Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28.920
Filtrar
1.
J Am Heart Assoc ; 13(14): e034308, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38958125

RESUMO

BACKGROUND: Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS: We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS: We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.


Assuntos
Atividades Cotidianas , Americanos Mexicanos , Qualidade de Vida , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Acidente Vascular Cerebral/psicologia , Características da Vizinhança , Cognição , Sobreviventes/psicologia , Recidiva , Texas/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Fatores de Tempo , População Branca
2.
J Prof Nurs ; 53: 80-85, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38997203

RESUMO

BACKGROUND: An ongoing nursing shortage poses significant challenges to the healthcare industry, prompting nursing education programs to find ways to increase nurse graduates. Unfortunately, the problem of attrition in nursing education is significant. Despite many years of attrition research, educators still seek to find answers to determine what factors cause some students to succeed and others to fail in nursing programs. Noncognitive variables, like grit, have been largely overlooked as potential solutions to the problem of attrition. PURPOSE: The purpose of this study was to explore the extent to which grit predicts academic potential in baccalaureate nursing students. METHODS: This cross-sectional study included a total of 63 baccalaureate nursing students in their first semester of a four-semester nursing program at a mid-sized public university in East Texas. Participants took an electronic survey reporting demographic information, completing the Short Grit Scale (Grit-S), and consenting to release of their pre-admission science grade point average (sGPA), ATI Test of Essential Academic Skills (TEAS) exam scores, and first-semester nursing GPA (nGPA). RESULTS: When added to sGPA and TEAS scores, grit scores were not a statistically significant predictor of nGPA. Students with high grit scores were just as likely to experience attrition as those with low scores, and grit did not statistically significantly predict first-semester attrition. CONCLUSIONS: Nurse educators are encouraged to pursue strategies to address attrition in nursing education. Traditional selection criteria of sGPA and TEAS exam scores were shown to be predictors of nGPA. Additional research is warranted to explore the relationship between noncognitive variables, especially grit, and nursing student academic potential.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Estudos Transversais , Feminino , Masculino , Texas , Adulto , Inquéritos e Questionários , Avaliação Educacional , Adulto Jovem
3.
BMC Health Serv Res ; 24(1): 797, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38987761

RESUMO

BACKGROUND: There is an urgent need to increase colorectal cancer screening (CRCS) uptake in Texas federally qualified health centers (FQHCs), which serve a predominantly vulnerable population with high demands. Empirical support exists for evidence-based interventions (EBIs) that are proven to increase CRCS; however, as with screening, their use remains low in FQHCs. This study aimed to identify barriers to and facilitators of implementing colorectal cancer screening (CRCS) evidence-based interventions (EBIs) in federally qualified health centers (FQHCs), guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: We recruited employees involved in implementing CRCS EBIs (e.g., physicians) using data from a CDC-funded program to increase the CRCS in Texas FQHCs. Through 23 group interviews, we explored experiences with practice change, CRCS promotion and quality improvement initiatives, organizational readiness, the impact of COVID-19, and the use of CRCS EBIs (e.g., provider reminders). We used directed content analysis with CFIR constructs to identify the critical facilitators and barriers. RESULTS: The analysis revealed six primary CFIR constructs that influence implementation: information technology infrastructure, innovation design, work infrastructure, performance measurement pressure, assessing needs, and available resources. Based on experiences with four recommended EBIs, participants described barriers, including data limitations of electronic health records and the design of reminder alerts targeted at deliverers and recipients of patient or provider reminders. Implementation facilitators include incentivized processes to increase provider assessment and feedback, existing clinic processes (e.g., screening referrals), and available resources to address patient needs (e.g., transportation). Staff buy-in emerged as an implementation facilitator, fostering a conducive environment for change within clinics. CONCLUSIONS: Using CFIR, we identified barriers, such as the burden of technology infrastructure, and facilitators, such as staff buy-in. The results, which enhance our understanding of CRCS EBI implementation in FQHCs, provide insights into designing nuanced, practical implementation strategies to improve cancer control in a critical setting.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Pesquisa Qualitativa , Humanos , Neoplasias Colorretais/diagnóstico , Texas , COVID-19/epidemiologia , Prática Clínica Baseada em Evidências , Feminino , Masculino , Melhoria de Qualidade/organização & administração
4.
PeerJ ; 12: e17635, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38993974

RESUMO

Documenting changes in the distribution and abundance of a given taxon requires historical data. In the absence of long-term monitoring data collected throughout the range of a taxon, conservation biologists often rely on preserved museum specimens to determine the past or present, putative geographic distribution. Distributional data for the Houston Toad (Anaxyrus houstonensis) has consistently been confounded by similarities with a sympatric congener, the Dwarf American Toad (A. americanus charlesmithi), both in monitoring data derived from chorusing surveys, and in historical data via museum specimens. In this case, misidentification can have unintended impacts on conservation efforts, where the Houston Toad is federally endangered, and the Dwarf American Toad is of least concern. Previously published reports have compared these two taxon on the basis of their male advertisement call and morphological appearance, often with the goal of using these characters to substantiate their taxonomic status prior to the advent of DNA sequencing technology. However, numerous studies report findings that contradict one another, and no consensus on the true differences or similarities can be drawn. Here, we use contemporary recordings of wild populations of each taxon to test for quantifiable differences in male advertisement call. Additionally, we quantitatively examine a subset of vouchered museum specimens representing each taxon to test previously reported differentiating morphometric characters used to distinguish among other Bufonids of East-Central Texas, USA. Finally, we assemble and qualitatively evaluate a database of photographs representing catalogued museum vouchers for each taxon to determine if their previously documented historic ranges may be larger than are currently accepted. Our findings reveal quantifiable differences between two allopatric congeners with respect to their male advertisement call, whereas we found similarities among their detailed morphology. Additionally, we report on the existence of additional, historically overlooked, museum records for the Houston Toad in the context of its putative historic range, and discuss errors associated with the curation of these specimens whose identity and nomenclature have not been consistent through time. These results bookend decades of disagreement regarding the morphology, voice, and historic distribution of these taxa, and alert practitioners of conservation efforts for the Houston Toad to previously unreported locations of occurrence.


Assuntos
Bufonidae , Vocalização Animal , Animais , Vocalização Animal/fisiologia , Masculino , Bufonidae/anatomia & histologia , Bufonidae/fisiologia , Bufonidae/classificação , Texas , Conservação dos Recursos Naturais , Feminino , Distribuição Animal
5.
PLoS One ; 19(7): e0304238, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38968308

RESUMO

BACKGROUND: Emerging evidence suggests newborn screening analytes may yield insights into the etiologies of birth defects, yet no effort has evaluated associations between a range of newborn screening analytes and birth defects. METHODS: This population-based study pooled statewide data on birth defects, birth certificates, and newborn screening analytes from Texas occurring between January 1, 2007 and December 31, 2009. Associations between a panel of thirty-six newborn screening analytes, collected by the statewide Texas Newborn Screening Program, and the presence of a birth defect, defined as at least one of 39 birth defects diagnoses recorded by the Texas Birth Defects Registry, were assessed using regression analysis. FINDINGS: Of the 27,643 births identified, 20,205 had at least one of the 39 birth defects of interest (cases) as identified by the Texas Birth Defects Registry, while 7,438 did not have a birth defect (controls). Among 1,404 analyte-birth defect associations evaluated, 377 were significant in replication analysis. Analytes most consistently associated with birth defects included the phenylalanine/tyrosine ratio (N = 29 birth defects), tyrosine (N = 28 birth defects), and thyroxine (N = 25 birth defects). Birth defects most frequently associated with a range of analytes included gastroschisis (N = 29 analytes), several cardiovascular defects (N = 26 analytes), and spina bifida (N = 23 analytes). CONCLUSIONS: Several significant and novel associations were observed between newborn screening analytes and birth defects. While some findings could be consequences of the defects themselves or to the care provided to infants with these defects, these findings could help to elucidate mechanisms underlying the etiology of some birth defects.


Assuntos
Anormalidades Congênitas , Triagem Neonatal , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/diagnóstico , Texas/epidemiologia , Feminino , Sistema de Registros , Masculino
6.
Dermatol Online J ; 30(2)2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38959916

RESUMO

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.


Assuntos
Dermatite Atópica , Serviço Hospitalar de Emergência , Atenção Primária à Saúde , Melhoria de Qualidade , Dermatite Atópica/terapia , Humanos , Projetos Piloto , Criança , Competência Clínica , Texas , Masculino
7.
Sch Psychol ; 39(4): 377-386, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38976401

RESUMO

Rates of depression in youth are continuing to increase at a steady rate, yet these youth often do not receive mental health services (Bertha & Balázs, 2013; Thomas et al., 2011). Schools are an ideal setting to connect youth to mental health services; however, many barriers exist with respect to schools having adequate resources and access to the appropriate levels of services (Duong et al., 2021; Owens & Peltier, 2002). Schools may collaborate with local community providers with available resources to address these gaps. The current article describes the pilot of a school-based mental health promotion program intended to reduce depression in youth by promoting access to care through referrals to community providers. Data were collected, via self-report measures, every 3 months for 12 months from students from three middle and high schools in North Texas. The students (N = 88) enrolled in this program experienced significant reductions in their depression symptoms at the end of 12 months. This program highlights the importance of school-community partnerships to promote access to care to address mental health concerns. The results from our pilot study demonstrate the feasibility and the potential of school-based programs in improving the mental health of youth in schools through community partnership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Assuntos
Depressão , Pobreza , Serviços de Saúde Mental Escolar , Estudantes , Humanos , Projetos Piloto , Adolescente , Masculino , Feminino , Depressão/terapia , Estudantes/psicologia , Instituições Acadêmicas , Texas , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Escolar , Promoção da Saúde/métodos
8.
J Healthc Manag ; 69(4): 296-308, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38976789

RESUMO

GOAL: Value-based care is not simply a matter of cost, but also one of outcomes and harms per dollar spent. This definition encompasses three key components: healthcare delivery that is organized around patients' medical conditions, costs and outcomes that are actively and consistently measured, and information technology that enables the other two components. Our objective in this project was to implement and measure a systemwide high-value, evidence-based care initiative with five pillars of high-value practices. METHODS: We performed a quasi-experimental study from September 1, 2019, to August 31, 2022, of a new care program at the University of Texas Medical Branch. Drawing from the ABIM Foundation's Choosing Wisely Campaign, the program was based on five pillars-blood management and antimicrobial, laboratory, imaging, and opioid stewardship-with interdisciplinary teams led by institutional subject matter experts (i.e., administrative leaders) accompanied by nursing, information technology, pharmacy, and clinical and nonclinical personnel including faculty and trainees. Each pillar addressed two goals with targeted interventions to assess improvements during the first three fiscal years (FYs) of implementation. The targets were set at 10% improvement by the end of each FY. Monthly measurements were recorded for each FY. PRINCIPAL FINDINGS: We tracked performance toward 30 pillar goals and determined that the teams were successful in 50%, 50%, and 70% of their goals for FY 2020, 2021, and 2022, respectively. For example, in the antimicrobial stewardship FY 2021 pillar, one goal was to decrease meropenem days of therapy (DOT) by 10% (baseline was 45 DOT/1,000 patient days; the target was 40.5 DOT/1,000 patient days). We measured quarterly DOT/1,000 patient day rates of 32.02, 30.57, and 26.9, respectively, for a cumulative rate of 26.9. Critical interventions included engaging and empowering providers and service lines (including outliers whose performance was outside norms), educational conferences, and transparent data analyses. PRACTICAL APPLICATIONS: We showed that a multidisciplinary approach to the implementation of an evidence-based, high-value care program through a partnership of engaged administrative leaders, providers, and trainees can result in sustainable and measurable high-value healthcare delivery. Specifically, structuring the program with pillars to address defined metrics resulted in progressive improvement in meeting value-based goals at the University of Texas Medical Branch. Also, challenges can be embraced as learning opportunities to inform value-based interventions that range from technological to educational tactics. The results at the University of Texas Medical Branch provide a benchmark for the implementation of a program that engages, empowers, and aligns innovative value-based care initiatives.


Assuntos
Prática Clínica Baseada em Evidências , Humanos , Texas , Medicina Baseada em Evidências , Atenção à Saúde/organização & administração
9.
PLoS One ; 19(7): e0306578, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38959281

RESUMO

Thoughtfully managed hydroperiods in natural and artificial wetlands could potentially provide a combination of desirable flood control services and high ecological functions. To explore how managed freshwater wetlands typical of the Houston, Texas area would respond to different hydrological regimes that might occur if wetlands were drained in anticipation of a heavy rain that did not materialize, we conducted a mesocosm experiment with six flooding depths and seven drought durations, followed by seven months of recovery. We found that the speed in which mesocosms dried out was a function of initial water depth, with mesocosms initially set with greater water depths (30 cm) taking ~ 38 days to dry out versus zero days for wetlands that were completely drained. Individual plant species (14 species planted; 8 species common at the end of the recovery period) were affected by drought length, flooding depth, or their interaction, although details of these responses varied among the species. The composition of the plant community at the end of the drought period was strongly affected by drought length, and the effect of the drought length treatment persisted through seven months of post-drought recovery, with the 80- and 160-day drought treatments diverging most strongly from shorter drought treatments. Above- and below-ground biomass of plants was not affected by the treatments, but above-ground dead biomass (litter) decreased with increasing drought length. Densities of mosquito larvae, snails and tadpoles were temporally variable, and were affected more during the treatment period and early in recovery than after a disturbance event late in recovery. Our results indicate that managed wetlands in southeast Texas would be quite resilient to dry periods of up to 40 days in duration, especially if water was not completely drained at the beginning of the drought. In addition, many species would persist in managed wetlands even with droughts of up to 160 days. This indicates considerable potential for managing the hydroperiods of artificial detention ponds by retaining water longer to increase ecological function, with little to no loss of flood control services, and for managing the hydroperiods of natural wetlands by draining them in advance of anticipated rains to increase flood control services, with little to no loss of ecological function.


Assuntos
Inundações , Água Doce , Invertebrados , Áreas Alagadas , Animais , Invertebrados/fisiologia , Plantas , Secas , Texas
10.
Sci Rep ; 14(1): 16730, 2024 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-39030391

RESUMO

We conducted a study in San Antonio, Texas, in the weeks preceding the 2022 state Governor election to determine if implicit or explicit measures of political preference could predict voter behavior. We adapted an established event-related potential (ERP) paradigm showing political statements to participants one word at the time where the last word made the statement pro-Republican or pro-Democratic. Our sample of college students included decided and undecided voters, and was reflective of the demographic make-up of south-central Texas. Our implicit measures were an established authoritarianism scale and the N400 effect to the sentence-final word. The N400 is an ERP to any stimulus that engages semantic memory and has been shown to measure implicit disagreement with political statements. Explicit measures of political preference and authoritarianism were predictive of vote choice. The expected N400 effect was found for Democratic voters, with larger amplitude to pro-Republican than pro-Democratic statements. Surprisingly, decided Republican voters showed no difference in N400 responses to pro-Republican and pro-Democratic statements and there was no group difference in the N400 effect. In turn, the N400 was not predictive of voter behavior. We argue that the N400 effect reflected individual political preferences, but that ultimately voter behavior aligned with partisan identity.


Assuntos
Potenciais Evocados , Política , Humanos , Feminino , Masculino , Adulto Jovem , Potenciais Evocados/fisiologia , Adulto , Eletroencefalografia , Texas , Adolescente , Autoritarismo
11.
BMC Pregnancy Childbirth ; 24(1): 479, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39014313

RESUMO

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.


Assuntos
Acessibilidade aos Serviços de Saúde , Pesquisa Qualitativa , Refugiados , Humanos , Feminino , Afeganistão/etnologia , Refugiados/psicologia , Gravidez , Adulto , Serviços de Saúde Materna , Texas , Saúde Materna/etnologia , Estados Unidos , Adulto Jovem , Barreiras de Comunicação
12.
Front Public Health ; 12: 1418526, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38983249

RESUMO

Background: HPV is responsible for most cervical, oropharyngeal, anal, vaginal, and vulvar cancers. The HPV vaccine has decreased cervical cancer incidence, but only 49% of Texas adolescents have initiated the vaccine. Texas shows great variation in HPV vaccination rates. We used geospatial analysis to identify areas with high and low vaccination rates and explored differences in neighborhood characteristics. Methods: Using Anselin's Local Moran's I statistic, we conducted an ecological analysis of hot and cold spots of adolescent HPV vaccination coverage in Texas from 2017 to 2021. Next, we utilized a Mann-Whitney U test to compare neighborhood characteristics of vaccination coverage in hot spots versus cold spots, leveraging data from the Child Opportunity Index (COI) and American Community Survey. Results: In Texas, there are 64 persistent vaccination coverage hotspots and 55 persistent vaccination coverage cold spots. The persistent vaccination coverage hot spots are characterized by ZIP codes with lower COI scores, higher percentages of Hispanic residents, higher poverty rates, and smaller populations per square mile compared to vaccine coverage cold spots. We found a more pronounced spatial clustering pattern for male adolescent vaccine coverage than we did for female adolescent vaccine coverage. Conclusion: In Texas, HPV vaccination coverage rates differ depending on the community's income level, with lower-income areas achieving higher success rates. Notably, there are also gender-based discrepancies in vaccination coverage rates, particularly among male adolescents. This knowledge can aid advocates in customizing their outreach initiatives to address these disparities.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Características de Residência , Análise Espaço-Temporal , Humanos , Texas , Vacinas contra Papillomavirus/administração & dosagem , Feminino , Adolescente , Masculino , Características de Residência/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinação/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle
13.
Health Serv Res ; 59(4): e14334, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38830636

RESUMO

OBJECTIVE: To examine the impact of the Affordable Care Act (ACA) health insurance exchanges (Marketplace) on the rate of uninsured discharges in Texas. DATA SOURCE AND STUDY SETTING: Secondary discharge data from 2011 to 2019 from Texas. STUDY DESIGN: We conducted a retrospective study estimating the effects of the ACA Marketplace using difference-in-difference regressions, with the main outcome being the uninsured discharge rate. We stratified our sample by patient's race, age, gender, urbanicity, major diagnostic categories (MDC), and emergent type of admissions. DATA COLLECTION/EXTRACTION METHODS: We used Texas hospital discharge records for non-elderly adults collected by the state of Texas and included acute care hospitals who reported data from 2011 to 2019. PRINCIPAL FINDINGS: The expansion of insurance through ACA Marketplaces led to reductions in the uninsured discharge rate by 9.9% (95% CI, -17.5%, -2.3%) relative to the baseline mean. The effects of the ACA were felt strongest in counties with any share of Hispanic, in counties with a larger population of Black, and other racial groups, in counties with a significant share of female and older age individuals, in counties considered to be urban, in high-volume diagnoses, and emergent type of admissions. CONCLUSIONS: These findings indicate that the ACA facilitated a shift in hospital payor mix from uninsured to insured.


Assuntos
Hospitalização , Pessoas sem Cobertura de Seguro de Saúde , Patient Protection and Affordable Care Act , Humanos , Texas , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Feminino , Masculino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Hospitalização/estatística & dados numéricos , Estados Unidos , Trocas de Seguro de Saúde/estatística & dados numéricos , Adulto Jovem , Cobertura do Seguro/estatística & dados numéricos , Adolescente , Fatores Sexuais , Alta do Paciente/estatística & dados numéricos , Fatores Etários
14.
Parasit Vectors ; 17(1): 245, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824598

RESUMO

BACKGROUND: Bovine babesiosis is caused by infection with the protozoal parasite Babesia bovis, which is transmitted by Rhipicephalus (Boophilus) spp. It can cause mortality rates up to 90% in immunologically naive Bos taurus cattle. In south Texas, R. (B.) microplus is known to infest nilgai antelope (Boselaphus tragocamelus); however, their susceptibility to infection with B. bovis and their role in the transmission of the parasite remain unknown. In this study, we challenged nilgai antelope with B. bovis and evaluated their susceptibility to infection. METHODS: Nilgai were needle inoculated with ≈108 B. bovis-parasitized erythrocytes (merozoites) or a homogenate of B. bovis-infected larval ticks (sporozoite) delivered intravenously. Bos taurus beef calves were inoculated in parallel, as this strain of B. bovis is lethal to cattle. Temperature and hematocrit were monitored daily over the course of each study, and whole blood was collected for molecular [polymerase chain reaction (PCR)] and serological [indirect enzyme-linked immunosorbent assay (ELISA)] diagnostic evaluation. Histological sections of nilgai cerebral tissue were examined for evidence of infection. Recipient bovine calves were sub-inoculated with blood from nilgai challenged with either stage of the parasite, and they were monitored for clinical signs of infection and evaluated by a PCR diagnostic assay. Red blood cells (RBCs) from prechallenged nilgai and B. taurus beef cattle were cultured with an in vitro B. bovis merozoite culture to examine colonization of the RBCs by the parasite. RESULTS: Nilgai did not display clinical signs of infection upon inoculation with either the merozoite or sporozoite stage of B. bovis. All nilgai were PCR-negative for the parasite, and they did not develop antibodies to B. bovis. No evidence of infection was detected in histological sections of nilgai tissues, and in vitro culture analysis indicated that the nilgai RBCs were not colonized by B. bovis merozoites. Cattle subinoculated with blood from challenged nilgai did not display clinical signs of infection, and they were PCR-negative up to 45 days after transfer. CONCLUSIONS: Nilgai do not appear to be susceptible to infection with a strain of B. bovis that is lethal to cattle. Tick control on these alternative hosts remains a critical priority, especially given their potential to disseminate ticks over long distances.


Assuntos
Antílopes , Babesia bovis , Babesiose , Animais , Babesia bovis/genética , Babesia bovis/patogenicidade , Babesia bovis/isolamento & purificação , Babesia bovis/imunologia , Babesiose/parasitologia , Bovinos , Antílopes/parasitologia , Doenças dos Bovinos/parasitologia , Eritrócitos/parasitologia , Texas , Virulência , Rhipicephalus/parasitologia , Feminino , Reação em Cadeia da Polimerase
15.
Addict Behav ; 156: 108063, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-38824720

RESUMO

OBJECTIVE: This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users. METHODS: Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use. RESULTS: 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users. CONCLUSIONS: Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.


Assuntos
Vaping , Humanos , Texas/epidemiologia , Masculino , Feminino , Adulto Jovem , Adolescente , Vaping/epidemiologia , Vaping/psicologia , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Adulto , Fumar Maconha/epidemiologia , Uso da Maconha/epidemiologia , Fumar Cigarros/epidemiologia , Amigos , Motivação , Uso de Tabaco/epidemiologia
16.
Genes (Basel) ; 15(6)2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38927587

RESUMO

Landscapes are consistently under pressure from human-induced ecological change, often resulting in shifting species distributions. For some species, changing the geographical breadth of their niche space results in matching range shifts to regions other than those in which they are formally found. In this study, we employ a population genomics approach to assess potential conservation issues arising from purported range expansions into the south Texas Brush Country of two sister species of ducks: mottled (Anas fulvigula) and Mexican (Anas diazi) ducks. Specifically, despite being non-migratory, both species are increasingly being recorded outside their formal ranges, with the northeastward and westward expansions of Mexican and mottled ducks, respectively, perhaps resulting in secondary contact today. We assessed genetic ancestry using thousands of autosomal loci across the ranges of both species, as well as sampled Mexican- and mottled-like ducks from across overlapping regions of south Texas. First, we confirm that both species are indeed expanding their ranges, with genetically pure Western Gulf Coast mottled ducks confirmed as far west as La Salle county, Texas, while Mexican ducks recorded across Texas counties near the USA-Mexico border. Importantly, the first confirmed Mexican × mottled duck hybrids were found in between these regions, which likely represents a recently established contact zone that is, on average, ~100 km wide. We posit that climate- and land use-associated changes, including coastal habitat degradation coupled with increases in artificial habitats in the interior regions of Texas, are facilitating these range expansions. Consequently, continued monitoring of this recent contact event can serve to understand species' responses in the Anthropocene, but it can also be used to revise operational survey areas for mottled ducks.


Assuntos
Patos , Hibridização Genética , Animais , Patos/genética , Texas , Humanos , México
17.
Environ Res ; 257: 119346, 2024 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-38838752

RESUMO

BACKGROUND: Asthma exacerbations are an important cause of emergency department visits but much remains unknown about the role of environmental triggers including viruses and allergenic pollen. A better understanding of spatio-temporal variation in exposure and risk posed by viruses and pollen types could help prioritize public health interventions. OBJECTIVE: Here we quantify the effects of regionally important Cupressaceae pollen, tree pollen, other pollen types, rhinovirus, seasonal coronavirus, respiratory syncytial virus, and influenza on asthma-related emergency department visits for people living near eight pollen monitoring stations in Texas. METHODS: We used age stratified Poisson regression analyses to quantify the effects of allergenic pollen and viruses on asthma-related emergency department visits. RESULTS: Young children (<5 years of age) had high asthma-related emergency department rates (24.1 visits/1,000,000 person-days), which were mainly attributed to viruses (51.2%). School-aged children also had high rates (20.7 visits/1,000,000 person-days), which were attributed to viruses (57.0%), Cupressaceae pollen (0.7%), and tree pollen (2.8%). Adults had lower rates (8.1 visits/1,000,000 person-days) which were attributed to viruses (25.4%), Cupressaceae pollen (0.8%), and tree pollen (2.3%). This risk was spread unevenly across space and time; for example, during peak Cuppressaceae season, this pollen accounted for 8.2% of adult emergency department visits near Austin where these plants are abundant, but 0.4% in cities like Houston where they are not; results for other age groups were similar. CONCLUSIONS: Although viruses are a major contributor to asthma-related emergency department visits, airborne pollen can explain a meaningful portion of visits during peak pollen season and this risk varies over both time and space because of differences in plant composition.


Assuntos
Asma , Serviço Hospitalar de Emergência , Pólen , Pólen/efeitos adversos , Asma/epidemiologia , Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Criança , Pré-Escolar , Adulto , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Texas/epidemiologia , Lactente , Feminino , Masculino , Idoso , Vírus/isolamento & purificação , Alérgenos/efeitos adversos , Poluentes Atmosféricos/análise , Visitas ao Pronto Socorro
18.
BMC Public Health ; 24(1): 1608, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886715

RESUMO

BACKGROUND: Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population. METHODS: We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers. RESULTS: Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs. CONCLUSIONS: Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.


Assuntos
Cuidado da Criança , Acessibilidade aos Serviços de Saúde , Provedores de Redes de Segurança , Humanos , Feminino , Adulto , Estudos Transversais , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Cuidado da Criança/estatística & dados numéricos , Texas , Criança , Adulto Jovem , Pré-Escolar , Pessoa de Meia-Idade , Adolescente , Necessidades e Demandas de Serviços de Saúde , Lactente , Inquéritos e Questionários
19.
Am J Public Health ; 114(8): 824-832, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38843477

RESUMO

Objectives. To identify appropriate interventions to prevent injury, we conducted a qualitative study among commercial shrimp fishermen in the Gulf of Mexico. Methods. Using qualitative and participatory research methods, including interviews, photovoice, and workplace observations in southeast Texas and the Rio Grande Valley in Texas, we examined the social‒structural dimensions that contribute to physical and psychological injury. Results. We found that multiple layers of vulnerability and danger exist among shrimpers with interacting themes: (1) recognizing risk, (2) precarious employment, and (3) psychological distress. Conclusions. Our results add to the growing body of knowledge that emphasizes the negative health impacts of underregulated, high-risk, and physically demanding work performed primarily by im/migrants. Public Health Implications. Our findings highlight the larger social‒structural conditions and context of hardships endemic to migrant labor and suggest implications for practice and policy interventions. (Am J Public Health. 2024;114(8):824-832. https://doi.org/10.2105/AJPH.2024.307696).


Assuntos
Pesquisa Qualitativa , Determinantes Sociais da Saúde , Migrantes , Humanos , Golfo do México , Migrantes/psicologia , Migrantes/estatística & dados numéricos , Texas , Masculino , Adulto , Pesqueiros , Pessoa de Meia-Idade , Feminino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA