial for maintaining HIV health. We examined the relationship between receipt of Ryan White HIV/AIDS Program (RWHAP) supplementary services and six different measures of RiC among 2,288 adults living with HIV who received HIV primary care services at a large, academically-affiliated HIV/AIDS clinic in the southeastern United States in 2016. The independent variable of interest was RWHAP supplementary services, which referred to whether patients received documented non-medical wraparound supplementary services. The outcome was six different measures of RiC: the Institute of Medicine (IOM) indicator, 6-month gap, 4-month constancy, missed visits dichotomous, missed visits count, and visit adherence. Separate multivariable models were fit for each RiC outcome. Receipt of supplementary RWHAP services was significantly (p < .05) and positively associated with RiC across all six measures (test statistic, 95% confidence interval): IOM (adjusted odds ratio (aOR) = 2.88, 2.16-3.83), 6-month gap (aOR = 1.76, 1.48-2.09), 4-month visit constancy (aOR = 2.03, 1.72-2.39), missed visits dichotomous (aOR = 1.40, 1.16-1.68), missed visit count (adjusted incidence rate ratio (aIRR) = 0.77, 0.67-0.88), and visit adherence (adjusted beta coefficient (adjß) = 0.05, 0.02-0.06). Our findings suggest that receipt of RWHAP services is important for retention in care, regardless of the measure employed.


Assuntos
Infecções por HIV/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sudeste dos Estados Unidos/epidemiologia , Adulto Jovem
11.
Sex Transm Infect ; 96(5): 368-374, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31601642

RESUMO

PURPOSE: Various disparities exist in HIV transmission among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has been shown to decrease the acquisition of HIV, but there is variation in uptake within the MSM population. We aim to characterise PrEP use and correlates of self-reported PrEP use in a large national sample of urban MSM in the USA. METHODS: Using data from a geosocial-networking application, a national sample (n=3744) from the largest 50 metropolitan centres in the USA was obtained. RESULTS: We found 18.1% (95% CI 16.8 to 19.3) of profiles reported using PrEP, with decreased reported PrEP use in younger MSM aged 18-24 years (adjusted OR (aOR)=0.5, 95% CI 0.3 to 0.7), obese MSM (aOR=0.5, 95% CI 0.3 to 0.9), black MSM (aOR=0.6, 95% CI 0.4 to 0.9) and MSM in the South (aOR=0.7, 95% CI 0.5 to 0.9). CONCLUSION: Significant disparities exist in PrEP reporting by age and among black, Southern US and obese MSM. More research is needed to better understand these disparities.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Obesidade/epidemiologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Sobrepeso/epidemiologia , Autorrelato , Determinantes Sociais da Saúde , Sudeste dos Estados Unidos/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
12.
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 , Dieta Saudável , 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
13.
Cancer Epidemiol ; 63: 101624, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31678815

RESUMO

INTRODUCTION: To evaluate disparities in breast cancer stage by subtype (categorizations of breast cancer based upon molecular characteristics) in the Delta Regional Authority (Delta), an impoverished region across eight Lower Mississippi Delta Region (LMDR) states with a high proportion of Black residents and high breast cancer mortality rates. METHODS: We used population-based cancer registry data from seven of the eight LMDR states to explore breast cancer staging (early and late) differences by subtype between the Delta and non-Delta in the LMDR and between White and Black women within the Delta. Age-adjusted incidence rates and rate ratios were calculated to examine regional and racial differences. Multilevel negative binomial regression models were constructed to evaluate how individual-level and area-level factors affect rates of early- and late-stage breast cancers by subtype. RESULTS: For all subtypes combined, there were no Delta/non-Delta differences in early and late stage breast cancers. Delta women had lower rates of hormone-receptor (HR+)/human epidermal growth factor 2 (HER2-) and higher rates of HR-/HER2- (the most aggressive subtype) early and late stage cancers, respectively, but these elevated rates were attenuated in multilevel models. Within the Delta, Black women had higher rates of late-stage breast cancer than White women for most subtypes; elevated late-stage rates of all subtypes combined remained in Black women in multilevel analysis (RR = 1.10; 95% CI = 1.04-1.15). CONCLUSIONS: Black women in the Delta had higher rates of late-stage cancers across subtypes. Culturally competent interventions targeting risk-appropriate screening modalities should be scaled up in the Delta to improve early detection.


Assuntos
Neoplasias da Mama/epidemiologia , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Mississippi/epidemiologia , Estadiamento de Neoplasias , Sudeste dos Estados Unidos/epidemiologia
14.
Cancer Med ; 8(17): 7399-7407, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595713

RESUMO

BACKGROUND: Conflicting evidence suggests that statins act chemopreventively against prostate cancer (PCa). Whether the association of statin use with PCa risk is Gleason score-dependent, time-, dose-respondent is not well studied. METHODS: We conducted a cohort study at a tertiary hospital in the Southeastern US using longitudinal data of electronic medical records (EMR) from 1994 to 2016. Only cancer-free men aged >18 years at baseline with follow-up time of ≥12 months were included. Time-dependent Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). RESULTS: Among 13 065 men, 2976 were diagnosed with PCa over median follow-up of 6.6 years. Statin use was associated with lower risk of both Gleason low- (score <7: aHR, 0.85; 95% CI, 0.74-0.96) and high-grade PCa (score ≥7: aHR, 0.54; 95% CI, 0.42-0.69). The protective association was observed only when statins had been used for a relatively longer duration (≥11 months) or higher dose (≥121 defined daily doses), and were more pronounced for PCa of higher Gleason score (<7: aHR, 0.85, 95% CI, 0.74-0.96; 7 [3 + 4]: aHR, 0.62, 95% CI, 0.43-0.90; 7 [4 + 3]: aHR, 0.49, 95% CI, 0.29-0.82; 8: aHR, 0.60, 95% CI, 0.37-0.96; 9-10: aHR, 0.24, 95% CI, 0.11-0.54). Lipophilic statins (aHR, 0.83; 95% CI, 0.72-0.95) might be more protective than hydrophilic statins (aHR, 0.91, 95% CI, 0.63-1.33) against PCa. CONCLUSION: Statin use might be associated with reduced PCa risk only when used for a relatively longer duration, and the risk reduction was higher for PCa of higher Gleason score.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Neoplasias da Próstata/epidemiologia , Idoso , Registros Eletrônicos de Saúde/estatística & dados numéricos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias da Próstata/patologia , Neoplasias da Próstata/prevenção & controle , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo
15.
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
16.
Psychiatr Serv ; 70(11): 1006-1012, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31378191

RESUMO

OBJECTIVE: The Brief Jail Mental Health Screen (BJMHS) is widely used at intake in county jails to identify detainees who may have serious mental illness and who should be referred for further mental health evaluation. The BJMHS may be administered multiple times across repeated jail bookings; however, the extent to which results may change over time is unclear. To that end, the authors examined the odds of screening positive on the BJMHS across repeated jail bookings. METHODS: Data were drawn from the administrative and medical records of a large, urban county jail that used the BJMHS at jail booking. The study sample comprised BJMHS results for the 12,531 jail detainees who were booked at least twice during the 3.5-year period (N=41,965 bookings). Multilevel logistic modeling was used to examine changes over time overall and within the four decision rules (current psychiatric medication, prior hospitalization, two or more current symptoms, and referral for any other reason). RESULTS: Results show that the odds of a positive screen overall increased with each jail booking, as did the odds of referral for any other reason. In contrast, the odds of screening positive for two or more current symptoms and prior hospitalization decreased. There was no change in the odds of screening positive for current psychiatric medication across bookings. CONCLUSIONS: Findings show that BJMHS results changed across bookings. Further research is needed to determine whether changes reflect true changes in mental health status, issues with fidelity, the repeated nature of the screening process, or other factors.


Assuntos
Entrevista Psicológica , Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia , Adulto Jovem
17.
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
18.
BMC Nephrol ; 20(1): 308, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31390993

RESUMO

INTRODUCTION: The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function. METHODS: We conducted a case-cohort study of incident ESRD cases (n = 737) with stored blood and a probability sampled subcohort (n = 4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS). RESULTS: Median (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m2 for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P = 0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR. CONCLUSION: In this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.


Assuntos
Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Europeu , Taxa de Filtração Glomerular/fisiologia , Falência Renal Crônica/epidemiologia , Área Carente de Assistência Médica , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Creatinina/sangue , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Rim/fisiopatologia , Falência Renal Crônica/sangue , Falência Renal Crônica/etnologia , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
19.
Child Obes ; 15(8): 555-559, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31448951

RESUMO

Background: Attributes of the built environment, such as neighborhood walkability, have been linked to increased physical activity and reduced obesity risk. This relationship, however, has primarily been documented in adults; less is known about neighborhood walkability and youth obesity, as limited prior research has produced mixed findings. The purpose of this study was to examine the association between neighborhood walkability and youth obesity, including differences by urbanicity. Methods: Data were collected in 2013 from youth aged 7-14 years (n = 13,469) in a Southeastern county school district. Height and weight were objectively measured and utilized to calculate body mass index (BMI) z-scores. Youth demographic characteristics and addresses were obtained, and a Walk Score® was gathered for each youth's home address. Multilevel linear regression analysis, accounting for nesting within census block groups, was conducted to examine the association between Walk Score and BMI z-score and to test for the moderating effect of urbanicity. Separate multilevel analyses examined Walk Score and BMI z-score among urban, urban-rural mixed, and rural youth subsamples. Results: Overall, as Walk Score increased, youth BMI z-score decreased. Walk Score was positively associated with BMI z-score among urban youth and negatively associated with BMI z-score among rural youth; no relationship was observed between Walk Score and youth in urban-rural mixed areas. Conclusions: Neighborhood walkability may impact youth differently across geographic areas. Further study is warranted about how youth utilize a walkable environment and mechanisms through which walkability influences youth physical activity and obesity risk.


Assuntos
Planejamento Ambiental/estatística & dados numéricos , Obesidade Pediátrica/epidemiologia , Características de Residência/estatística & dados numéricos , Caminhada/fisiologia , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , População Rural/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
20.
Vet Pathol ; 56(6): 915-920, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31345138

RESUMO

Multiple oncogenic viruses, including lymphoproliferative disease virus (LPDV) and reticuloendotheliosis virus (REV), have been detected in wild turkeys (Meleagris gallopavo). The prevalence of infection with these viruses appears to be more common than overt disease; thus, data on the manifestation of associated disease in wild turkeys are scarce. Diagnostic records from wild turkeys submitted to the Southeastern Cooperative Wildlife Disease Study from 1980 to 2017 were reviewed to identify cases of neoplasia. Neoplasia was reported in 59 of 851 (6.9%) wild turkeys submitted. Of the cases of neoplasia tested by polymerase chain reaction, LPDV was detected in 34 of 58 (59%), REV in 10 of 39 (26%), both viruses in 3 of 39 (8%), and no retroviruses detected in 5 of 39 (13%) turkeys. The most common gross lesions observed among turkeys with neoplasms were emaciation (30/40; 75%); nodules in the skin (26/59; 44%), liver (17/59; 29%), or spleen (9/59; 15%); and splenomegaly (14/59; 24%). Microscopically, nodules were composed of pleomorphic round cells with large eccentric nuclei and prominent nucleoli resembling lymphocytes or lymphoblasts (57/59; 97%) except for 2 cases, one of myeloid cell origin and the other with primarily spindloid cells. This study indicates the need to characterize the pathogenesis and potential health threat posed by REV and LPDV to wild turkeys. Experimental infection studies and the development of additional diagnostic tests to confirm the role of retroviruses in lymphoproliferative disease are warranted.


Assuntos
Doenças das Aves/virologia , Transtornos Linfoproliferativos/veterinária , Neoplasias/veterinária , Retroviridae/isolamento & purificação , Infecções Tumorais por Vírus/veterinária , Animais , Animais Selvagens , Doenças das Aves/epidemiologia , Doenças das Aves/patologia , Feminino , Geografia , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/virologia , Masculino , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/virologia , Prevalência , Retroviridae/genética , Sudeste dos Estados Unidos/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Infecções Tumorais por Vírus/patologia , Infecções Tumorais por Vírus/virologia , Perus
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