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1.
Support Care Cancer ; 28(1): 271-278, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31037379

RESUMO

BACKGROUND: Adjuvant endocrine therapy (AET) significantly reduces recurrence and mortality in women with estrogen receptor-positive breast cancer. Adherence to AET is about 50-60% for 5 years, and while numerous studies have identified barriers to AET adherence, few have identified the role of social support as a facilitator. Therefore, the objective of this study is to explore the role of social support during the ongoing management of AET. METHODS: We conducted semi-structured in-depth interviews with breast cancer survivors (n = 22) who filled a prescription for AET in the previous 12 months. Women were recruited from Los Angeles, California, and Houston, Texas, between 2014 and 2015. Interview questions prompted discussion about AET and how social support affects AET adherence. We analyzed interview transcripts with a grounded theory approach and grouped social support into four categories (emotional, informational, instrumental, and appraisal), then used a thematic content analysis to identify the sources and delivery of support. RESULTS: Women described that informational support was provided by medical providers who explained the purpose, benefits, and management of AET. Emotional support in the form of reassurance, communication, and empathy was provided by family, survivorship groups, medical providers, and spirituality/religiosity. Women identified several organizations and exercises that provided them with instrumental and appraisal support in the form of physical and emotional benefits, which was also provided by family, friends, and medical providers. CONCLUSION: We identified that social support delivered to breast cancer survivors provided women with educational, physical, and emotional benefits that may play an important role in their continuation of AET.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Sobreviventes de Câncer/psicologia , Adesão à Medicação , Recidiva Local de Neoplasia/prevenção & controle , Apoio Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Quimioterapia Adjuvante , Terapia Combinada , Emoções/fisiologia , Exercício/fisiologia , Feminino , Humanos , Entrevistas como Assunto , Los Angeles/epidemiologia , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Texas/epidemiologia
2.
J Surg Res ; 245: 360-366, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425876

RESUMO

BACKGROUND: While the prevalence of HIV infection in the population is 0.5%, it is higher among trauma patients as are rates of unknown seropositivity. Routine HIV screening for all trauma evaluations was implemented at our urban level I center in 2009. We aimed to evaluate use and results of the program in our trauma population. METHODS: This was a retrospective analysis of all trauma evaluations between July 2015 and February 2018. After passage of legislation rescinding the requirement for consent to perform HIV testing, our trauma service instituted an order set which automatically tested for HIV unless the ordering physician opted out. Patients found to be infected with HIV were to be counseled and referred to specialty care. RESULTS: Of 6175 consecutive trauma evaluations during the study period, 449 (7.3%) patients had been screened within the prior year and were excluded. Of the remaining cohort, 2024 (35.3%) patients were screened with 27 (1.3%) testing positive. Among those testing positive for infection, 100% were male, 77% white, 63% non-Hispanic, and 70% lacked insurance. Twenty-five (92.6%) patients received counseling and 19 were referred to specialty care. Age, gender, race, ethnicity, Injury Severity Score, trauma activation level, and payor type were not significant predictors for positive HIV screen on logistic regression analysis. CONCLUSIONS: Despite a significantly higher rate of HIV in the trauma population, only a third of patients are screened. Such high infection rates justify the existence of this screening program but steps must be taken to increase screening rate. LEVEL OF EVIDENCE: Level 3.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Adulto , Aconselhamento/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Texas/epidemiologia
3.
J Stroke Cerebrovasc Dis ; 29(2): 104582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859033

RESUMO

BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.


Assuntos
Ansiedade/psicologia , Isquemia Encefálica/psicologia , Hemorragias Intracranianas/complicações , Ataque Isquêmico Transitório/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Comorbidade , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/psicologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Pessoa Solteira/psicologia , Isolamento Social , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Texas/epidemiologia
4.
Sleep Health ; 5(6): 592-597, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31706800

RESUMO

OBJECTIVES: To explore (a) how perceptions of personal and divine control over one's sleep schedule combine in distinct ways to predict sleep quality among college students and (b) whether health behaviors and psychological distress mediate the associations between perceptions of sleep control and sleep quality. METHODS: We surveyed 1251 students attending a public university in South Texas. All measures were derived from self-reports. Binary logistic regression techniques were used to predict the odds of reporting high-quality sleep in the past month. Mediation analyses were used to decompose the estimated effects of perceptions of sleep control on sleep quality via smoking, drinking, and psychological distress. RESULTS: Compared to participants who reported both low personal control and low divine control over their sleep schedules, students who reported both high personal control and high divine control exhibited 148% greater odds of reporting high-quality sleep (odds ratio = 2.48; 95% confidence interval = 1.434-4.294). These same participants also showed the highest predicted probabilities of reporting high-quality sleep (22%) compared to students with other sleep control orientations. Mediation analyses indicated that reduced psychological distress partially accounted for these differences, whereas smoking and drinking behaviors did not. CONCLUSION: College students who felt they and God both shared full control over their sleep schedules reported the highest quality sleep, which was partially explained by their lower average levels of psychological distress.


Assuntos
Controle Interno-Externo , Religião , Sono , Estudantes/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/epidemiologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Texas/epidemiologia , Universidades , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 934, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694567

RESUMO

BACKGROUND: Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. METHODS: We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. RESULTS: A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. CONCLUSIONS: Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.


Assuntos
Institutos de Câncer , Neoplasias Pulmonares/diagnóstico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Neoplasias Hematológicas , Transplante de Células-Tronco Hematopoéticas , Humanos , Incidência , Leucemia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Texas/epidemiologia , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/microbiologia , Adulto Jovem
6.
Public Health Rep ; 134(6): 626-633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31530093

RESUMO

OBJECTIVES: Screening for hepatitis C virus (HCV) infection in jail provides an opportunity to educate and offer care to a high-risk population. We aimed to (1) estimate the prevalence of HCV infection in jail; (2) describe the demographic characteristics, risk factors, and pre-incarceration health insurance status associated with HCV infection; and (3) examine the implementation of HCV screening in jail. METHODS: We conducted a retrospective analysis of an opt-out HCV screening program with HCV RNA confirmation and patient education at the Dallas County Jail from April 1 through November 2, 2017. We extracted data on test results, demographic characteristics, and release destination from electronic medical records. A nurse navigator recorded data on patient self-reported risk factors and pre-incarceration health insurance status. RESULTS: Of 4089 incarcerated persons screened, 708 (17.3%) had a positive HCV antibody result. Of these, 641 (90.5%) had an HCV RNA test ordered; 576 (89.9%) had RNA tests completed, of whom 413 (71.7%) had a positive HCV RNA result. Of these 413, 352 (85.2%) received patient education. Half of HCV RNA-positive incarcerated persons (n = 207, 50.1%) were born outside the birth cohort (1945-1965). Among those with HCV infection, commonly reported risk factors were injection drug use (168 of 352; 47.8%) and tattoos (82 of 352; 23.4%). Most incarcerated persons with HCV infection (284 of 350; 81.1%) did not have health insurance. HCV antibody prevalence was higher among incarcerated persons released to prison (232 of 961; 24.1%) than to outside agencies (38 of 403; 9.4%) or the community (178 of 1026; 17.4%). CONCLUSIONS: Screening for HCV with RNA confirmation in jail provides an opportunity for disease education, transmission prevention, and navigation to HCV treatment. Future efforts should examine post-incarceration linkage to care.


Assuntos
Educação em Saúde , Hepatite C/diagnóstico , Programas de Rastreamento/organização & administração , Prisões/organização & administração , Adulto , Testes Diagnósticos de Rotina , Feminino , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia
7.
Public Health Rep ; 134(6): 643-650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539480

RESUMO

OBJECTIVE: A disproportionate number of tuberculosis cases and tuberculosis deaths occur among persons experiencing homelessness in the United States. Our objective was to identify risks for homelessness and death during mycobacterial treatment among persons experiencing homelessness with tuberculosis in Texas. METHODS: Using data from the Centers for Disease Control and Prevention's TB Genotyping Information Management System, we evaluated data on demographic, laboratory, and clinical characteristics of persons experiencing homelessness in Texas during the year before tuberculosis diagnosis, from January 1, 2010, through December 31, 2017. RESULTS: Of 10 130 new diagnoses of tuberculosis among persons living in Texas during the study period, 543 were reported as being homeless in the year before tuberculosis diagnosis. The odds of dying during treatment were 2.26 (95% confidence interval, 1.68-3.03) times higher among persons with tuberculosis experiencing homelessness than among persons with tuberculosis living in homes. CONCLUSIONS: Our findings indicate that persons experiencing homelessness bear an undue burden of tuberculosis mortality in Texas. The burden may be related to poorer health caused by poverty stressors, comorbidities, or lack of access to health care.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Vigilância da População , Tuberculose/epidemiologia , Tuberculose/mortalidade , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Comorbidade , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Texas/epidemiologia , Tuberculose/tratamento farmacológico
8.
MMWR Morb Mortal Wkly Rep ; 68(38): 813-818, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557149

RESUMO

Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.


Assuntos
Manufaturas/efeitos adversos , Indústria Manufatureira , Exposição Ocupacional/efeitos adversos , Silicose/diagnóstico , Adulto , California/epidemiologia , Colorado/epidemiologia , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Silicose/epidemiologia , Texas/epidemiologia , Washington/epidemiologia
9.
Parasit Vectors ; 12(1): 395, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395085

RESUMO

BACKGROUND: West Nile virus (WNV) is a mosquito-transmitted disease of birds that has caused bird population declines and can spill over into human populations. Previous research has identified bird species that infect a large fraction of the total pool of infected mosquitoes and correlate with human infection risk; however, these analyses cover small spatial regions and cannot be used to predict transmission in bird communities in which these species are rare or absent. Here we present a mechanistic model for WNV transmission that predicts WNV spread (R0) in any bird community in North America by scaling up from the physiological responses of individual birds to transmission at the level of the community. We predict unmeasured bird species' responses to infection using phylogenetic imputation, based on these species' phylogenetic relationships with bird species with measured responses. RESULTS: We focused our analysis on Texas, USA, because it is among the states with the highest total incidence of WNV in humans and is well sampled by birders in the eBird database. Spatio-temporal patterns: WNV transmission is primarily driven by temperature variation across time and space, and secondarily by bird community composition. In Texas, we predicted WNV R0 to be highest in the spring and fall when temperatures maximize the product of mosquito transmission and survival probabilities. In the most favorable months for WNV transmission (April, May, September and October), we predicted R0 to be highest in the "Piney Woods" and "Oak Woods & Prairies" ecoregions of Texas, and lowest in the "High Plains" and "South Texas Brush County" ecoregions. Dilution effect: More abundant bird species are more competent hosts for WNV, and predicted WNV R0 decreases with increasing species richness. Keystone species: We predicted that northern cardinals (Cardinalis cardinalis) are the most important hosts for amplifying WNV and that mourning doves (Zenaida macroura) are the most important sinks of infection across Texas. CONCLUSIONS: Despite some data limitations, we demonstrate the power of phylogenetic imputation in predicting disease transmission in heterogeneous host communities. Our mechanistic modeling framework shows promise both for assisting future analyses on transmission and spillover in heterogeneous multispecies pathogen systems and for improving model transparency by clarifying assumptions, choices and shortcomings in complex ecological analyses.


Assuntos
Doenças das Aves/transmissão , Aves/virologia , Culicidae/virologia , Modelos Biológicos , Febre do Nilo Ocidental/veterinária , Animais , Doenças das Aves/virologia , América do Norte/epidemiologia , Filogenia , Estações do Ano , Texas/epidemiologia , Febre do Nilo Ocidental/transmissão , Vírus do Nilo Ocidental/fisiologia
10.
Tex Med ; 115(8): e1, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381809

RESUMO

Much of the southern United States is characterized by unique social, structural, and political systems that may relate to increased stress and poor health outcomes for those living with HIV. Notably, research indicates that Texas has higher survival rates for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) than general southern trends, which might suggest that Texans living with HIV experience HIV-related stressors and coping strategies influential to health differently than those living elsewhere in the South. This study used grounded theory and semi-structured interviews to increase understanding of HIV-related stress in Texas. Participants (N=20) were 12 people living with HIV in Texas and 8 HIV-care providers in Texas. Results indicated 5 emergent stress-related themes: housing strain, substance use, limited financial abilities, relationship dynamics, and internal pressures and psychosocial resiliency. Results also highlighted some of the potentially unique ways in which this sample experienced these themes, which may relate to relatively better HIV-related outcomes in Texas. Overall, our findings deepen understanding of how people living with HIV in Texas may experience stress and inform potential approaches to HIV care elsewhere.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/psicologia , Estresse Psicológico/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Pesquisa Qualitativa , Estigma Social , Fatores Socioeconômicos , Texas/epidemiologia
11.
Parasitol Res ; 118(10): 2909-2918, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418111

RESUMO

Helminth parasites have been a popular research topic due to their global prevalence and adverse effects on livestock and game species. The Northern bobwhite (Colinus virginianus), a popular game bird in the USA, is one species subject to helminth infection and has been experiencing a decline of > 4% annually over recent decades. In the Rolling Plains Ecoregion of Texas, the eyeworm (Oxyspirura petrowi) and caecal worm (Aulonocephalus pennula) helminths are found to be highly prevalent in bobwhite. While there have been increasing studies on the prevalence, pathology, and phylogeny of the eyeworm and caecal worm, there is still a need to investigate the bobwhite immune response to infection. This study utilizes previously sequenced bobwhite cytokines and toll-like receptors to develop and optimize qPCR primers and measure gene expression in bobwhite intramuscularly challenged with eyeworm and caecal worm glycoproteins. For the challenge experiments, separate treatments of eyeworm and caecal worm glycoproteins were administered to bobwhite on day 1 and day 21. Measurements of primary and secondary immune responses were taken at day 7 and day 28, respectively. Using the successfully optimized qPCR primers for TLR7, IL1ß, IL6, IFNα, IFNγ, IL10, and ß-actin, the gene expression analysis from the challenge experiments revealed that there was a measurable immune reaction in bobwhite in response to the intramuscular challenge of eyeworm and caecal worm glycoproteins.


Assuntos
Doenças das Aves/imunologia , Colinus/imunologia , Glicoproteínas/imunologia , Spirurina/imunologia , Thelazioidea/imunologia , Animais , Doenças das Aves/parasitologia , Ceco/parasitologia , Colinus/parasitologia , Citocinas/biossíntese , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Texas/epidemiologia
12.
BMC Public Health ; 19(1): 1091, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409349

RESUMO

BACKGROUND: The United States appears to be in the midst of an opioid epidemic. National data indicate a rise in emergency department visits for opioid-related causes over the past decade. This data, while important in helping to explain the magnitude of the epidemic nationally offers only a glimpse of what can be expected to occur locally. The objective of this secondary data analysis was to describe the impact that opioid abuse, adverse events, poisoning, and dependence have on emergency department utilization for individuals who purchased health insurance under the Affordable Care Act in Central Texas from a community-based health maintenance organization. METHODS: Individuals who purchased health insurance from Sendero Health Plans in calendar years 2016, 2017, and 2018 were eligible for participation if they had both an emergency department encounter and an opioid-related ICD-10-CM diagnosis. Eligible individuals were assessed to determine if they were dispensed an opioid agonist or opioid antagonist prescription during the year of their emergency department encounter. Sendero medical claims data for calendar years 2016, 2017, and 2018 were used to calculate both the incidence and ratio of emergency department visits per 100,000-person Sendero member population. Sendero data were compared to available national data estimates. RESULTS: A total of 55 individuals had an emergency department encounter with a primary or secondary opioid-related diagnosis from January 1, 2016 through December 31, 2018. These 55 individuals had 69 unique emergency department encounters during this time period. The incidence of new claims per 100,000-member Sendero population was 67.1, 64.5, and 62.6 in 2016, 2017, and 2018 respectively. The ratio of unique emergency department encounters per 100,000-member Sendero population was 95.9, 82.6, and 66.5 in 2016, 2017, and 2018 respectively. CONCLUSION: Health insurance claims data from a community-based health plan can be used as a source of local information by policy makers and officials as they seek to address the impact of opioid abuse, adverse events, poisoning, and dependence in Central Texas as national data may not represent the local impact of this epidemic.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/envenenamento , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epidemias , Transtornos Relacionados ao Uso de Opioides/terapia , Adolescente , Adulto , Planejamento em Saúde Comunitária , Feminino , Humanos , Revisão da Utilização de Seguros , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Patient Protection and Affordable Care Act , Texas/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
PLoS One ; 14(7): e0218870, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276513

RESUMO

BACKGROUND: For the estimated 554,000 homeless individuals on any given night in the United States, obtaining quality sleep is often challenging. This group is known to have multiple health disparities, potentially affected by sleep problems; therefore, identifying lifestyle factors-such as physical activity-that are associated with improving both quality and quantity of sleep has important implications for public health. Here, we examine associations of physical activity with subjective sleep problems within a large sample of homeless adults. METHODS: Participants were homeless adults recruited from Dallas and Oklahoma (N = 747; 66.1% men, Mage = 43.7±12.1). Participants self-reported insufficient sleep (number of days without sufficient rest/sleep in the last month; categorized as 0, 1-13, 14-29, or ≥30 days), sleep duration (over average 24 hours; categorized as ≤6 [short sleeper], 7-9 [optimal sleeper], or ≥10 hours [long sleeper]), and unintentional daytime sleep (number of days with unintentional sleep in the last month; categorized as 0 vs ≥30 days). Physical activity was assessed subjectively using the BRFSS Physical Activity Questionnaire. Regression analyses were performed to examine the associations between physical activity and sleep problems, controlling for age, sex, race, education, body mass, months homeless, at-risk drinking, self-rated health, serious mental illness, smoking status, and recruitment city. RESULTS: Failure to meet/exceed physical activity guidelines was associated with higher likelihood of being a long sleeper (OR = 2.64, 95% CI: 1.46, 4.78) but a lower likelihood of having ≥30 days of insufficient rest/sleep (OR = 0.52, 95% CI: 0.29, 0.93). CONCLUSIONS: Findings suggest that physical activity promotion may hold promise for addressing the problem of too much sleep, but not other manifestations of sleep problems among this vulnerable group.


Assuntos
Exercício/fisiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Transtornos do Sono-Vigília/fisiopatologia , Sono/fisiologia , Adulto , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oklahoma/epidemiologia , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Autorrelato , Transtornos do Sono-Vigília/epidemiologia , Texas/epidemiologia
14.
Ann Surg Oncol ; 26(9): 2694-2702, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31264116

RESUMO

BACKGROUND: We previously reported a significant volume-outcome relationship in mortality rates after gastrectomies for gastric cancer patients in Texas (1999-2001). We aimed to identify whether changes in the volume distribution of gastrectomies occurred, whether volume-outcome relationships persisted, and potential changes in the factors influencing volume-outcome relationships. METHODS: We performed a population-based study using the Texas Inpatient Public Use Data File between 2010 and 2015. Hospitals were classified as high-volume centers (HVCs, > 15 cases per year), intermediate-volume centers (IVCs, 3-15 cases per year), and low-volume centers (LVCs, < 3 cases per year). We conducted multivariate analyses to evaluate factors associated with inpatient mortality and adverse events. RESULTS: We identified 2733 gastric cancer patients who underwent gastrectomy at 193 hospitals. Fewer hospitals performed gastrectomy than previously (193 vs. 214). There were more HVCs (5 vs. 2) and LVCs (142 vs. 134), but fewer IVCs (46 vs. 78). The proportion of patients who underwent gastrectomy at HVCs and LVCs increased, while the proportion at IVCs decreased. HVCs maintained lower in-hospital mortality rates than IVCs or LVCs, although mortality rates decreased in both LVCs and IVCs. In adjusted multivariate analyses, treatment at HVCs remained a strong predictor for lower rates of mortality (odds ratio [OR] 0.39, p = 0.019) and adverse events (OR 0.56, p = 0.013). CONCLUSION: Despite improvements, patient morbidity and mortality at LVCs and IVCs remain higher than at HVCs, demonstrating that volume-outcome relationships still exist for gastrectomy and that opportunities for improvement remain.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Gastrectomia/mortalidade , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Neoplasias Gástricas/mortalidade , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Texas/epidemiologia
16.
Tex Med ; 115(6): 22-29, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260547

RESUMO

Distorted death statistics inaccurately portray how people are dying, with significant public health implications. System changes and physician education could help.


Assuntos
Causas de Morte , Atestado de Óbito , Morte , Erros de Diagnóstico , Humanos , Saúde Pública , Texas/epidemiologia , Estatísticas Vitais
17.
Tex Med ; 115(7): 22-29, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334820

RESUMO

Measles - a deadly disease the U.S. Centers for Disease Control and Prevention (CDC) declared eradicated in America in 2000 - has made an unwelcome return in 2019. The anti-vaccine movement is weakening Texas' ability to withstand outbreaks, but there are still many things physicians can do to work with patients and communities to improve vaccination rates.


Assuntos
Surtos de Doenças , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacinação/estatística & dados numéricos , Movimento contra Vacinação , Humanos , Texas/epidemiologia , Estados Unidos
18.
J Helminthol ; 94: e65, 2019 Jul 23.
Artigo em Catalão | MEDLINE | ID: mdl-31331406

RESUMO

Helminths were examined from 145 scaled quail (Callipepla squamata) collected during the 2012-2013, 2013-2014 and 2014-2015 hunting seasons from a semi-arid region of Texas that spans four ecoregions. Helminth infracommunities were species poor, averaging 1.7 (range 1-4) species. Six species occurred within the component community of which one (Oxyspirura petrowi) is known to be pathogenic to quail. Aulonocephalus pennula was most abundant (9991 individuals, 95% of total) followed by O. petrowi (391 individuals, 4%). Each of the remaining four species was rare (≤21% prevalence) and contributed few individuals (<1%). In the High Plains ecoregion, prevalence of O. petrowi was higher in host collections made during the 2013-2014 hunting season than either hunting seasons 2012-2013 or 2014-2015 and was higher in the High Plains ecoregion than the Edwards Plateau ecoregion during the 2013-2014 hunting season. Mean abundance of A. pennula and O. petrowi was higher in scaled quail from the High Plains ecoregion than the Edwards Plateau ecoregion. Our results provide new information about helminth fauna in scaled quail, persistence of indirect lifecycle helminth species within a semi-arid region, and the occurrence of pathogenic helminth species within this host species.


Assuntos
Doenças das Aves/parasitologia , Helmintíase Animal/epidemiologia , Helmintos/classificação , Codorniz/parasitologia , Animais , Feminino , Helmintos/isolamento & purificação , Estágios do Ciclo de Vida , Prevalência , Texas/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-31344779

RESUMO

This paper presents a spatial analysis of the association between industrial benzene emissions and the 10-year incidence rates of cancers likely to be associated with benzene exposure (Lymphohematopoietic, lung and lip cancers) at the county level in Texas. The spatial distribution of incident cases of the above cancers between 2004 and 2013 was assessed at the county level and found to have positive spatial auto-correlation. Subsequently, point pattern analysis was performed on industrial emissions of benzene reported to the Toxic Release Inventory (TRI), revealing a non-random spatial pattern. Universal kriging was performed using the industrial emissions data to derive estimates of ambient benzene levels at the county level. An ordinary linear regression model was fitted using the incidence rates as the outcome and the estimated benzene level along with chosen covariates and the residuals were assessed for lingering spatial auto-correlation. As the residuals showed that spatial auto-correlation persists, a spatial conditional auto-regression (CAR) model was fitted instead. In the spatial CAR linear regression model, estimated levels of ambient benzene were not found to be significantly associated with the 10-year incidence rates of lymphohematopoietic, lung and lip cancers at the county level.


Assuntos
Poluentes Atmosféricos/análise , Benzeno/análise , Neoplasias/epidemiologia , Humanos , Incidência , Indústrias , Modelos Lineares , Análise Espacial , Texas/epidemiologia
20.
Surgery ; 166(6): 1099-1104, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31296429

RESUMO

BACKGROUND: Poor air quality has previously been associated with lung cancer development, but the risks associated with regional differences in air quality are poorly understood. We investigated the association of air quality indices with development of lung cancer in all Texas counties. METHODS: Lung cancer incidence, air quality indicators (particulate matter <2.5 µm, radon levels, oil well density), and known risk factors were obtained using data from the Texas Commission on Environmental Quality and the Texas Cancer Registry. Linear regression models were constructed to correlate air quality indicators with lung cancer incidence and advanced stage at diagnosis (stage III or IV), while controlling for other patient characteristics. RESULTS: Lung cancer incidence ranged from 27.6 to 103.4 cases per 100,000 people. In the study, 2.5 µm was associated with increased lung cancer incidence (ß = 4.38, P < .0001), but not radon levels (ß = -2.70, P = .41). Air quality indicators were not significantly associated with an advanced cancer diagnosis. CONCLUSION: There are wide differences in the incidence of lung cancer across Texas. These differences seem to be related to air quality. Identifying high-risk areas may help to guide strategies such as implementation of targeted lung cancer screening programs.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Neoplasias Pulmonares/epidemiologia , Material Particulado/análise , Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Detecção Precoce de Câncer/estatística & dados numéricos , Implementação de Plano de Saúde , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Estadiamento de Neoplasias , Material Particulado/efeitos adversos , Medição de Risco/métodos , Fatores de Risco , Fumar/epidemiologia , Texas/epidemiologia
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