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1.
MMWR Morb Mortal Wkly Rep ; 69(5152): 1633-1637, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33382676

RESUMO

To prevent further transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), CDC currently recommends that persons who have been in close contact with someone with SARS-CoV-2 infection should quarantine (stay away from other persons) for 14 days after the last known contact.* However, quarantine might be difficult to maintain for a prolonged period. A shorter quarantine might improve compliance, and CDC recommends two options to reduce the duration of quarantine for close contacts without symptoms, based on local circumstances and availability of testing: 1) quarantine can end on day 10 without a test or 2) quarantine can end on day 7 after receiving a negative test result.† However, shorter quarantine might permit ongoing disease transmission from persons who develop symptoms or become infectious near the end of the recommended 14-day period. Interim data from an ongoing study of household transmission of SARS-CoV-2 were analyzed to understand the proportion of household contacts that had detectable virus after a shortened quarantine period. Persons who were household contacts of index patients completed a daily symptom diary and self-collected respiratory specimens for 14 days. Specimens were tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). Among 185 household contacts enrolled, 109 (59%) had detectable SARS-CoV-2 at any time; 76% (83/109) of test results were positive within 7 days, and 86% (94 of 109) were positive within 10 days after the index patient's illness onset date. Among household contacts who received negative SARS-CoV-2 test results and were asymptomatic through day 7, there was an 81% chance (95% confidence interval [CI] = 67%-90%) of remaining asymptomatic and receiving negative RT-PCR test results through day 14; this increased to 93% (95% CI = 78%-98%) for household members who were asymptomatic with negative RT-PCR test results through day 10. Although SARS-CoV-2 quarantine periods shorter than 14 days might be easier to adhere to, there is a potential for onward transmission from household contacts released before day 14.


Assuntos
/diagnóstico , Busca de Comunicante , Características da Família , Quarentena/estatística & dados numéricos , Humanos , Tennessee/epidemiologia , Fatores de Tempo , Wisconsin/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 69(44): 1631-1634, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151916

RESUMO

Improved understanding of transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), within households could aid control measures. However, few studies have systematically characterized the transmission of SARS-CoV-2 in U.S. households (1). Previously reported transmission rates vary widely, and data on transmission rates from children are limited. To assess household transmission, a case-ascertained study was conducted in Nashville, Tennessee, and Marshfield, Wisconsin, commencing in April 2020. In this study, index patients were defined as the first household members with COVID-19-compatible symptoms who received a positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test result, and who lived with at least one other household member. After enrollment, index patients and household members were trained remotely by study staff members to complete symptom diaries and obtain self-collected specimens, nasal swabs only or nasal swabs and saliva samples, daily for 14 days. For this analysis, specimens from the first 7 days were tested for SARS-CoV-2 using CDC RT-PCR protocols.† A total of 191 enrolled household contacts of 101 index patients reported having no symptoms on the day of the associated index patient's illness onset, and among these 191 contacts, 102 had SARS-CoV-2 detected in either nasal or saliva specimens during follow-up, for a secondary infection rate of 53% (95% confidence interval [CI] = 46%-60%). Among fourteen households in which the index patient was aged <18 years, the secondary infection rate from index patients aged <12 years was 53% (95% CI = 31%-74%) and from index patients aged 12-17 years was 38% (95% CI = 23%-56%). Approximately 75% of secondary infections were identified within 5 days of the index patient's illness onset, and substantial transmission occurred whether the index patient was an adult or a child. Because household transmission of SARS-CoV-2 is common and can occur rapidly after the index patient's illness onset, persons should self-isolate immediately at the onset of COVID-like symptoms, at the time of testing as a result of a high risk exposure, or at the time of a positive test result, whichever comes first. Concurrent to isolation, all members of the household should wear a mask when in shared spaces in the household.§.


Assuntos
Infecções por Coronavirus/transmissão , Características da Família , Pneumonia Viral/transmissão , Adolescente , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Tennessee/epidemiologia , Wisconsin/epidemiologia , Adulto Jovem
3.
J Vet Diagn Invest ; 32(4): 565-571, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32532177

RESUMO

Investigations of 2 cases of high mortality in cull sows and feeder pigs from a buying station in Ohio and cull sows at an abattoir in Tennessee were conducted at the Iowa State University Veterinary Diagnostic Laboratory. The animals were presented as weak, lethargic, and some with high fever. Rapidly escalating mortality was reported to be as high as 30-50% within groups at the buying station over 8-10 d, and 30-40% over 5-7 d at the abattoir. Splenomegaly and red lymph nodes were the most consistent macroscopic findings, with scant fibrinous polyserositis observed in one sow. The microscopic lesions of vasculitis, fibrin thrombi, fibrinosuppurative polyserositis, and intralesional bacteria were consistent with acute bacterial septicemia. Bacterial culture isolated Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) from multiple organs, including spleen, lung, and kidney. PCR tests were negative for African swine fever virus, classical swine fever virus, Erysipelothrix rhusiopathiae, porcine reproductive and respiratory syndrome virus, porcine circovirus 2, and Salmonella spp. Porcine circovirus 3 was inconsistently detected at low levels by PCR, with a lack of associated lesions. Next-generation sequencing identified S. zooepidemicus and porcine partetravirus in the serum sample of the feeder pig from the buying station. Phylogenetic analysis of the szP gene indicated that the S. zooepidemicus isolates from Ohio and Tennessee are in genotype VI. We conclude that the cause of these high mortality events in swine was S. zooepidemicus septicemia.


Assuntos
Sepse/veterinária , Infecções Estreptocócicas/veterinária , Streptococcus equi/isolamento & purificação , Doenças dos Suínos/mortalidade , Animais , Feminino , Genótipo , Ohio/epidemiologia , Filogenia , Sepse/microbiologia , Sepse/mortalidade , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade , Streptococcus equi/classificação , Sus scrofa , Suínos , Doenças dos Suínos/microbiologia , Tennessee/epidemiologia
4.
South Med J ; 113(6): 285-291, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483638

RESUMO

OBJECTIVE: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System. METHODS: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99). CONCLUSIONS: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Intervalo entre Nascimentos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde , Período Pós-Parto , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Estado Civil/estatística & dados numéricos , Mississippi/epidemiologia , Razão de Chances , Nascimento Prematuro/epidemiologia , Tennessee/epidemiologia , Adulto Jovem
5.
Public Health Rep ; 135(3): 329-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32228123

RESUMO

INTRODUCTION: In April 2017, the Tennessee Department of Health (TDH) was notified of an increase in the number of persons newly diagnosed with HIV in eastern Tennessee in the same month. Two were identified as persons with a history of injection drug use (IDU) and named each other as syringe-sharing partners, prompting an investigation into a possible HIV cluster among persons with a history of IDU. MATERIALS AND METHODS: TDH and public health staff members in eastern Tennessee collaborated to implement procedures outlined in TDH's HIV/hepatitis C virus (HCV) Outbreak Response Plan, including conducting enhanced interviewing and using a preestablished database for data collection and management. To complement contact tracing and enhanced interviewing, TDH partnered with the Centers for Disease Control and Prevention to conduct molecular HIV analyses. RESULTS: By June 27, 2017, the investigation had identified 31 persons newly diagnosed with HIV infection; 8 (26%) self-reported IDU, 4 of whom were also men who have sex with men (MSM). Of the remaining 23 persons newly diagnosed with HIV infection, 10 were MSM who did not report IDU, 9 reported high-risk heterosexual contact, and 4 had other or unknown risk factors. Molecular analysis of the 14 HIV-1 polymerase genes (including 7 of the 8 persons self-reporting IDU) revealed 3 distinct molecular clusters, one of which included 3 persons self-reporting IDU. PRACTICE IMPLICATIONS: This investigation highlights the importance of implementing an established Outbreak Response Plan and using HIV molecular analyses in the event of a transmission cluster or outbreak investigations. Future HIV outbreak surveillance will include using Global Hepatitis Outbreak Surveillance Technology to identify HCV gene sequences as a potential harbinger for HIV transmission networks.


Assuntos
Infecções por HIV/epidemiologia , Vigilância em Saúde Pública/métodos , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Feminino , Hepatite C/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Epidemiologia Molecular , Fatores de Risco , Tennessee/epidemiologia
6.
South Med J ; 113(4): 150-155, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32239226

RESUMO

OBJECTIVES: Despite studies demonstrating the negative impact of food insecurity on health in children, limited research has been done to assess the prevalence and sequelae of food insecurity in sickle cell disease (SCD). We tested the hypothesis that food insecurity is common in children with SCD and is associated with increased SCD morbidity. METHODS: Between May and November 2017, we conducted a single-center cross-sectional study using the previously validated, self-administered, US 18-item household food security survey module and the 9-item youth (12-17 years old) food security survey module during regular outpatient clinic visits. We also included the incidence of vaso-occlusive pain or acute chest syndrome requiring hospitalizations in the year before the questionnaire. RESULTS: A total of 75 caregivers and 24 children completed the surveys. The median age of the children was 10.4 years (interquartile range 5.5-15.3), 46.7% were boys. The rate of household food insecurity was 21.3% (16 of 75). Among the 24 children who completed the youth survey, 45.8% were classified as food insecure. Discordance occurred between caregivers' and children's assessment of food insecurity. A total of 81.8% (9 of 11) children reported being food insecure, whereas their caregivers reported to be food secure. The incidence for pain and acute chest syndrome in the year pre-enrollment was not different between food-secure and food-insecure children (59.3 and 43.8/100 patient-years, P = 0.54; 8.5 and 12.5/100 patient-years, P = 0.49, respectively). CONCLUSIONS: In a tertiary care medical center in Tennessee, one in five households with children with SCD were assessed as food insecure, with a substantial discordance between caregiver and child assessment of food insecurity.


Assuntos
Anemia Falciforme/dietoterapia , Crianças com Deficiência/estatística & dados numéricos , Características da Família , Abastecimento de Alimentos/normas , Adolescente , Anemia Falciforme/epidemiologia , Criança , Estudos Transversais , Feminino , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Tennessee/epidemiologia
7.
J Pediatr Surg ; 55(6): 1081-1087, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32173121

RESUMO

BACKGROUND/PURPOSE: Wilms tumor (WT) poses a cancer health disparity to black children globally, which has not been evaluated thoroughly for other pediatric renal cancers. We aimed to characterize health disparities among Tennessee children treated for any renal cancer. METHODS: The Tennessee Cancer Registry (TCR) was queried for patients ≤18 years having any renal cancer (n = 160). To clarify treatment and outcomes, we performed a retrospective cohort study of pediatric renal cancer patients in our institutional cancer registry (ICR; n = 121). Diagnoses in both registries included WT, Sarcoma/Other, and Renal Cell Carcinoma. Wilcoxon/Pearson, Kaplan-Meier, and logistic regression were completed. RESULTS: In both registries, WT comprised the most common renal cancer and youngest median age. Sarcoma was intermediate in frequency and age, and RCC was least common, having the oldest age (p < 0.001). In the TCR, black patients comprised 26% of all patients, presented more commonly with distant disease than white patients (37% v. 16%; p = 0.021), and showed worse overall survival (73% v. 89%; p = 0.018), while the ICR showed similar survival between race groups (92% v. 93%, p = 0.868). Sarcoma and metastases were independent predictors of death in both registries (p ≤ 0.002). CONCLUSIONS: Black children in Tennessee presented with more advanced disease and experienced worse survival when combining all renal cancer types, particularly RCC and Sarcoma. When treated at a comprehensive pediatric cancer center, these survival disparities appear diminished. TYPE OF STUDY: Prognostic study. LEVEL OF EVIDENCE: Level II (retrospective cohort).


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias Renais/epidemiologia , Adolescente , Afro-Americanos/estatística & dados numéricos , Carcinoma de Células Renais/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias , Sistema de Registros , Estudos Retrospectivos , Sarcoma/epidemiologia , Tennessee/epidemiologia , Tumor de Wilms/epidemiologia
8.
Environ Health ; 19(1): 28, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126999

RESUMO

BACKGROUND: Evidence of causal relationship between mortality of older adults and low- concentration PM2.5 remains limited. OBJECTIVES: This study investigates the effects of low-concentration PM2.5 on the mortality of adults older than 65 using the closure of coal-fired power plants in the Eastern United States as a natural experiment. METHODS: We investigated power plants in the Eastern United States (US) that had production changes through unit shutdown or plant retirement between 1999 and 2013. We included only non-clustered power plants without scrubbers and with capacities greater than 50 MW. We used instrumental variable (IV) and difference-in-differences (DID) approaches to estimate the causal impact of PM2.5 concentrations on mortality among Medicare beneficiaries. We compared changes in monthly age-adjusted mortality before and after the retirement of coal-fired plants between the treated and control counties; we accounted for annual wind direction in our selection of treated and control counties. In the models, we initially included only county and monthly fixed effects, and then adjusted for covariates including: 1) only weather variables (temperature, dew point, pressure); and 2) weather variables and socio-economic variables (median household income and poverty rate). RESULTS: The monthly age-adjusted mortality rate averaged across all plants was approximately 423 per 100,000 (SD = 69) and was higher for males than females. Mean PM2.5 concentrations across all counties were 12 µg/m3 (SD = 3.78). Using the IV method, we found that reductions in PM2.5 concentrations significantly decreased monthly mortality among older adults. IV results show that a 1-µg/m3 reduction in PM2.5 concentrations leads to 7.17 fewer deaths per 100,000 per month, or a 1.7% lower monthly mortality rate among people older than 65 years. Using the DID approach, we found that power plant retirement significantly decreased: 1) monthly PM2.5 levels by 2.1 µg/m3, and 2) monthly age-adjusted mortality by approximately 15 people per 100,000 (or 3.6%) in treated counties relative to control counties. The mortality effects were higher among males than females and its impact was the greatest among people older than 75 years. CONCLUSION: These findings provide evidence of the effectiveness of local, plant-level control measures in reducing near-plant PM2.5 and mortality among U.S. Medicare beneficiaries.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Carvão Mineral , Exposição Ambiental/efeitos adversos , Mortalidade/tendências , Material Particulado/efeitos adversos , Centrais Elétricas , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Feminino , Georgia/epidemiologia , Humanos , Masculino , North Carolina/epidemiologia , Ohio/epidemiologia , Tamanho da Partícula , Medição de Risco , Tennessee/epidemiologia
9.
Am J Clin Nutr ; 111(6): 1244-1251, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077920

RESUMO

BACKGROUND: Red and processed meat, recognized carcinogens, are risk factors for colorectal neoplasia, including polyps, the precursor for colorectal cancer. The mechanism is unclear. One possible explanation is the mutagenic activity of these foods, perhaps due to generation during cooking [e.g., heterocyclic amine (HCA) intake]. Few studies have evaluated meat intake and sessile serrated lesion (SSL) risk, a recently recognized precursor, and no study has evaluated meat cooking methods and meat-derived mutagens with SSL risk. OBJECTIVE: We evaluated intakes of meat, meat cooking methods, and inferred meat mutagens with SSL risk and in comparison to risk of other polyps. METHODS: Meat, well-done meat, and inferred meat mutagen intakes were evaluated. Polytomous logistic regression models were used to estimate ORs and 95% CIs among cases (556 hyperplastic polyp, 1753 adenoma, and 208 SSL) and controls (3804) in the large colonoscopy-based, case-control study, the Tennessee Colorectal Polyp Study. RESULTS: The highest quartile intakes of red meat (OR: 2.38; 95% CI: 1.44, 3.93), processed meat (OR: 2.03; 95% CI: 1.30, 3.17), well-done red meat (OR: 2.19; 95% CI: 1.34, 3.60), and the HCA 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQX; OR: 2.48; 95% CI: 1.49, 4.16) were associated with increased risk of SSLs in comparison to the lowest quartile intake. CONCLUSIONS: High intakes of red and processed meats are strongly and especially associated with SSL risk and part of the association may be due to HCA intake. Future studies should evaluate other mechanism(s) and the potential for primary prevention.


Assuntos
Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Culinária/métodos , Exposição Dietética/efeitos adversos , Carne/análise , Mutagênicos/efeitos adversos , Aminas/efeitos adversos , Aminas/análise , Aminas/metabolismo , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Exposição Dietética/análise , Feminino , Temperatura Alta , Humanos , Masculino , Pessoa de Meia-Idade , Mutagênicos/análise , Mutagênicos/metabolismo , Fatores de Risco , Tennessee/epidemiologia
10.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32060140

RESUMO

BACKGROUND: Hepatitis C virus (HCV) prevalence doubled among pregnant women from 2009 to 2014, reaching 3.4 per 1000 births nationwide. Infants exposed to HCV may acquire HCV by vertical transmission. National guidelines recommend that infants exposed to HCV be tested; however, it is unclear if these recommendations are being followed. Our objectives were to determine if infants exposed to HCV were tested and to determine hospital- and patient-level factors associated with differences in testing. METHODS: In this retrospective cohort study of infants exposed to HCV who were enrolled in the Tennessee Medicaid program, we used vital statistics-linked administrative data for infants born between January 1, 2005, and December 31, 2014. Infants were followed until 2 years old. Multilevel logistic regression was used to assess the association of HCV testing and hospital- and patient-level characteristics. RESULTS: Only 23% of 4072 infants exposed to HCV were tested. Infants whose mothers were white versus African American (96.6% vs 3.1%; P <.001), used tobacco (78% vs 70%; P <.001), and had HIV (1.3% vs 0.4%; P = .002) were more likely to be tested. Infants exposed to HCV who had a higher median of well-child visits (7 vs 6; P <.001) were more likely to be tested. After accounting for maternal and infant characteristics and health care use patterns, African American infants were less likely to undergo general testing (adjusted odds ratio 0.32; 95% confidence interval, 0.13-0.78). CONCLUSIONS: Testing occurred in <1 in 4 infants exposed to HCV and less frequently among African American infants. Public health systems need to be bolstered to ensure that infants exposed to HCV are tested for seroconversion.


Assuntos
Hepatite C/diagnóstico , Hepatite C/transmissão , Transmissão Vertical de Doença Infecciosa , Triagem Neonatal , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Troca Materno-Fetal , Medicaid , Visita a Consultório Médico/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Fumar/epidemiologia , Tennessee/epidemiologia , Estados Unidos , Adulto Jovem
11.
BMC Infect Dis ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914949

RESUMO

BACKGROUND: Despite recent improvement in management, infective endocarditis (IE) continues to be associated with considerable risk of morbidity and mortality. Early identification of predictors of inpatient mortality is key in improving patient outcomes in IE. The aim of our study was to evaluate the role of serum troponin levels measurements as a marker of increased mortality. METHODS: A case-control study included adult patients with IE admitted to a tertiary care hospital in east Tennessee between December 2012 and July 2017. Cases were defined as patients with definitive IE who died in-hospital; controls were patients who did not die in hospital. First patient admission was included only. Data collected included the patients' demographic and baseline clinical information, microbiological data, injection drug use status, elevated serum troponins levels. RESULTS: Two hundred eighty three patients with definitive IE were included; median (IQR) age was 41 (30-57) years, and 153 (54%) patients were men. One-hundred sixty-four (58%) were injection drug users. The most frequent IE type was: 167 (59%) right-sided, 86 (30%) left-sided, 24 (9%) both left and right-sided, and 10 (4%) device related. The most commonly isolated organism was Staphylococcus aureus (n = 141), and 64% were methicillin-resistant. Two-hundred twelve (75%) patients had a troponin level obtained, and 57 (27%) had an elevated troponin value. Thirty-six (13%) patients died in-hospital; in-hospital mortality was associated elevated troponin values (adjusted odds ratio [adjOR], 7.3; 95%CI, 3.3-15.9), and methicillin-resistant S. aureus IE (adjOR 2.6; 95%CI, 1.2-5.8). Forty-four (16%) patients received IE valve surgery, and none of these patients died in the hospital. CONCLUSION: Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels.


Assuntos
Endocardite/diagnóstico , Endocardite/mortalidade , Mortalidade Hospitalar , Troponina/sangue , Adulto , Idoso , Estudos de Casos e Controles , Usuários de Drogas/estatística & dados numéricos , Endocardite/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/microbiologia , Abuso de Substâncias por Via Intravenosa/mortalidade , Tennessee/epidemiologia , Estados Unidos/epidemiologia
12.
Ann Epidemiol ; 41: 43-48.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31928897

RESUMO

PURPOSE: Population-based data on trends and characteristics on polydrug overdoses are critically needed to help understand the changing drug epidemic in the United States, and to identify risk patterns and targets for overdose prevention for prescription and illicit opioid deaths. We conducted a statewide study in Tennessee to evaluate characteristics and trends of polydrug overdose deaths during 2013-2017. METHODS: We identified polydrug overdose deaths using ICD-10 codes and literal cause-of-death text in the death statistical files. We evaluated trends, contributing drugs, and demographic characteristics of overdoses (n = 2567 single-drug and n = 4683 polydrug deaths). Average annual percent change estimates (AAPCs) with associated 95% CIs were estimated using Poisson regression. RESULTS: Polydrug overdoses increased annually, with higher AAPC for polydrug compared with single-drug overdoses (AAPC: 13.6%, 95% CI: 10.6%-16.7% and 5.2%, 95% CI: 2.9%-7.5%, respectively). The highest increases in polydrug overdoses were observed in males (AAPC: 15.4%, non-Hispanic blacks (AAPC: 33.3%), and decedents aged 18-34 years (AAPC: 21.3%). CONCLUSIONS: All drug and opioid polydrug deaths increased during 2013-2017, with the highest increases seen in males, blacks, and younger age groups. Over 80% of illicit opioid overdoses involved more than one drug, highlighting the need to go beyond opioids to prevent overdoses.


Assuntos
Analgésicos Opioides/envenenamento , Atestado de Óbito , Overdose de Drogas/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Tennessee/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Am J Addict ; 29(2): 97-104, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31898858

RESUMO

BACKGROUND AND OBJECTIVES: Substance use in community college students has been explored in only a handful of studies. Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behavior. Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research. The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services. METHODS: We conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use). RESULTS: Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences. DISCUSSION AND CONCLUSIONS: Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population. SCIENTIFIC SIGNIFICANCE: The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students. (Am J Addict 2020;29:97-104).


Assuntos
Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tennessee/epidemiologia , Universidades , Adulto Jovem
14.
Prev Med ; 130: 105883, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31704283

RESUMO

We performed a statewide evaluation of prescribing patterns of controlled substances (CS) before and after an overdose, using Tennessee's Hospital Discharge Data System and the Controlled Substance Monitoring Database (CSMD). Adults' first non-fatal overdose discharges either from the emergency department (ED) or inpatient (IP) stay occurring between 2013 and 2016 were linked to prescriptions in the CSMD. The difference in the proportion of patients filling a prescription before versus after an overdose was calculated. Included were 49,398 patients with an overdose and a prescription record; most (60.5%) were treated in the ED. Among any drug type overdose the percentage of patients who filled a CS prescription within a year of experiencing an overdose was as follows: opioid analgesics: 59.1%, benzodiazepines: 37.3%, stimulants: 5.0%, muscle relaxants: 3.4%, concurrent opioid-benzodiazepines: 24.0% with the percent difference from before to after similar in both settings. Among patients treated for an opioid overdose, this represented a decrease in opioid analgesics filled by 9.7% (95%CI: -11.2, -8.3) among those treated in the ED, and by 7.1% (95% CI: -8.3, -5.9) among treated inpatients. Among patients treated for a heroin overdose, 12.2% (95%CI: -15.2, -9.3) fewer of those treated in the ED and 8.8% (95%CI: -15.0, -2.7%) fewer of treated inpatients filled a CS prescription in that year. The most common opioid analgesics included hydrocodone and oxycodone. The number of patients filling buprenorphine for treatment increased in the year after overdoses associated with any drug or opioids but decreased among those treated for a heroin overdose.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Substâncias Controladas , Bases de Dados Factuais , Feminino , Registros Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Tennessee/epidemiologia , Adulto Jovem
15.
Support Care Cancer ; 28(8): 3955-3964, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31872295

RESUMO

PURPOSE: Fertility-related services in pediatric oncology are increasing, but barriers to care remain and few structured programs are described in the literature. Therefore, the study objectives were (1) to characterize fertility-related services in a large pediatric oncology center and (2) to discuss recommendations for fertility-related services across the pediatric cancer continuum. METHODS: Medical records of all cases referred to our Fertility Preservation Clinic within a 3-year period were reviewed, which included 292 patients/survivors with malignant disease. Approximately half (n = 152/292, 52.1%) were cancer patients referred prior to treatment (n = 92/152) or while on active therapy (n = 60/152). The other half (n = 140/292; 47.9%) were survivors who had completed treatment. RESULTS: Referrals more than doubled over 3 years. Most patients referred before treatment were offered and opted for FP (72.8% attempted; 58.9% completed). More male than female patients opted for FP (77.6% vs. 22.4%), but completion rates were higher among females (93.3% vs. 76.9%). Rates of FP before treatment did not increase over time (p = .752). Many patients on-treatment were referred for infertility risk counseling, demonstrating information/support needs in this group. Referred survivors questioned their fertility post-treatment and completed fertility assessments, indicating intact fertility among few (~ 15%). CONCLUSIONS: This review demonstrated the acceptance and increasing need for fertility-related services in pediatric oncology across the cancer continuum, including FP before treatment, counseling during treatment, and fertility assessment in survivorship. Based on our experiences, current recommendations are discussed and include standardized procedures, streamlined referrals, adequate communication/education (of providers and families), and meeting specific needs of young cancer patients/survivors.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias/terapia , Adolescente , Adulto , Sobreviventes de Câncer , Comunicação , Aconselhamento/métodos , Aconselhamento/estatística & dados numéricos , Tomada de Decisões , Feminino , Fertilidade , Preservação da Fertilidade/psicologia , Preservação da Fertilidade/estatística & dados numéricos , Humanos , Masculino , Oncologia/métodos , Neoplasias/epidemiologia , Neoplasias/psicologia , Neoplasias/reabilitação , Pediatria/métodos , Encaminhamento e Consulta , Estudos Retrospectivos , Tennessee/epidemiologia , Adulto Jovem
16.
Public Health Rep ; 135(1): 90-96, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31738858

RESUMO

OBJECTIVES: From 2006 through 2012, the number of acute hepatitis C virus (HCV) infections increased 364% among persons aged ≤30, including reproductive-aged women, in Central Appalachian states. Outreach to reproductive-aged women with newly diagnosed HCV infection affords a unique opportunity to provide counseling, further testing, and linkage to treatment. We modeled a centrally located statewide effort to reach this population and their health care providers to ascertain pregnancy status, HCV risk factors, and opportunities for linkage to additional services. METHODS: Using the Tennessee Department of Health's surveillance database, we identified women aged 18-45 residing in Tennessee with newly reported chronic HCV infection from May through October 2017. We contacted health care providers and patients to request information on pregnancy status and HCV risk factors as well as to provide linkage to treatment services. RESULTS: Of 1548 women included in this study, health care provider or patient contact information was available for 1316 (85.0%) women. Of the 1316 women, 806 (61.2%) women had a health care provider or patient response, of whom 242 (30.0%) were pregnant. Of 296 patients contacted, 194 (65.5%) reported intranasal drug use, 193 (65.2%) reported having been incarcerated for more than 24 hours, and 180 (60.8%) reported injection drug use. Ninety-eight (33.1%) patients were referred for confirmatory testing, and 174 (58.8%) were referred to treatment. CONCLUSION: A high proportion of reproductive-aged women with newly diagnosed HCV infection were pregnant. Surveillance-informed outreach to this population was feasible and provided opportunities for counseling and linkage to confirmatory testing and treatment. Future studies should evaluate whether a similar model would enhance testing and linkage to care of HCV-exposed infants.


Assuntos
Hepatite C Crônica/epidemiologia , Adolescente , Adulto , Região dos Apalaches/epidemiologia , Feminino , Hepatite C Crônica/diagnóstico , Humanos , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Gravidez , Prisioneiros/estatística & dados numéricos , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tatuagem/estatística & dados numéricos , Tennessee/epidemiologia , Adulto Jovem
18.
Drug Alcohol Depend ; 205: 107664, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31707272

RESUMO

BACKGROUND: Research on adolescent heroin use has focused on national surveillance, access, prevalence of use, and overdose deaths, however, to our knowledge, no study has examined local-level differences in the prevalence of adolescent heroin use in the context of nonmedical prescription opioid (NMPO) use. This study characterizes heroin and NMPO use among US high school students in select urban areas by sex and race/ethnicity. METHODS: Data are from 21 urban school districts that participate in CDC's Local Youth Risk Behavior Surveillance System. We describe 2017 prevalence estimates (and 95 % confidence intervals) of lifetime heroin and NMPO use among youth stratified by sex and race/ethnicity (i.e., White, Black, Hispanic/Latino). RESULTS: The highest estimates of heroin use were in Baltimore, MD (7.6 %), Shelby County, TN (6.3 %), and Duval County, FL (6.1 %), whereas NMPO use was highest in Duval County, FL (18.1 %), Cleveland, OH (18.0 %), and Shelby County, TN (16.8 %). Heroin use was higher among boys than girls, especially among Hispanic/Latino boys in Duval County (12.3 %) and Black boys in Baltimore (10.9 %). NMPO use was highest among Hispanic/Latino girls (21.3 %) and White girls (19.9 %) in Duval County. DISCUSSION: While some cities and subpopulations with high levels of adolescent heroin use also had elevated levels of NMPO use, others did not, illustrating the complexities of this opioid epidemic.


Assuntos
Heroína , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Vigilância da População , Estudantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Baltimore/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/etnologia , Prevalência , Assunção de Riscos , Instituições Acadêmicas/estatística & dados numéricos , Tennessee/epidemiologia
19.
Int Breastfeed J ; 14: 43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666803

RESUMO

Background: The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children. Methods: The Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors' diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2-3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders. Results: Of the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors' diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors' diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79). Conclusions: Analysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.


Assuntos
Aleitamento Materno , Comportamento Alimentar , Hipersensibilidade Alimentar/epidemiologia , Fórmulas Infantis/efeitos adversos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hipersensibilidade Alimentar/etiologia , Humanos , Lactente , Recém-Nascido , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/etiologia , Gravidez , Estudos Prospectivos , Tennessee/epidemiologia
20.
Prog Community Health Partnersh ; 13(3): 237-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564664

RESUMO

THE PROBLEM: Nationwide efforts to reduce smoking in the United States have been successful. Yet, there is unequal geographic progress in reducing rates of smoking and smoking-related illnesses. Located in a tobacco-producing state with weak tobacco laws, Nashville, Tennessee, has an adult smoking rate of 22.0%, requiring 45,000 smokers to quit to meet the Healthy People 2020 goal of 12%. PURPOSE: The purpose of this article was to detail the development a community-academic partnership (CAP) and its process for devising a local implementation strategy for tobacco control. KEY POINTS: Nashville's CAP developed with a community-based organization (CBOs) seeking out an academic partner. This unique approach addressed many of the challenges CAPs face, helped identify priorities and potential barriers to success and led to early wins. CONCLUSION: The success of Nashville's efforts suggests that CAPs should clearly delineate roles for members of the CAP, engage diverse stakeholders, be responsive to the community, and allow adequate time for planning and prioritizing.


Assuntos
Relações Comunidade-Instituição , Abandono do Hábito de Fumar/métodos , Adulto , Programas Gente Saudável/métodos , Humanos , Modelos Organizacionais , Fumar/epidemiologia , Tennessee/epidemiologia , Universidades/organização & administração , População Urbana/estatística & dados numéricos
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