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1.
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
2.
Am Surg ; 85(8): 927-933, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560314

RESUMO

Selection of orthotopic liver transplantation (OLT) candidates is increasingly inclusive of patients with high BMI. We aim to characterize the influence of obesity on the surgical outcome measures of prolonged operative time and unplanned reoperation. We reviewed the records of obese and normal weight OLT recipients over a 10-year period from a single institution. Variables that trended (P < 0.1) with endpoints on univariate analysis were put into multivariate logistic regression models to determine independent association (P < 0.05). We included 195 obese and 171 normal weight OLT recipients in our study. On multivariate analysis, obesity was the only preoperative risk factor that trended with unplanned reoperation (odds ratio 2, P = 0.05). Similarly, only obesity remained independently associated with prolonged length of operation (defined as ≥275 minutes) on multivariate analysis (odds ratio 1.7, P = 0.04). In summary, obesity may make OLT more technically challenging and, thus, represents an independent risk factor for unplanned reoperations and prolonged operative time.


Assuntos
Transplante de Fígado , Obesidade/complicações , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tennessee/epidemiologia
4.
Public Health Rep ; 134(5): 537-541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390300

RESUMO

OBJECTIVES: Between 2003 and 2013, the rate of neonatal abstinence syndrome (NAS)-a postnatal drug withdrawal syndrome-in Tennessee increased approximately 10-fold. NAS surveillance is relatively new, and underestimation associated with surveillance has not been described. We compared data from the Tennessee NAS public health surveillance system (TNSS) with a second source of NAS data, hospital discharge data system (HDDS), and estimated the true number of infants with NAS using capture-recapture methods. METHODS: We obtained NAS data on cases of NAS among Tennessee infants from TNSS and HDDS from January 1, 2013, through December 31, 2016. We matched cases of NAS identified in TNSS to cases identified in HDDS. We estimated the true number of infants with NAS by using the Lincoln-Peterson estimator capture-recapture methodology. RESULTS: During the study period, 4070 infants with NAS were reported to TNSS, and 5321 infants with NAS were identified in HDDS; 2757 were in both data sets. Using capture-recapture methods, the total estimated number of infants with NAS during the study period was 7855 (annual mean = 1972; estimated range = 1531-2427), which was 93% more than in TNSS and 48% more than in HDDS. Drugs used for the medication-assisted treatment of substance use disorder were the most commonly reported substances associated with NAS (n = 2389, 59%). CONCLUSIONS: TNSS underestimated the total burden of NAS based on the capture-recapture estimate. Case-based public health surveillance is important for monitoring the burden of and risk factors for NAS and helping guide public health interventions.


Assuntos
Efeitos Psicossociais da Doença , Síndrome de Abstinência Neonatal/epidemiologia , Vigilância em Saúde Pública , Humanos , Recém-Nascido , Transtornos Relacionados ao Uso de Substâncias , Tennessee/epidemiologia
5.
J Vet Intern Med ; 33(5): 2336-2342, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454105

RESUMO

BACKGROUND: Mycoplasma haemolamae (Mhl) and gastrointestinal nematodes can cause anemia in camelids. Control programs aim to suppress parasitism without promoting anthelminthic resistance, but few evidence-based guidelines define acceptable parasite loads in camelids. HYPOTHESIS/OBJECTIVES: In clinically healthy nonanemic camelids, compare erythrocyte variables to Mhl real-time PCR status and to fecal egg count (FEC). Determine the FEC threshold above which erythrocyte variables are consistently below reference interval medians. ANIMALS: One hundred fourteen client-owned adult alpacas and llamas. METHODS: In a cross-sectional study, whole blood in ethylenediaminetetraacetic acid (EDTA) was assessed for packed cell volume (PCV) by centrifugation, erythrocyte count (RBC), and hemoglobin concentration (HGB) using an ADVIA120 analyzer, and Mhl using real-time PCR. Trichostrongyle eggs per gram (epg) were counted by modified McMaster test on freshly collected feces. Significant differences in erythrocyte variables based on Mhl status and FEC thresholds were assessed by independent t test and one-way ANOVA, respectively. RESULTS: Packed cell volume, RBC, and HGB were not significantly different between Mhl-positive and Mhl-negative animals, but were significantly lower in animals with FEC >1000 epg compared to those with <500 epg. All animals with FEC >600 epg had RBC and HGB below the reference interval median. All animals with FEC >750 epg had PCV below the reference interval median. CONCLUSIONS AND CLINICAL IMPORTANCE: In healthy nonanemic camelids, positive Mhl PCR is not associated with lower erythrocyte variables and such animals may not warrant treatment. Fecal egg count >600-750 epg has a negative effect on erythrocyte variables, and may be a guide for deworming protocols.


Assuntos
Camelídeos Americanos/microbiologia , Camelídeos Americanos/parasitologia , Infecções por Mycoplasma/veterinária , Tricostrongiloidíase/veterinária , Animais , Camelídeos Americanos/sangue , Estudos Transversais , Contagem de Eritrócitos/veterinária , Feminino , Hematócrito/veterinária , Hemoglobinas/análise , Masculino , Mycoplasma/isolamento & purificação , Infecções por Mycoplasma/sangue , Infecções por Mycoplasma/epidemiologia , Contagem de Ovos de Parasitas/veterinária , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Tennessee/epidemiologia , Trichostrongyloidea/isolamento & purificação
6.
Am J Public Health ; 109(9): 1266-1272, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318589

RESUMO

Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years.Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event.Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals.Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.


Assuntos
Síndrome de Imunodeficiência Adquirida , Terapia Antirretroviral de Alta Atividade , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tennessee/epidemiologia , Adulto Jovem
7.
Accid Anal Prev ; 131: 15-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31233992

RESUMO

Global road safety records demonstrate spatial variation of comprehensive cost of traffic crashes across countries. To the best of our knowledge, no study has explored the variation of this matter at a local geographical level. This study proposes a method to estimate the comprehensive crash cost at the zonal level by using person-injury cost. The current metric of road safety attributes safety to the location of the crash, which makes it challenging to assign the crash cost to home-location of the individuals who were involved in traffic crashes. To overcome this limitation, we defined Home-Based Approach crash frequency as the expected number of crashes by severity that road users who live in a certain geographic area have during a specified period. Using crash data from Tennessee, we assign those involved in traffic crashes to the census tract corresponding to their home address. The average Comprehensive Crash Cost at the Zonal Level (CCCAZ) for the period of the study was $18.2 million (2018 dollars). Poisson and Geographically Weighted Poisson Regression (GWPR) models were used to analyzing the data. The GWPR model was more suitable compared to the global model to address spatial heterogeneity. Findings indicate population of people over 60-years-old, the proportion of residents that use non-motorized transportation, household income, population density, household size, and metropolitan indicator have a negative association with CCCAZ. Alternatively, VMT, vehicle per capita, percent educated over 25-year-old, population under 16-year-old, and proportion of non-white races and individuals who use a motorcycle as their commute mode have a positive association with CCCAZ. Findings are discussed in line with road safety literature.


Assuntos
Acidentes de Trânsito/economia , Regressão Espacial , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Tennessee/epidemiologia , Transportes/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto Jovem
8.
Environ Monit Assess ; 191(Suppl 2): 330, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254117

RESUMO

The effects of childhood exposure to ambient air pollution and their influences on healthcare utilization and respiratory outcomes in Memphis pediatric asthma cohort are still unknown. This study seeks to (1) investigate individual-level associations between asthma and exposure measures in high asthma rate and low asthma rate areas and (2) determine factors that influence asthma at first year of a child's life, first 2 years, first 5 years, and during their childhood. Datasets include physician-diagnosed asthma patients, on-road and individual PM2.5 emissions, and high-resolution spatiotemporal PM2.5 estimates. Spatial analytical and logistic regression models were used to analyze the effects of childhood exposure on outcomes. Increased risk was associated with African American (AA) (odds ratio (OR) = 3.09, 95% confidence interval (CI) 2.80-3.41), aged < 5 years old (OR = 1.31, 95% 1.17-1.47), public insurance (OR = 2.80, 95% CI 2.60-3.01), a 2.5-km radius from on-road emission sources (OR = 3.06, 95% CI 2.84-3.30), and a 400-m radius from individual PM2.5 sources (OR = 1.33, 95% CI 1.25-1.41) among the cohort with residence in high asthma rate areas compared to low asthma rates areas. A significant interaction was observed between race and insurance with the odds of AA being approximately five times (OR = 4.68, 95% CI 2.23-9.85), public insurance being about three times (OR = 2.65, 95% CI 1.68-4.17), and children in their first 5 years of life have more hospital visits than other age groups. Findings from this study can guide efforts to minimize emissions, manage risk, and design interventions to reduce disease burden.


Assuntos
Poluentes Atmosféricos/análise , Asma/epidemiologia , Exposição por Inalação/estatística & dados numéricos , Material Particulado/análise , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Humanos , Lactente , Exposição por Inalação/análise , Modelos Logísticos , Masculino , Fatores de Risco , Tennessee/epidemiologia
9.
J Urol ; 202(5): 899-904, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31188730

RESUMO

PURPOSE: Computerized tomography urography is used to evaluate patients with gross or microscopic hematuria. Computerized tomography urography is a high radiation dose scan and, thus, it confers a higher risk of secondary malignancy. A computerized tomography urography split bolus protocol reduces radiation exposure but it may reduce sensitivity. In this study we used a theoretical cohort of patients with hematuria in which to model the risk of missing malignancies against the benefit of averting secondary malignancies. MATERIALS AND METHODS: We calculated the prevalence of renal cell carcinoma and upper tract urothelial carcinoma in patients with hematuria by pooled analysis of cohort studies, which in conjunction with split bolus sensitivity allows for the estimation of missed malignancies. The number of prevented secondary malignancies was calculated from lifetime attributable risk estimates. Sensitivity analyses were run to determine the minimum sensitivity required for a net population benefit. RESULTS: Estimates of split bolus computerized tomography urography sensitivity ranged from 80% to 100% (mean 95.2%). At the low estimate of 80% sensitivity split bolus computerized tomography urography was beneficial in men and women with microscopic hematuria at ages less than 50 and less than 60 years, respectively. An increase in sensitivity to 90% improved the benefit 1 decade in each gender, representing 68.8% of patients with microscopic hematuria. The overall population of patients with microscopic hematuria benefited from split bolus computerized tomography urography at 91.1% sensitivity. However, in patients with gross hematuria the threshold for an overall population benefit was high at 98.4% sensitivity. CONCLUSIONS: Exposure to ionizing radiation risks causing secondary malignancy. These data indicate that split bolus computerized tomography urography may be performed safely in 70% of the population of patients with microscopic hematuria. However, it is not currently advisable in patients with gross hematuria or in other patients at high risk.


Assuntos
Hematúria/diagnóstico , Modelos Teóricos , Medição de Risco/métodos , Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Neoplasias Urológicas/complicações , Adulto , Idoso , Feminino , Seguimentos , Hematúria/epidemiologia , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Exposição à Radiação , Tennessee/epidemiologia , Neoplasias Urológicas/diagnóstico
10.
Pediatr Blood Cancer ; 66(8): e27775, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31038281

RESUMO

OBJECTIVE: The most commonly occurring childhood cancers are diagnosed during the preschool years; yet limited psycho-oncology research has focused on this developmental time period. The primary objective was to examine rates of posttraumatic stress symptoms (PTSS) in young children with cancer and compare these findings with those of children without a history of serious illness (comparisons). The secondary aim was to examine risk and modifiable factors associated with PTSS. METHOD: Ninety-seven caregivers of patients (n = 50) and comparisons (n = 47) aged three to six years completed diagnostic interviews for the assessment of PTSD. They also completed a survey measure of PTSS adapted from the Child Behavior Checklist (CBCL-PTSD), along with measures of their child's temperament and their own current psychological functioning. RESULTS: On the CBCL-PTSD, no differences in PTSS were observed between children with cancer and comparisons, although many in both groups appeared at risk, with approximately 34% of children with cancer and 27% of comparisons meeting threshold scores for probable PTSD. However, using a "gold-standard" clinical-interview assessment, only three children in the patient group and no children in the comparison group met diagnostic criteria for PTSD. Parental distress and child temperament were significantly associated with PTSS scores. CONCLUSION: Findings indicate PTSD is relatively infrequent in children with cancer, and survey measures may overestimate rates of PTSD in young children. However, other emotional or behavioral issues may be present. Ultimately, screening for potential emotional/behavioral concerns in young children with cancer is indicated, and interventions should continue to target caregiver distress.


Assuntos
Cuidadores/psicologia , Neoplasias/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Neoplasias/psicologia , Prevalência , Prognóstico , Psicologia da Criança , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Tennessee/epidemiologia
12.
BMC Health Serv Res ; 19(1): 208, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940130

RESUMO

BACKGROUND: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs. METHODS: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth statewide, and by hospital cohort. We compared the distribution of hospital EED percentages pre- and post-intervention. Lastly, we used multivariable logistic regression to estimate the effect of QI interventions on maternal and infant outcomes. RESULTS: Implementation of the QI intervention was associated with significant declines in likelihood of EEDs immediately following the intervention (odds ratio, OR = 0.72; p < 0.001), but these results varied by hospital cohort. Hospital risk-adjusted EED percentages ranged from 1.6-13.6% in the pre-intervention period, which significantly declined to 2.2-9.6% in the post-intervention period (p < 0.001). The QI intervention was also associated with significant reductions in operative vaginal delivery and perineal laceration, and immediate infant ventilation, but increased NICU admissions. CONCLUSIONS: A statewide QI intervention to reduce EEDs was associated with modest but significant declines in EEDs beyond concurrent and national trends, and showed mixed results in related infant and maternal outcomes.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Procedimentos Desnecessários/estatística & dados numéricos , Adulto , Feminino , Humanos , Lactente , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Tennessee/epidemiologia
13.
Papillomavirus Res ; 7: 141-149, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30980966

RESUMO

INTRODUCTION: Evidence of human papillomavirus (HPV) vaccine impact on anogenital warts (AGWs) by race or urbanicity in the US is lacking. We evaluated HPV vaccine impact in Tennessee by assessing AGW trends among Tennessee Medicaid (TennCare) enrollees aged 15-39 years from 2006-2014. METHODS: Persons with incident AGWs were identified using diagnosis/pharmacy codes from TennCare billing claims. We calculated sex-specific annual AGW incidence by age group, race, and urbanicity; estimated annual percent changes (APCs) using log-linear models; and performed pairwise comparisons by race and urbanicity. RESULTS: AGW incidence decreased among females aged 15-19 (APC = -10.6; P < 0.01) and 20-24 years (APC = -3.9; P = 0.02). Overall trends were similar between Whites and Blacks, and between those living in metropolitan statistical areas (MSAs) and non-MSAs. Rates among males aged 15-19 years began decreasing after 2010. Among enrollees aged 25-39 years, rates increased or were stable. CONCLUSIONS: Following introduction of the HPV vaccine in 2006, AGWs decreased among age groups most likely to be vaccinated. The change in trend among young males after 2010 suggests early herd effects. Our findings indicate vaccine effects and support the importance of improving adherence to current vaccination recommendations for preventing AGWs and other HPV-related diseases.


Assuntos
Doenças do Ânus/epidemiologia , Doenças do Ânus/prevenção & controle , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/prevenção & controle , Vacinas contra Papillomavirus/imunologia , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Incidência , Masculino , Medicaid , Vacinas contra Papillomavirus/administração & dosagem , Fatores Raciais , Tennessee/epidemiologia , Estados Unidos , Adulto Jovem
15.
Ann Intern Med ; 170(10): 673-681, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31035288

RESUMO

Background: Poor olfaction is common among older adults and has been linked to higher mortality. However, most studies have had a relatively short follow-up and have not explored potential explanations. Objective: To assess poor olfaction in relation to mortality in older adults and to investigate potential explanations. Design: Community-based prospective cohort study. Setting: 2 U.S. communities. Participants: 2289 adults aged 71 to 82 years at baseline (37.7% black persons and 51.9% women). Measurements: Brief Smell Identification Test in 1999 or 2000 (baseline) and all-cause and cause-specific mortality at 3, 5, 10, and 13 years after baseline. Results: During follow-up, 1211 participants died by year 13. Compared with participants with good olfaction, those with poor olfaction had a 46% higher cumulative risk for death at year 10 (risk ratio, 1.46 [95% CI, 1.27 to 1.67]) and a 30% higher risk at year 13 (risk ratio, 1.30 [CI, 1.18 to 1.42]). Similar associations were found in men and women and in white and black persons. However, the association was evident among participants who reported excellent to good health at baseline (for example, 10-year mortality risk ratio, 1.62 [CI, 1.37 to 1.90]) but not among those who reported fair to poor health (10-year mortality risk ratio, 1.06 [CI, 0.82 to 1.37]). In analyses of cause-specific mortality, poor olfaction was associated with higher mortality from neurodegenerative and cardiovascular diseases. Mediation analyses showed that neurodegenerative diseases explained 22% and weight loss explained 6% of the higher 10-year mortality among participants with poor olfaction. Limitation: No data were collected on change in olfaction and its relationship to mortality. Conclusion: Poor olfaction is associated with higher long-term mortality among older adults, particularly those with excellent to good health at baseline. Neurodegenerative diseases and weight loss explain only part of the increased mortality. Primary Funding Source: National Institutes of Health and Michigan State University.


Assuntos
Vida Independente , Transtornos do Olfato/mortalidade , Idoso , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Humanos , Masculino , Doenças Neurodegenerativas/mortalidade , Pennsylvania/epidemiologia , Estudos Prospectivos , Fatores de Risco , Tennessee/epidemiologia
16.
Sleep Health ; 5(3): 221-226, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30928495

RESUMO

OBJECTIVES: To identify factors that most saliently characterize the profile of individuals who complain of chronic insomnia, with or without quantitative sleep impairment. DESIGN: Community-dwelling adults reported on their demographics and functioning via questionnaires and completed 2 weeks of sleep diaries. SETTING: Shelby County in the Memphis, TN, area. PARTICIPANTS: Population-based sample, stratified by sex and age to maximally represent sleep and health across the life span. MEASUREMENTS: Participants were classified into 4 groups according to whether or not they endorsed a chronic insomnia complaint and whether they demonstrated good or poor quantitative sleep on diaries. Discriminant analysis determined which of the following variables significantly maximized spread among the sleep groups: age, sex, race, body mass index, household education, number of medications, frequency of substance use, number of medical conditions, depression, anxiety, fatigue, daytime sleepiness, and daytime insomnia impact. RESULTS: On the most powerful discriminant function, participants with more medical conditions, greater depression and anxiety, and older age were more likely to complain of chronic insomnia than to not complain and, within these levels, to have poor rather than good quantitative sleep. A second function found African Americans particularly likely to be noncomplaining poor sleepers compared to Whites. CONCLUSIONS: Findings make progress in clarifying the profile of individuals who self-identify as having chronically poor sleep. Notably, general depression and anxiety surpassed sleep-related daytime impairment measures in discriminating complaining sleepers. Negativistic self-appraisals driving diffuse psychological symptoms may thus be viable intervention targets for reducing persistent insomnia complaints independently of sleep-specific concerns.


Assuntos
Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Tennessee/epidemiologia , Adulto Jovem
17.
Ticks Tick Borne Dis ; 10(3): 682-689, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30846418

RESUMO

Borrelia miyamotoi is a relapsing fever spirochete transmitted by ticks in the Ixodes ricinus complex. In the eastern United States, B. miyamotoi is transmitted by I. scapularis, which also vectors several other pathogens including B. burgdorferi sensu stricto. In contrast to Lyme borreliae, B. miyamotoi can be transmitted vertically from infected female ticks to their progeny. Therefore, in addition to nymphs and adults, larvae can vector B. miyamotoi to wildlife and human hosts. Two widely varying filial infection prevalence (FIP) estimates - 6% and 73% - have been reported previously from two vertically infected larval clutches; to our knowledge, no other estimates of FIP or transovarial transmission (TOT) rates for B. miyamotoi have been described in the literature. Thus, we investigated TOT and FIP of larval clutches derived from engorged females collected from hunter-harvested white-tailed deer in 2015 (n = 664) and 2016 (n = 599) from Maine, New Hampshire, Tennessee, and Wisconsin. After engorged females oviposited in the lab, they (n = 492) were tested for B. miyamotoi infection by PCR. Subsequently, from each clutch produced by an infected female, larval pools, as well as 100 individual eggs or larvae, were tested. The TOT rate of the 11 infected females was 90.9% (95% CI; 57.1-99.5%) and the mean FIP of the resulting larval clutches was 84.4% (95% CI; 68.1-100%). Even though the overall observed vertical transmission rate (the product of TOT and FIP; 76.7%, 95% CI; 44.6-93.3%) was high, additional horizontal transmission may be required for enzootic maintenance of B. miyamotoi based on the results of a previously published deterministic model. Further investigation of TOT and FIP variability and the underlying mechanisms, both in nature and the laboratory, will be needed to resolve this question. Meanwhile, studies quantifying the acarological risk of Borrelia miyamotoi disease need to consider not only nymphs and adults, but larval I. scapularis as well.


Assuntos
Infecções por Borrelia/veterinária , Borrelia/isolamento & purificação , Cervos/parasitologia , Transmissão Vertical de Doença Infecciosa , Ixodes/microbiologia , Animais , Animais Selvagens/parasitologia , Borrelia/genética , Infecções por Borrelia/epidemiologia , Infecções por Borrelia/transmissão , Feminino , Larva/microbiologia , Maine/epidemiologia , New Hampshire/epidemiologia , Ninfa/microbiologia , Reação em Cadeia da Polimerase , Tennessee/epidemiologia
18.
J Health Care Poor Underserved ; 30(1): 249-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30827981

RESUMO

OBJECTIVE: To examine alternative tobacco product (ATP) use and associated factors among middle school students in Appalachian Tennessee. METHOD: Data (2015-2016; N=573) from school-based tobacco surveys in 11 middle schools in Appalachian Tennessee were analyzed. Multiple logistic regression model described factors associated with ATP use. RESULTS: More than one-tenth (13.2%) of participants have ever used ATPs. Approximately 9%, 7%, 6%, and 2% of participants have ever used e-cigarettes, cigarettes, smokeless tobacco, and little cigars or cigarillos, respectively. The following were significantly associated with ever use of ATPs: believing tobacco users have more friends, owning tobacco-branded item(s), living with a tobacco user, having ever smoked cigarettes, and living in homes where smoking is allowed. CONCLUSION: More than one in 10 of participants have ever used at least one ATP, and association with desirable objects and situations may promote ATP use. Interventions should seek to reduce these positive images and make all tobacco products unappealing.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Estudantes/psicologia , Produtos do Tabaco/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Adolescente , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Risco , Estudantes/estatística & dados numéricos , Tennessee/epidemiologia
19.
Pediatr Blood Cancer ; 66(6): e27669, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30758124

RESUMO

BACKGROUND: Osteonecrosis is a common toxicity associated with glucocorticoid (e.g., dexamethasone and prednisone) treatment of children with acute lymphoblastic leukemia (ALL), but risk factors are incompletely defined. Infections are also a common complication of ALL therapy. Lipopolysaccharide (LPS) is used experimentally to mimic infection-related systemic effects. To our knowledge, the contribution of systemic infections to the risk of glucocorticoid-induced osteonecrosis has not been investigated. PROCEDURE: Patients with ALL on St. Jude Total Therapy XV (n = 365) were assessed for documented bacteremia prior to development of osteonecrosis, which was confirmed by MRI, and graded using the National Cancer Institute's Common Terminology for Adverse Events (version 3.0). In a preclinical model, Balb/cJ mice treated with dexamethasone plus or minus LPS were assessed for frequency and severity of osteonecrosis and arteriopathy. RESULTS: We found that patients with ALL who experienced bacteremia had a higher frequency of symptomatic osteonecrosis (≥grade 2) than those who did not (OR: 1.88; 95% CI, 1.03-3.41, P = 0.038). LPS exacerbated experimental dexamethasone-induced osteonecrosis. Mice treated with dexamethasone plus LPS had a higher incidence of osteonecrosis (P = 0.00086) and arteriopathy (P = 0.0047) than did those treated with dexamethasone alone, and the severity of osteonecrosis (P = 0.00045) and arteriopathy (P = 0.0048) was also more pronounced with the addition of LPS treatment. The increase in osteonecrosis was not explained by any alteration of dexamethasone pharmacokinetics by LPS. CONCLUSIONS: These data identify systemic infection during ALL therapy as a novel risk factor in the development of glucocorticoid-induced osteonecrosis.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Bacteriemia/complicações , Dexametasona/efeitos adversos , Osteonecrose/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Índice de Gravidade de Doença , Animais , Criança , Seguimentos , Humanos , Incidência , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Osteonecrose/etiologia , Osteonecrose/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Tennessee/epidemiologia
20.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30659064

RESUMO

BACKGROUND: Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between implementation and changes in racial disparities in breastfeeding rates. Our goal was to determine if a hospital- and community-based initiative in the Southern United States could increase compliance with the Ten Steps, lead to Baby-Friendly designation, and decrease racial disparities in breastfeeding. METHODS: Hospitals in Mississippi, Louisiana, Tennessee, and Texas were enrolled into the Communities and Hospitals Advancing Maternity Practices initiative from 2014 to 2017 and received an intensive quality improvement and technical assistance intervention to improve compliance with the Ten Steps. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming in practices. RESULTS: The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points (95% confidence interval 1.6-19.5) over the course of 31 months. Breastfeeding initiation increased from 66% to 75% for all races combined, and exclusivity increased from 34% to 39%. Initiation and exclusive breastfeeding among African American infants increased from 46% to 63% (P < .05) and from 19% to 31% (P < .05), respectively. Skin-to-skin care after cesarean delivery was significantly associated with increased breastfeeding initiation and exclusivity in all races; rooming in was significantly associated with increased exclusive breastfeeding in African American infants only. CONCLUSIONS: Increased compliance with the Ten Steps was associated with a decrease in racial disparities in breastfeeding.


Assuntos
Aleitamento Materno/tendências , Grupos de Populações Continentais/educação , Disparidades em Assistência à Saúde/tendências , Maternidades/tendências , Aleitamento Materno/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Louisiana/epidemiologia , Mississippi/epidemiologia , Gravidez , Tennessee/epidemiologia , Texas/epidemiologia
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