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1.
Parasit Vectors ; 15(1): 407, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329477

RESUMO

BACKGROUND: The canine heartworm Dirofilaria immitis, a filarioid nematode of dogs and other carnivores, is widespread in the USA and the world. Over 20 different mosquito species serve as intermediate hosts of D. immitis, but their contribution to transmission varies according to factors like host feeding patterns, geographic locations and climatic conditions. The yellow fever mosquito, Aedes aegypti, is a competent vector of D. immitis but is often dismissed as a vector of veterinary relevance given its anthropophilic feeding behavior. We evaluated the prevalence of D. immitis in pet dogs along the USA-Mexico border and assessed whether Ae. aegypti in the area are naturally infected with heartworm and are potentially acting as a vector. METHODS: A total of 200 whole blood samples collected from pet dogs in the Lower Rio Grande Valley in south Texas from 2016 to 2019 were included in this study. Canine serum samples for D. immitis were tested using the DiroCHEK® Canine Heartworm Antigen Test Kit pre- and post-immune complex dissociations (ICD) and blood samples were tested using high-resolution melt (HRM) quantitative PCR (qPCR) and a probe-based qPCR. Additionally, mosquito specimens were collected and identified, and Ae. aegypti heads, abdomens and pools were tested using conventional PCR (cPCR) and HRM qPCR. RESULTS: Overall, heartworm prevalence in dogs aged > 6 months was 40.8% (64/157) when the results from all testing modalities were considered. Heartworm antigen was detected in 33.5% and 40.7% of the dogs using DiroCHEK® pre- and post-ICD, respectively. By molecular screening, 20.1% of dogs tested positive with probe-based qPCR, while only one tested positive with HRM qPCR. Of the Ae. aegypti abdomens from blood-fed Ae. aeygpti tested, 20 (21.7%) from mosquitoes that fed on dogs and four (7%) from those that fed on humans tested positive for heartworm. Among Ae. aegypti heads from blood-fed Ae. aeygpti, two (1.1%) were positive based on cPCR and four (2.5%) were positive based on HRM qPCR. No D. immitis DNA was detected in the 208 pools of whole bodies (358 individuals) of Ae. aegypti gravid females. CONCLUSIONS: Our study highlights a high prevalence of heartworm in dogs in south Texas and provides evidence that Ae. aegypti could be contributing to heartworm transmission in canine populations in this region.


Assuntos
Aedes , Dirofilaria immitis , Dirofilariose , Doenças do Cão , Humanos , Feminino , Cães , Animais , Dirofilaria immitis/genética , Dirofilariose/epidemiologia , Prevalência , Texas/epidemiologia , Mosquitos Vetores , Doenças do Cão/epidemiologia
2.
Prev Med ; 164: 107331, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36334680

RESUMO

Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices.


Assuntos
Acidentes por Quedas , Fragilidade , Idoso , Estados Unidos , Humanos , Acidentes por Quedas/prevenção & controle , Texas/epidemiologia , Medicare , Promoção da Saúde
3.
J Stroke Cerebrovasc Dis ; 31(12): 106851, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36335753

RESUMO

OBJECTIVES: Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke outcomes. We report here the methods, background literature, and initial recruitment of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers, and community. MATERIALS AND METHODS: Rigorous active and passive stroke surveillance captures all strokes in Nueces County, Texas. Stroke patients are followed for 90 days to determine their care transitions and factors influencing their rehabilitation setting. Informal caregivers of the stroke patients are identified and interviewed at 90 days to determine aspects of their caregiving and caregiver outcomes. Available community resources are compared with stated needs among stroke patient and caregivers to determine unmet needs. RESULTS: Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413 were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by 355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating potential caregivers met the eligibility criteria. CONCLUSIONS: BASIC-PAC has strong initial recruitment and is poised to provide valuable data on multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse stroke outcomes in MAs. Based on the study findings, interventions can be developed that will improve stroke health equity.


Assuntos
Acidente Vascular Cerebral , Cuidados Semi-Intensivos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/epidemiologia , Americanos Mexicanos , Encéfalo , Texas/epidemiologia
4.
Health Aff (Millwood) ; 41(11): 1626-1634, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36343310

RESUMO

The COVID-19 pandemic has taken a heightened toll on people incarcerated in prisons in the United States, with those incarcerated experiencing a higher rate of infection and mortality than the US population more generally. What is less well known is the degree to which COVID-19 outcomes differ among incarcerated populations, especially by race and ethnicity, where significant differences have been found among the US population as a whole. This knowledge gap is, in part, due to a lack of reporting of COVID-19 outcomes by race and ethnicity by most state prison systems. To shed light on this topic, we analyzed mortality patterns of the population incarcerated in Texas state prison facilities during both the year before (beginning April 1, 2019) and the first year of (beginning April 1, 2020) the COVID-19 pandemic. We used a unique data set of roster information from the Texas Department of Criminal Justice and medical examiner records. COVID-19 mortality was 1.61 and 2.12 times higher for Black and Hispanic populations, respectively, when compared with the White population in Texas prisons. Strategies for COVID-19 mitigation in carceral settings, such as vaccination and decarceration, should include an equity component to minimize disparities.


Assuntos
COVID-19 , Estados Unidos , Humanos , Prisões , Etnicidade , Pandemias , Texas/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-36360676

RESUMO

Prior to the COVID-19 pandemic, the United States was facing an epidemic of opioid overdose deaths, clouding accurate inferences about the impact of the pandemic at the population level. We sought to determine the existence of increases in the trends of opioid-related overdose (ORO) deaths in the Greater Houston metropolitan area from January 2015 through December 2021, and to describe the social vulnerability present in the geographic location of these deaths. We merged records from the county medical examiner's office with social vulnerability indexes (SVIs) for the region and present geospatial locations of the aggregated ORO deaths. Time series analyses were conducted to determine trends in the deaths, with a specific focus on the years 2019 to 2021. A total of 2660 deaths were included in the study and the mean (standard deviation, SD) age at death was 41.04 (13.60) years. Heroin and fentanyl were the most frequent opioids detected, present in 1153 (43.35%) and 1023 (38.46%) ORO deaths. We found that ORO deaths increased during the years 2019 to 2021 (p-value ≤ 0.001) when compared with 2015. Compared to the year 2019, ORO deaths increased for the years 2020 and 2021 (p-value ≤ 0.001). The geographic locations of ORO deaths were not associated with differences in the SVI. The COVID-19 pandemic had an impact on increasing ORO deaths in the metropolitan Houston area; however, identifying the determinants to guide targeted interventions in the areas of greatest need may require other factors, in addition to community-level social vulnerability parameters.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Estados Unidos , Humanos , Adulto , Analgésicos Opioides , Overdose de Opiáceos/epidemiologia , Texas/epidemiologia , Pandemias
6.
Artigo em Inglês | MEDLINE | ID: mdl-36361149

RESUMO

Rates of non-cigarette (colloquially, other) tobacco use is elevated among adults with behavioral health conditions. Little is known about whether behavioral health providers are using brief interventions, including the evidence-based 5As (Ask, Advise, Assess, Assist, and Arrange) for other tobacco use, or what provider factors may be associated with use of these interventions. The current study redressed this gap. Overall, 86 providers in Texas (9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs) that provide a broad range of mental and behavioral health services, 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment programs) took a survey assessing their beliefs regarding (1) patients' concerns about other tobacco use; (2) their desire to quit; (3) importance of intervening on other tobacco use with cessation counseling; (4) perceived skills to intervene; (5) knowledge of referral options for treatment. Logistic regression analyses were conducted to determine the association between each factor and use of the 5As. Results showed that 70.9% of providers asked patients about other tobacco use status, 65.1% advised them to quit, 59.3% assessed quit interest, 54.7% assisted with a quit attempt, and 31.4% arranged a follow-up. Providers who believed patients were concerned about other tobacco use, recognized the importance of offering other tobacco use cessation counseling, believed they had the necessary skills to treat other tobacco use, and possessed knowledge of referral options, respectively, were more likely to deliver the 5As (ps < 0.05). Results add to a limited literature on provider intervention practices for other tobacco use in settings where behavioral health care is provided, highlighting the significance of provider beliefs, perceived skills, and referral knowledge to care delivery. Findings reveal opportunities to increase delivery of the 5As for other tobacco use to behavioral health patients and suggest provider factors that could be targeted to build this capacity.


Assuntos
Abandono do Hábito de Fumar , Adulto , Humanos , Abandono do Hábito de Fumar/métodos , Tabaco , Texas/epidemiologia , Encaminhamento e Consulta , Uso de Tabaco , Atenção à Saúde
7.
JAMA Netw Open ; 5(11): e2239849, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36322085

RESUMO

Importance: There is a large body of epidemiologic evidence that heat is associated with increased risk of mortality. One of the most effective strategies to mitigate the effects of heat is through air conditioning (AC); Texas regulates the internal temperature of jails to stay between 65 and 85 °F degrees, but these same standards do not apply to state and private prisons. Objective: To analyze whether heat during warm months is associated with an increased risk of mortality in Texas prisons without AC. Design, Setting, and Participants: This case-crossover study included individuals who died in Texas prisons between 2001 and 2019. The association of heat in warm months with mortality in Texas prisons with and without AC was estimated. Data analysis was conducted from January to April 2022. Exposures: Increasing daily heat index above 85 °F and extreme heat days (days above the 90th percentile heat index for the prison location). Main Outcomes and Measures: Daily mortality in Texas prisons. Results: There were 2083 and 1381 deaths in prisons without and with AC, respectively, during warm months from 2001 to 2019. Most of the deceased were male (3339 of 3464 [96%]) and the median (IQR) age at death was 54 (45-62) years. A 1-degree increase above 85 °F heat index and an extreme heat day were associated with a 0.7% (95% CI, 0.1%-1.3%) and a 15.1% (95% CI, 1.3%-30.8%) increase in the risk of mortality in prisons without AC, respectively. Approximately 13% of mortality or 271 deaths may be attributable to extreme heat during warm months between 2001 to 2019 in Texas prison facilities without AC. In prisons with AC, a negative percentage change in mortality risk was observed, although the 95% CI crossed zero (percentage change in mortality risk: -0.6%; 95% CI, -1.6% to 0.5%). The estimates in prisons without AC were statistically different than the estimates in prisons with AC (P = .05). Conclusions and Relevance: This study found an average of 14 deaths per year between 2001 to 2019 were associated with heat in Texas prisons without AC vs no deaths associated with heat in prisons with AC. Adopting an AC policy in Texas prisons may be important for protecting the health of one of our most vulnerable populations.


Assuntos
Ar Condicionado , Prisões , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Temperatura Alta , Texas/epidemiologia , Estudos Cross-Over
8.
Artigo em Inglês | MEDLINE | ID: mdl-36429934

RESUMO

Background-This project sought to assess needs, perceived challenges, and priorities regarding substance use disorder (SUD) in East Texas and develop a community-driven research agenda to address those challenges. Methods-Data were gathered through nine focus-group discussions (FGDs) with stakeholders: people living with SUD, families, medical providers, counselors, representatives of community-based organizations, and law enforcement officers. We asked participants how substance use manifests in their communities, which challenges they confronted in coping with substance use and misuse, and in which order their needs should be prioritized. Findings were reported at community forums to confirm the list of challenges and prioritize needs. Results-Five themes emerged from the FGDs indicating major challenges: (a) access to SUD treatment and recovery resources, (b) mental health and resiliency, (c) education, training, and professional development to facilitate treatments, (d) care and service coordination, and (e) community/social support for people living with SUD and their families. Conclusions-Significant resources such as financing, collaboration across silos, and community education are needed to effectively manage this public health problem. Our findings can inform research and outreach to help East Texans develop interventions, research programs, and educational opportunities for clinicians, community-based organizations, law enforcement officers, and counselors to build capacity for SUD prevention, treatment, and recovery.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Humanos , Texas/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Saúde Mental , Organizações , Saúde Pública
9.
Artigo em Inglês | MEDLINE | ID: mdl-36360949

RESUMO

The Community Engagement Alliance (CEAL) Against COVID-19 Disparities aims to conduct community-engaged research and outreach. This paper describes the Texas CEAL Consortium's activities in the first year and evaluates progress. The Texas CEAL Consortium comprised seven projects. To evaluate the Texas CEAL Consortium's progress, we used components of the RE-AIM Framework. Evaluation included estimating the number of people reached for data collection and education activities (reach), individual project goals and progress (effectiveness), partnerships established and partner engagement (adoption), and outreach and education activities (implementation). During the one-year period, focus groups were conducted with 172 people and surveys with 2107 people across Texas. Partners represented various types of organizations, including 11 non-profit organizations, 4 academic institutions, 3 civic groups, 3 government agencies, 2 grassroots organizations, 2 faith-based organizations, 1 clinic, and 4 that were of other types. The main facets of implementation consisted of education activities and the development of trainings. Key recommendations for future consortiums relate to funding and research logistics and the value of strong community partnerships. The lessons learned in this first year of rapid deployment inform ongoing work by the Texas CEAL Consortium and future community-engaged projects.


Assuntos
COVID-19 , Humanos , Texas/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Redes Comunitárias , Universidades , Grupos Focais
10.
PLoS One ; 17(10): e0274905, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36228017

RESUMO

BACKGROUND: A number of modifiable risk factors have been designated as being causally related to cancer development. We aimed to estimate the percentage of incident cancer cases diagnosed in persons aged ≥25 years in Texas in 2015, overall and by race/ethnicity, that were attributable to these modifiable risk factors. METHODS: We calculated population attributable fractions (PAFs) for cancers attributable to thirteen modifiable risk factors using prevalence data from the Texas Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey, as well as relative risks estimates from prior studies and cancer incidence data from the Texas Cancer Registry. RESULTS: Overall, 32.3% of all incident cancers (N = 33,416) in 2015 were attributable to modifiable risk factors. Men (35.1%) had a numerically higher overall PAF than women (29.5%). Tobacco smoking caused the highest proportion of cancers (18.4%), followed by overweight and obesity (6.6%) and excess alcohol consumption (2.9%). Non-Hispanic Blacks had a numerically higher overall PAF (36.8%) than non-Hispanic Whites (31.9%) and Hispanics (31.7%). Further, non-Hispanic Blacks had the highest combined PAFs for 85% of cancer sites analyzed, including lung/bronchus and mouth/pharynx/larynx. CONCLUSION: Modifiable risk factors cause about one third of cancers in Texas. Non-Hispanic Blacks are especially affected by an excessive preventable cancer burden.


Assuntos
Etnicidade , Neoplasias , Feminino , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Neoplasias/etiologia , Inquéritos Nutricionais , Prevalência , Fatores de Risco , Texas/epidemiologia
11.
Pediatr Infect Dis J ; 41(11): e494-e497, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36223237

RESUMO

Streptococcus gallolyticus subsp. pasteurianus is an unusual pathogen in infants, which causes sepsis and meningitis. We describe the clinical course and treatment of 15 infants with bacteremia and/or meningitis due to S. gallolyticus. Outcomes were favorable with limited neuroimaging findings. One-third of isolates displayed reduced susceptibility to penicillin highlighting the importance of performing antimicrobial susceptibility testing in infants with meningitis.


Assuntos
Anti-Infecciosos , Infecções Estreptocócicas , Anti-Infecciosos/uso terapêutico , Criança , Hospitais , Humanos , Lactente , Penicilinas/uso terapêutico , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus , Streptococcus gallolyticus , Texas/epidemiologia
12.
AIDS Res Ther ; 19(1): 43, 2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123679

RESUMO

BACKGROUND: People with HIV (PWH) commonly have elevated cholesterol and triglycerides levels that have been linked to medications. However, healthy behaviors including lifestyle changes can lower high cholesterol (CHOL) or high triglycerides (TG), thereby reducing individual risk for cardiovascular diseases. This study aimed to determine the prevalence and risk factors associated with high CHOL or TG among PWH in Texas. METHODS: Cross-sectional data of 981 PWH from the 2015-2017 Texas and Houston Medical Monitoring Projects were examined. High CHOL or TG was identified by medical chart diagnosis, CHOL or TG medication use, or most recent fasting lab ≥ 200 mg/dl (total CHOL) or ≥ 150 mg/dl (TG). High CHOL or TG associations with sociodemographic and clinical characteristics were assessed using Rao-Scott chi-square tests. Prevalence of high CHOL or TG development was calculated using multivariable logistic regression model. RESULTS: High CHOL or TG prevalence was 41% with participants being mostly male (73%), ≥ 40 years (68%), with overweight (31%) or obesity (28%), and virally suppressed (62%). Compared with PWH < 40 years of age, PWH in their 40s, 50s, and ≥ 60s were 57%, 64%, and 62% more likely to have high CHOL or TG, respectively. Participants with overweight and obesity were 41% and 30% more likely to have high CHOL or TG than those with normal weight (BMI: 18.5- < 25), respectively. CONCLUSION: Since high CHOL and TG are modifiable CVD risk factors, increased education and lifestyle modification interventions are warranted to prevent the development of high CHOL or TG among PWH.


Assuntos
Doenças Cardiovasculares , Infecções por HIV , Hipercolesterolemia , Doenças Cardiovasculares/etiologia , Colesterol , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Hipercolesterolemia/complicações , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Texas/epidemiologia , Triglicerídeos
13.
BMC Pregnancy Childbirth ; 22(1): 700, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096759

RESUMO

BACKGROUND: Maternal mental health conditions (MMHCs), which include depression and anxiety disorders during pregnancy and through five years postpartum, are among the most common obstetric complications in the United States overall and in Texas in particular. In the context of potential expansion of postpartum Medicaid coverage from 60 days to one year, we sought to capture the societal, financial burden of untreated MMHCs. METHODS: We estimated the economic impact of untreated maternal mental health conditions (MMHCs) among births in Texas in 2019 using a cost-of-illness model. RESULTS: We found that MMHCs affected 13.2% of mothers and, when left untreated, cost $2.2 billion among mothers and children born in Texas in 2019 when following the birth cohort from conception through five years postpartum. We found that MMHCs affected 17.2% of mothers enrolled in Texas' Medicaid for Pregnant Women and cost $962 million. In addition, the prevalence of MMHCs and resulting costs varied considerably among women of different races and ethnicities. Employers and health care payers, including Medicaid, bore most of these costs. CONCLUSIONS: The Texas Health and Human Services Commission's (HHSC) efforts to increase awareness about MMHCs and increase access to care represent an important step toward improving maternal and child health and maximizing benefits to Texas HHSC, employers, and insurers.


Assuntos
Transtornos Mentais , Saúde Mental , Criança , Feminino , Humanos , Saúde Materna , Medicaid , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Gravidez , Texas/epidemiologia , Estados Unidos/epidemiologia
14.
Am J Infect Control ; 50(10): 1110-1117, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36150795

RESUMO

BACKGROUND: The Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive--conducted prior to identified cases--or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps. METHODS: Data from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type. RESULTS: DSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009). CONCLUSIONS: Increased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.


Assuntos
COVID-19 , Desinfetantes , Higienizadores de Mão , COVID-19/prevenção & controle , Humanos , Controle de Infecções , Complexo Ferro-Dextran , Assistência de Longa Duração , Casas de Saúde , Pandemias/prevenção & controle , SARS-CoV-2 , Instituições de Cuidados Especializados de Enfermagem , Sabões , Texas/epidemiologia , Água
16.
South Med J ; 115(9): 674-680, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36055654

RESUMO

OBJECTIVES: The purpose was to evaluate the characteristics of off-highway vehicle (OHV) crashes correlated with neurological injury and accident severity in the pediatric population in El Paso, Texas. METHODS: A retrospective review of 213 patients who were victims of an OHV crash attended at a regional Level I trauma center from 2012 to 2020 was performed. OHVs were defined as vehicles designated for use outside public roads. Neurological outcomes included any traumatic brain injury (TBI) or a brain hemorrhage/hematoma. Severe injury was defined as a Glasgow Coma Scale less than 8, a length of stay longer than 7 days, a Pediatric Trauma Score lower than 8, and requiring pediatric intensive care unit admission. Bivariate and multivariate analyses by logistic regression models were conducted to determine the factors related to the neurological outcomes and accident severity. RESULTS: Of 213 OHV crash patients, 104 (48.8%) had TBI and 22 (10.3%) had brain hemorrhages or hematomas. Risk analyses demonstrated that children younger than age 6 years and occupants of recreational OHVs have a significantly higher risk of severe injuries. Off-highway motorcycles and all-terrain vehicles were risk factors for TBI, whereas helmets were a protective factor. CONCLUSIONS: OHVs are associated with both TBIs and severe injuries. Stricter laws requiring helmets and forbidding children younger than 6 to ride are required, as modifying these factors could reduce the incidence of OHV crashes and their complications.


Assuntos
Veículos Off-Road , Acidentes , Acidentes de Trânsito , Criança , Dispositivos de Proteção da Cabeça , Humanos , Motocicletas , Estudos Retrospectivos , Texas/epidemiologia
17.
Medicina (Kaunas) ; 58(8)2022 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-36013477

RESUMO

Background and Objectives: Early detection through appropriate screening is key to curing breast cancer. The Access to Breast Care for West Texas (ABC4WT) program offers no-cost mammography to underserved women in West Texas. The U.S. Preventative Task Force (USPSTF) guidelines are breast cancer screening guidelines which suggest screening for all women at the age of 50 years. The focus of this study was to identify sociodemographic barriers and determinants for breast cancer screenings, as well as screening outcomes, in low income, uninsured, or under-insured communities in West Texas. Materials and Methods: The ABC4WT program's patient database was queried from 1 November, 2018, to 1 June, 2021, for sociodemographic variables, screening history, and results to identify high-risk groups for outreach. The American College of Radiology's risk assessment and quality assurance tool, BI-RADS (Breast Imaging-Reporting and Data System), a widely accepted lexicon and reporting schema for breast imaging, was used for risk differentiation. Results: The cancer rate for ABC4WT's program was significantly higher than the national mean (5.1), at 23.04 per 1000 mammograms. Of the 1519 mammograms performed, women between 40 and 49 years old represented the highest percentages of BI-RADS 4 and 5 (42.0% and 28.0%, respectively; p = 0.049). This age group also received 43.7% of biopsies performed and comprised 28.6% (n = 10) of cancers diagnosed (n = 35) (p = 0.031). Additionally, participants with a monthly household income of less than USD 800/month/person were more likely to result in a cancer diagnosis (70.6%) than higher incomes (29.4%) (p = 0.021). Conclusions: These determinants most starkly impacted women 40-49 years old who would not have been screened by U.S. Preventative Services Task Force (USPSTF) guidelines. This population with increased cancer risk should be encouraged to undergo screening for breast cancer via mammography.


Assuntos
Neoplasias da Mama , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Mamografia/métodos , Programas de Rastreamento/métodos , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Texas/epidemiologia
18.
Resuscitation ; 179: 29-35, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35933059

RESUMO

INTRODUCTION: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. Female OHCA patients have lower rates of BCPR compared to men and other survival outcomes vary. The influence of the COVID-19 pandemic on OHCA incidence and outcomes in different health disparity populations is unknown. METHODS: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES). We determined the association of both prehospital characteristics and survival outcomes with the pandemic period in each study group through Pearson's χ2 test or Fisher's exact tests. We created mixed multivariable logistic regression models to compare odds of cardiac arrest care and outcomes between 2019 and 2020 for the study groups. RESULTS: Black OHCA patients (aOR = 0.73; 95% CI: 0.65 - 0.82) had significantly lower odds of BCPR compared to White OHCA patients, were less likely to achieve ROSC (aOR = 0.86; 95% CI: 0.74 - 0.99) or have a good CPC score (aOR = 0.47; 95% CI: 0.29 - 0.75). Compared to White patients with OHCA, Hispanic persons were less likely to have a field TOR (aOR = 0.86; 95% CI: 0.75 - 0.99) or receive BCPR (aOR = 0.78; 95% CI: 0.69 - 0.87). Female OHCA patients had higher odds of surviving to hospital admission compared to males (aOR = 1.29; 95% CI: 1.15 - 1.44). CONCLUSION: Many OHCA outcomes worsened for Black and Hispanic patients. While some aspects of care worsened for women, their odds of survival improved compared to males.


Assuntos
COVID-19 , Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Feminino , Humanos , Masculino , Pandemias , Sistema de Registros , Texas/epidemiologia
19.
Sci Diabetes Self Manag Care ; 48(5): 387-399, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35915582

RESUMO

PURPOSE: The purpose of this study was to investigate the health status and needs of the Asian American/Pacific Islander (AAPI) population with diabetes in Texas. METHODS: This was a cross-sectional secondary analysis of data collected from the Behavioral Risk Factors Surveillance System in Texas from 2015 to 2019 for non-Hispanic White (NHW) and AAPI adults. RESULTS: Although the overall crude diabetes prevalence was lower in AAPI adults, age-adjusted diabetes prevalence was higher than in NHWs. Significant risk factors associated with diabetes in the AAPI group included being male, marital status, lower education levels, lower income, being overweight/obese, and having a sedentary lifestyle. Engagement in self-management activities (checking blood glucose, checking feet, attending a diabetes management course) was lower in AAPIs than in NHWs. CONCLUSIONS: Given stiff barriers to adequate screening and self-management support in diabetes care among ethnic populations such as AAPIs, targeted efforts to improve diabetes screening and effective care are warranted. Because today's AAPI populations are predominantly first-generation immigrant groups who suffer from language barriers, efforts should be made to develop health surveys in multiple languages for wider inclusion of understudied groups like AAPIs in diabetes-related research.


Assuntos
Americanos Asiáticos , Diabetes Mellitus , Adulto , Glicemia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Texas/epidemiologia
20.
JMIR Public Health Surveill ; 8(8): e34589, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35972778

RESUMO

BACKGROUND: Monitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists. OBJECTIVE: To increase the accessibility of Bayesian methods among health surveillance researchers, we introduce a Bayesian methodology and open source software package, surveil, for time-series modeling of disease incidence and mortality. Given case count and population-at-risk data, the software enables health researchers to draw inferences about underlying risk and derivative quantities including age-standardized rates, annual and cumulative percent change, and measures of inequality. METHODS: We specify a Poisson likelihood for case counts and model trends in log-risk using the first-difference (random-walk) prior. Models in the surveil R package were built using the Stan modeling language. We demonstrate the methodology and software by analyzing age-standardized colorectal cancer (CRC) incidence rates by race and ethnicity for non-Latino Black (Black), non-Latino White (White), and Hispanic/Latino (of any race) adults aged 50-79 years in Texas's 4 largest metropolitan statistical areas between 1999 and 2018. RESULTS: Our analysis revealed a cumulative decline of 31% (95% CI -37% to -25%) in CRC risk among Black adults, 17% (95% CI -23% to -11%) for Latino adults, and 35% (95% CI -38% to -31%) for White adults from 1999 to 2018. None of the 3 observed groups experienced significant incidence reduction in the final 4 years of the study (2015-2018). The Black-White rate difference (per 100,000) was 44 (95% CI 30-57) in 1999 and 35 (95% CI 28-43) in 2018. Cumulatively, the Black-White gap accounts for 3983 CRC cases (95% CI 3746-4219) or 31% (95% CI 29%-32%) of total CRC incidence among Black adults in this period. CONCLUSIONS: Stalled progress on CRC prevention and excess CRC risk among Black residents warrant special attention as cancer prevention and control priorities in urban Texas. Our methodology and software can help the public and health agencies monitor health inequalities and evaluate progress toward disease prevention goals. Advantages of the methodology over current common practice include the following: (1) the absence of piecewise linearity constraints on the model space, and (2) formal inference can be undertaken on any model-derived quantities of interest using Bayesian methods.


Assuntos
Neoplasias Colorretais , Teorema de Bayes , Neoplasias Colorretais/epidemiologia , Humanos , Incidência , Software , Texas/epidemiologia
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