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2.
MMWR Morb Mortal Wkly Rep ; 68(7): 177-180, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789880

RESUMO

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that can occur following prenatal exposure to opioids (1). NAS surveillance in the United States is based largely on diagnosis codes in hospital discharge data, without validation of these codes or case confirmation. During 2004-2014, reported NAS incidence increased from 1.5 to 8.0 per 1,000 U.S. hospital births (2), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes identified in hospital discharge data, without case confirmation. However, little is known about how well these codes identify NAS or how the October 1, 2015, transition from ICD-9-CM to the tenth revision of ICD-CM (ICD-10-CM) codes affected estimated NAS incidence. This report describes a pilot project in Illinois, New Mexico, and Vermont to use birth defects surveillance infrastructure to obtain state-level, population-based estimates of NAS incidence among births in 2015 (all three states) and 2016 (Illinois) using hospital discharge records and other sources (varied by state) with case confirmation, and to evaluate the validity of NAS diagnosis codes used by each state. Wide variation in NAS incidence was observed across the three states. In 2015, NAS incidence for Illinois, New Mexico, and Vermont was 3.0, 7.5, and 30.8 per 1,000 births, respectively. Among evaluated diagnosis codes, those with the highest positive predictive values (PPVs) for identifying confirmed cases of NAS, based on a uniform case definition, were drug withdrawal syndrome in a newborn (ICD-9-CM code 779.5; state range = 58.6%-80.2%) and drug withdrawal, infant of dependent mother (ICD-10-CM code P96.1; state range = 58.5%-80.2%). The methods used to assess NAS incidence in this pilot project might help inform other states' NAS surveillance efforts.


Assuntos
Anormalidades Congênitas/epidemiologia , Síndrome de Abstinência Neonatal/epidemiologia , Vigilância da População/métodos , Humanos , Illinois/epidemiologia , Recém-Nascido , New Mexico/epidemiologia , Vermont/epidemiologia
3.
AJR Am J Roentgenol ; 212(3): 706-711, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30673339

RESUMO

OBJECTIVE: The objective of our study was to determine whether detection rates of specific benign and malignant diagnoses differ for breast cancer screening with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM) alone. MATERIALS AND METHODS: We analyzed observational data from the Vermont Breast Cancer Surveillance System, including 86,349 DBT screening examinations and 97,378 FFDM screening examinations performed at eight radiology facilities in Vermont that adopted DBT screening during 2012-2016. We determined the most severe diagnosis made within 6 months after positive screening examinations. Multivariable-adjusted logistic regression was used to compare detection rates for specific diagnoses on DBT versus FFDM. RESULTS: Compared with FFDM, DBT had a lower recall rate (adjusted odds ratio [OR], 0.81; 95% CI, 0.77-0.85) but comparable biopsy rate (OR = 1.05; 95% CI, 0.93-1.17), benign biopsy rate (OR = 1.12; 95% CI, 0.97-1.29), and cancer detection rate (OR = 0.94; 95% CI, 0.78-1.14). Among benign diagnoses, DBT and FFDM had comparable detection rates for nonproliferative lesions (OR = 1.19; 95% CI, 0.92-1.53), fibroepithelial proliferations (OR = 1.24; 95% CI, 0.85-1.81), proliferative lesions without atypia (OR = 1.13; 95% CI, 0.90-1.42), atypical lesions (OR = 0.77; 95% CI, 0.43-1.38), and lobular carcinoma in situ (LCIS) (OR = 0.92; 95% CI, 0.53-1.61). Among malignant diagnoses, DBT and FFDM had comparable detection rates for ductal carcinoma in situ (OR = 1.05; 95% CI, 0.70-1.57) and invasive breast cancer (OR = 0.92; 95% CI, 0.74-1.13), with no statistically significant differences in detection of invasive ductal carcinoma (OR = 0.83; 95% CI, 0.66-1.06), invasive lobular carcinoma (OR = 1.11; 95% CI, 0.59-2.07), or invasive mixed ductal-lobular carcinoma (OR = 1.49; 95% CI, 0.65-3.39). CONCLUSION: Compared with FFDM, breast cancer screening with DBT has a lower recall rate while detecting a similar distribution of benign and malignant diagnoses.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Programas de Rastreamento/métodos , Adulto , Idoso , Biópsia , Neoplasias da Mama/epidemiologia , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Sistema de Registros , Vermont/epidemiologia
4.
Epidemiology ; 30(1): 154-159, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30299405

RESUMO

BACKGROUND: The 2003 revision of the US Standard Certificate of Live Birth (birth certificate) and Pregnancy Risk Assessment Monitoring System (PRAMS) are important for maternal weight research and surveillance. We examined quality of prepregnancy body mass index (BMI), gestational weight gain, and component variables from these sources. METHODS: Data are from a PRAMS data quality improvement study among a subset of New York City and Vermont respondents in 2009. We calculated mean differences comparing prepregnancy BMI data from the birth certificate and PRAMS (n = 734), and gestational weight gain data from the birth certificate (n = 678) to the medical record, considered the gold standard. We compared BMI categories (underweight, normal weight, overweight, obese) and gestational weight gain categories (below, within, above recommendations), classified by different sources, using percent agreement and the simple κ statistic. RESULTS: For most maternal weight variables, mean differences between the birth certificate and PRAMS compared with the medical record were less than 1 kg. Compared with the medical record, the birth certificate classified similar proportions into prepregnancy BMI categories (agreement = 89%, κ = 0.83); PRAMS slightly underestimated overweight and obesity (agreement = 84%, κ = 0.73). Compared with the medical record, the birth certificate overestimated gestational weight gain below recommendations and underestimated weight gain within recommendations (agreement = 81%, κ = 0.69). Agreement varied by maternal and pregnancy-related characteristics. CONCLUSIONS: Classification of prepregnancy BMI and gestational weight gain from the birth certificate or PRAMS was mostly similar to the medical record but varied by maternal and pregnancy-related characteristics. Efforts to understand how misclassification influences epidemiologic associations are needed.


Assuntos
Estatura , Peso Corporal , Confiabilidade dos Dados , Monitoramento Epidemiológico , Ganho de Peso na Gestação , Registros Médicos/normas , Resultado da Gravidez/epidemiologia , Adulto , Declaração de Nascimento , Índice de Massa Corporal , Feminino , Humanos , Recém-Nascido , Cidade de Nova Iorque , Gravidez , Medição de Risco , Vermont/epidemiologia
6.
Drug Alcohol Depend ; 189: 187-192, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30049531

RESUMO

BACKGROUND: Posttraumatic Stress Disorder (PTSD) and opioid misuse are commonly co-occurring disorders. Both disorders are associated with deficits in response inhibition; however, these associations have not considered their comorbidity. Response inhibition has not been examined in a sample with comorbid PTSD and opioid misuse. The present study examined the effect of PTSD symptom severity on response inhibition in current and past opioid misusers. METHODS: Participants were currently (used within the last month) misusing opioids (56.6%) or in recovery (43.4%). All participants met DSM 5 criteria for PTSD. Response inhibition was measured with the stop signal task. RESULTS: Response inhibition was associated with increased PTSD symptom severity for those in recovery but not among current users. Additionally, across both groups, there were deficits in response inhibition when withholding automatic responses for a threatening stimulus compared to a neutral stimulus. CONCLUSIONS: PTSD Symptoms may exert a stronger effect on response inhibition among those in recovery as opposed to those who are actively using opioids.


Assuntos
Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vermont/epidemiologia , Adulto Jovem
7.
Epidemiol Infect ; 146(15): 1977-1986, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29941066

RESUMO

In North America, the raccoon-associated variant of rabies virus (RRV) is of special concern, given its relatively rapid spread throughout the eastern USA and its potential public health impact due to high raccoon host densities in urban areas. Northward expansion of this epizootic included an outbreak in the Canadian province of Quebec in 2006-2009 due to trans-border spread from the State of Vermont. To inform a more proactive approach to future control efforts, this study uses phylogenetic analyses to explore the role of geography and alternative carnivore hosts in the dynamics of RRV spread within Vermont. Specifically, we sought to examine whether striped skunks, a species frequently infected by RRV, could be part of the maintenance host community. Whole genome sequencing of 160 RRV samples from Vermont and neighbouring US states were used for fine-scale phylogeographic analyses. Results, together with the complete surveillance record of raccoon rabies since its entry into Vermont in 1994, document incursions by two distinct viral lineages and identify topographical features of the landscape which have significantly influenced viral spread, resulting in a complex distribution pattern of viral variants throughout the state. Results of phylogenetic cluster analysis and discrete state reconstruction contained some evidence of skunk-to-skunk and skunk-to-raccoon transmission but overall failed to support a role for skunks as alternative maintenance hosts.


Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa , Vírus da Raiva/isolamento & purificação , Raiva/veterinária , Guaxinins , Zoonoses/epidemiologia , Animais , Análise por Conglomerados , Monitoramento Epidemiológico , Genótipo , Geografia , Mephitidae , Epidemiologia Molecular , Filogenia , Raiva/epidemiologia , Raiva/transmissão , Vírus da Raiva/classificação , Vírus da Raiva/genética , Análise de Sequência de DNA , Vermont/epidemiologia , Sequenciamento Completo do Genoma , Zoonoses/transmissão
8.
J Adolesc Health ; 62(6): 674-680, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29784113

RESUMO

PURPOSE: The objective of this study was to examine barriers to accessing and utilizing routine preventive health-care checkups for Vermont young adults. METHODS: A population-based analysis was conducted using aggregated data from the 2011-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys of Vermont young adults aged 18-25 years (N = 1,329). Predictors analyzed as barriers were classified county of residence, health-care coverage, and annual household income level, as well as covariates, with the outcome of the length of time since the last routine checkup. RESULTS: A total of 81.1% of Vermont young adults reported having a routine checkup in the past 2 years. Health-care coverage was a predictor of undergoing routine checkups within the past 2 years, with 85.2% of insured respondents undergoing checkups compared with 56.3% of uninsured respondents (p < .001). Additionally, 81.9% of respondents from Vermont counties classified as mostly rural reported undergoing a checkup within the past 2 years (p < .05). A total of 80.8% of respondents from the middle level (p < .05) and 89.0% of respondents from the highest level (p < .001) of annual household incomes reported undergoing a checkup in the past 2 years. Finally, age (p < .001) and sex (p < .01) were shown to indicate receipt of routine preventive checkups more often. CONCLUSIONS: For Vermont young adults, health-care coverage, classified county of residence, and household income level were shown to be indicators of undergoing routine preventive health care more often. Further investigation is needed to examine how these barriers may impede preventive screenings, thereby contributing to the ongoing development of health-care guidelines and policies for young adults in rural settings.


Assuntos
Acesso aos Serviços de Saúde , Cobertura do Seguro/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Estudos Transversais , Feminino , Humanos , Masculino , Vigilância da População , Distribuição por Sexo , Fatores Socioeconômicos , Vermont/epidemiologia , Adulto Jovem
9.
J Wildl Dis ; 54(4): 790-801, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29792757

RESUMO

In the US, rabies virus (RV) has been enzootic in raccoons ( Procyon lotor) since the late 1940s. Oral rabies vaccination (ORV) was implemented in the 1990s to halt the spread of raccoon RV and continues to be used as a wildlife management tool. Our objective was to evaluate a recombinant human adenovirus-rabies virus glycoprotein vaccine in northern New York, Vermont, and New Hampshire over a 3-yr period, using changes in RV neutralizing antibody (RVNA) seroprevalence in raccoon populations as an immunologic index of ORV impact. Vaccine baits were distributed at 75 baits/km2 and 750-m flight-line spacing in the study area. Animal sampling occurred during 10-d intervals pre- and post-ORV during 2012-14 within eight study cells: four northern cells had a history of ORV with a different vaccine for 3 or more years prior and four southern cells were ORV naive. Baseline raccoon RVNA seroprevalence was 27.3% ( n=1,079, 95% confidence interval [CI]: 24.8-30.1) before ORV in 2012. Raccoon RVNA seroprevalence averaged 68.5% ( n=1,551, 95% CI: 66.2-70.8) post-ORV during the 3-yr study. The RVNA seroprevalence levels in this study were considered to be adequate for stopping raccoon RV transmission and supported and expanded the results from a West Virginia field trial, as well as earlier evaluations along the Canada-US border.


Assuntos
Anticorpos Antivirais/sangue , Vacinas Antirrábicas/imunologia , Raiva/veterinária , Guaxinins , Vacinação/veterinária , Administração Oral , Animais , Animais Selvagens/imunologia , Biomarcadores , Feminino , Masculino , New Hampshire/epidemiologia , New York/epidemiologia , Raiva/epidemiologia , Raiva/prevenção & controle , Vacinas Antirrábicas/administração & dosagem , Estudos Soroepidemiológicos , Vacinação/métodos , Vermont/epidemiologia
10.
J Community Health ; 43(4): 731-737, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29427129

RESUMO

This study examines trends in age-adjusted incidence rates of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) in comparison to oral cavity proper squamous cell carcinoma (OSCC) in the population of Vermont from 1999 to 2013. Data on cases of oral and pharynx cancers diagnosed in Vermont between 1999 and 2013 were obtained from the Vermont cancer registry. The age-adjusted incidence rates and annual percentage change of HPV-related OPSCC and OSCC were calculated using Joinpoint trend analysis. Four hundred and thirty-one cases of HPV-related OPSCC were diagnosed from 1999 to 2013. Males constituted 83% (P < 0.0001) of the cases and the 6th decade of life marked the highest incidence. The overall age-adjusted incidence rates for HPV-related OPSCC significantly increased (from 2.39 to 3.86 per 100,000, P < 0.0001). In males, it significantly increased (from 3.62 to 6.93 per 100,000, P < 0.0001), while in females it remained stable (from 1.18 to 1.02 per 100,000, P = 0.28) during 1999-2013. The average rate of HPV-related OPSCC significantly increased by 4.4% annually (P = 0.004). In males the average rate significantly increased by 5.3% annually (P = 0.001) and in females the rate increased by 0.37% annually (P = 0.87). In contrast, age-adjusted overall incidence rates for OSCC significantly decreased (from 3.99 to 3.35 per 100,000, P = 0.018). The overall rate of OSCC decreased by 0.96% annually (P = 0.37) and the highest incidence of cases was in the 7th decade of life. In conclusion, there was an increasing trend of HPV-related OPSCC, specifically in males, and there appears to be a decreasing trend of OSCC in Vermont.


Assuntos
Neoplasias Orofaríngeas/epidemiologia , Infecções por Papillomavirus/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Sistema de Registros , Fatores Sexuais , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Vermont/epidemiologia , Adulto Jovem
11.
Am J Clin Pathol ; 149(3): 234-240, 2018 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-29425271

RESUMO

Objectives: Lyme disease (LD) incidence is increasing, but data suggest some clinicians are not fully aware of recommended procedures for ordering and interpreting diagnostic tests. The study objective was to assess clinicians' knowledge and practices regarding LD testing in a high-incidence region. Methods: We distributed surveys to 1,142 clinicians in the University of Vermont Medical Center region, of which 144 were completed (12.6% response rate). We also examined LD laboratory test results and logs of calls to laboratory customer service over a period of 2.5 years and 6 months, respectively. Results: Most clinicians demonstrated basic knowledge of diagnostic protocols, but many misinterpreted Western blot results. For example, 42.4% incorrectly interpreted a positive immunoglobulin M result as an overall positive test in a patient with longstanding symptoms. Many also reported receiving patient requests for unvalidated tests. Conclusions: Additional education and modifications to LD test ordering and reporting systems would likely reduce errors and improve patient care.


Assuntos
Competência Clínica , Erros de Diagnóstico/estatística & dados numéricos , Doença de Lyme/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Incidência , Doença de Lyme/epidemiologia , Masculino , Pessoa de Meia-Idade , Vermont/epidemiologia
12.
J Rural Health ; 34(4): 396-400, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29119681

RESUMO

PURPOSE: Rural residents are significantly more likely to be overweight and obese than are urban residents. However, few data have compared weight control program responses in these population groups. Therefore, the primary aim of this study was to evaluate the weight loss outcomes of participants in a multisite, online behavioral intervention by residential location (rural vs urban) and, second, assess any possible differences in adherence to treatment goals. METHODS: A total of 492 adult participants (mean BMI = 35.7 kg/m2 ; 90% female; 24% minority) were categorized based on their home ZIP code and the 2010 US Census Urban and Rural Classification criteria (58.3% rural; 41.7% urban). Weight (kg) was measured in-person at baseline and 6 months after participating in a behavioral weight control intervention. Adherence to physical activity and calorie and fat intake goals was assessed based on weekly self-monitoring journals. Weekly online chat attendance and completion of weekly online self-monitoring journals were recorded. Presence of obesogenic foods in the home was self-reported at baseline and 6 months. FINDINGS: There were no statistically significant differences in weight loss between rural and urban participants (-6.1 kg vs -5.3 kg, P = .16), nor were there differences in chat attendance, self-monitoring journals, self-reported physical activity, calorie intake, or obesogenic foods reported in the household. CONCLUSIONS: Overall, there was no difference in weight loss and adherence to treatment goals for rural and urban participants. Further research on rural and urban residents is necessary to explore the factors responsible for the disparity in obesity prevalence.


Assuntos
População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Perda de Peso , Adulto , Análise de Variância , Arkansas/epidemiologia , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Obesidade/epidemiologia , Obesidade/psicologia , Sobrepeso/classificação , Sobrepeso/epidemiologia , Sobrepeso/psicologia , Inquéritos e Questionários , Vermont/epidemiologia
13.
Arch Pathol Lab Med ; 141(11): 1523-1528, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28795842

RESUMO

CONTEXT: - Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. OBJECTIVES: - To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. DESIGN: - All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. RESULTS: - A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. CONCLUSIONS: - In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/anormalidades , Mama/patologia , Detecção Precoce de Câncer/métodos , Hipertrofia/cirurgia , Mamoplastia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Mama/crescimento & desenvolvimento , Mama/cirurgia , Carcinoma de Mama in situ/complicações , Carcinoma de Mama in situ/diagnóstico , Carcinoma de Mama in situ/epidemiologia , Carcinoma de Mama in situ/patologia , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/complicações , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/epidemiologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Seguimentos , Humanos , Hiperplasia , Hipertrofia/complicações , Incidência , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Estudos Prospectivos , Fatores de Risco , Vermont/epidemiologia , Adulto Jovem
14.
Resuscitation ; 118: 75-81, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28713042

RESUMO

BACKGROUND: Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile. OBJECTIVE: The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system. METHODS: A retrospective cohort study was conducted using the statewide EMS electronic patient care report system. Cases were identified by searching for any incident that had a primary impression of "cardiac arrest" or a primary symptom of "cardiorespiratory arrest" or "death." Data were collected from the two years prior to and following implementation of the BLS-TOR rule from January 1, 2012 through March 31, 2016. RESULTS: There were 702 OHCA cases were identified, with 329 cases meeting inclusion criteria. The transport rate was 91.1% in the pre-intervention group compared with 69.4% in the post-intervention group (χ2=24.8; p<0.001). EMS compliance rate with the BLS-TOR rule was 66.7%. Of the 265 patients transported during the study, 87 patients met (post-intervention group; n=22) or retrospectively met (pre-intervention group; n=65) the BLS-TOR requirements for field termination of resuscitation. None of these patients survived to hospital discharge. CONCLUSION: Rural EMS systems may benefit from implementation and utilization of the universal BLS-TOR rule.


Assuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Futilidade Médica , Parada Cardíaca Extra-Hospitalar/terapia , Serviços de Saúde Rural/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Suspensão de Tratamento/normas , Protocolos Clínicos , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Retrospectivos , População Rural , Resultado do Tratamento , Vermont/epidemiologia
15.
Addict Behav ; 70: 18-22, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28161618

RESUMO

Little work has focused on the underlying mechanisms that may link financial strain and smoking processes. The current study tested the hypothesis that financial strain would exert an indirect effect on cognitive-based smoking processes via depressive symptoms. Three clinically significant dependent variables linked to the maintenance of smoking were evaluated: negative affect reduction motives, negative mood abstinence expectancies, and perceived barriers for quitting. Participants included 102 adult daily smokers (Mage=33.0years, SD=13.60; 35.3% female) recruited from the community to participate in a self-guided (unaided; no psychological or pharmacological intervention) smoking cessation study. Results indicated that depressive symptoms explain, in part, the relation between financial strain and smoking motives for negative affect reduction, negative mood abstinence expectancies, and perceived barriers for quitting. Results indicate that smoking interventions for individuals with high levels of financial strain may potentially benefit from the addition of therapeutic tactics aimed at reducing depression.


Assuntos
Cognição , Transtorno Depressivo/epidemiologia , Motivação , Fumar/epidemiologia , Estresse Psicológico/economia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/psicologia , Estresse Psicológico/psicologia , Texas/epidemiologia , Vermont/epidemiologia , Adulto Jovem
16.
Occup Environ Med ; 74(3): 211-217, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27821675

RESUMO

OBJECTIVE: To understand why 2 studies relating crystalline silica exposure to lung-cancer mortality in Vermont granite workers yielded conflicting results. METHODS: Data used in the 2 studies were linked to identify discrepancies. Mortality data and employment histories from the earlier study were revised based on data obtained in the later study. SMR were computed and Poisson regressions corresponding to those in the earlier study were performed using the original and revised data. Analyses were repeated with the addition of workers omitted from the earlier study. RESULTS: After correction of incomplete mortality and employment information in the original data, the overall SMR for the cohort in the earlier study increased from 1.17 (95% CI 1.03 to 1.36) to 1.39 (95% CI 1.22 to 1.59), and was similar to the SMR of 1.37 observed in the later study (95% CI 1.23 to 1.52). The exposure-response relationship was attenuated, particularly when person-years in all exposure categories were included in the analysis. Inclusion of additional workers had a smaller impact on the SMRs but further attenuated the exposure-response relationship. CONCLUSIONS: Differing results from the 2 studies are partly attributable to incomplete vital status and work history information used in the earlier study, as well as differences in cohort inclusion criteria. However, differences in length of follow-up and other factors likely play a larger role.


Assuntos
Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Dióxido de Silício/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Viés , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Vermont/epidemiologia
17.
J Cardiopulm Rehabil Prev ; 37(2): 103-110, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28033166

RESUMO

PURPOSE: Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality rates following a major cardiac event. Although a dose-response relationship between the number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study, we examined associations between the number of sessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES). METHODS: Multiple logistic regression and classification and regression tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and the number of sessions completed in a prospectively collected CR clinical database (n = 1658). RESULTS: Current smoking, lower SES, nonsurgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (ie, risk profiles) predict the number of sessions completed. Those with the highest-risk profile for nonadherence (<65 years old, current smoker, lower SES) completed on average 9 sessions while those with the lowest-risk profile (>72 years old, not current smoker, higher SES, surgical diagnosis) completed 27 sessions on average. CONCLUSIONS: Younger individuals, as well as those who report smoking or economic challenges or have a nonsurgical diagnosis, may require additional support to maintain CR session attendance.


Assuntos
Reabilitação Cardíaca/estatística & dados numéricos , Terapia por Exercício/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Vermont/epidemiologia
18.
J Oncol Pract ; 12(9): e848-57, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27577620

RESUMO

PURPOSE: In the rural United States, there are multiple potential barriers to the timely initiation of chemotherapy. The goal of this study was to identify factors associated with delays in the time from initial diagnosis to first systemic therapy (TTC) among women with breast cancer in Vermont. METHODS: Using data from the Vermont Cancer Registry, we explored TTC for 702 female Vermont residents diagnosed with stage I to III breast cancer between 2006 and 2010 who received adjuvant chemotherapy. Multivariable linear regression was used to evaluate the associations between TTC and patient, tumor, treatment, and geographic variables. RESULTS: Mean TTC was 10.2 weeks. Longer drive time (P < .001), more invasive surgery (P = .01), and breast reconstruction (P < .001) were each associated with longer TTC. Each additional 15 minutes of drive time was associated with a 0.34-week (95% CI, 0.22 to 0.46 weeks) increase in TTC. Participants age younger than 65 years whose primary payer was Medicare (n = 27) had significantly longer average TTC, by 2.37 weeks (P = .001), compared with those with private or military insurance. There was also substantial variation in TTC across hospitals (P < .001). CONCLUSION: Most female patients with stage I to III breast cancer in Vermont are receiving adjuvant chemotherapy within the National Comprehensive Cancer Network-recommended timeframe; however, improvements remain needed for certain subgroups. Novel approaches for women with long drive times need to be developed and evaluated in the community. Variation in TTC by hospital, even after adjusting for patient, tumor, and treatment factors, also suggests opportunities for process improvement.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Antineoplásicos/uso terapêutico , Neoplasias da Mama/epidemiologia , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Vermont/epidemiologia
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