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1.
J Am Board Fam Med ; 34(6): 1189-1202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34772774

RESUMO

BACKGROUND: Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic. METHODS: We surveyed 1622 primary care practices to understand organizational characteristics, scope of care, capacity, and organizational stress. RESULTS: Practices (484) varied in type, ownership, location, and care for medically underserved and diverse patient populations. Most practices accepted uninsured and Medicaid patients. Practices reported a broad scope of care, including offering behavioral health and medication-assisted therapy for opioid addiction. Over half addressed social needs like transportation and unstable housing. One in three practices experienced a significant stress in 2019, prepandemic, and only 18.8% of practices anticipated a stress in 2020. CONCLUSIONS: Primary care serves as the foundation of our health care system and is an essential service, but it is severely stressed, under-resourced, and overburdened in the best of times. Primary care needs strategic workforce planning, adequate access to resources, and financial investment to sustain its value and innovation.


Assuntos
COVID-19 , Pandemias , Acesso aos Serviços de Saúde , Humanos , Medicaid , Atenção Primária à Saúde , SARS-CoV-2 , Estados Unidos , Virginia
2.
J Environ Manage ; 300: 113823, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34649318

RESUMO

Forested wetland soils within the Piedmont and Coastal Plain physiographic provinces of Northern Virginia (NOVA) were investigated to determine the utility of a handheld colorimeter, the Nix Pro Color Sensor ("Nix"), for predicting carbon contents (TC) and stocks (TC stocks) from on-site color measurements. Both the color variables recorded with each Nix scan ("Nix color variables"; n = 15) and carbon contents significantly differed between sites, with redder soils (higher a and h) at Piedmont sites, and higher TC at sites with darker soils (lower values of L, or lightness; p < 0.05). Nix-carbon correlation analysis revealed strong relationships between L (lightness), X (a virtual spectral variable), R (additive red), and KK (black) and log-transformed TC (Ln[TC]; |r| = 0.70; p < 0.01 for all). Simple linear regressions were conducted to identify how well these four final Nix variables could predict soil carbon. Using all color measurements, about 50% of Ln(TC) variability could be explained by L, X, R, or KK (p < 0.01), yet with higher predictive power obtained for Coastal Plain soils (0.55 < R2 < 0.65; p < 0.01). Regression model strength was maximized between Ln(TC) and the four final Nix variables using simple linear regressions when color measurements observed at a specific depth were first averaged (0.66 < R2 < 0.70; p < 0.01). While further study is warranted to investigate Nix applicability within various soil settings, these results demonstrate potential for the Nix and its soil color measurements to assist with rapid field-based assessments of soil carbon in forested wetlands.


Assuntos
Solo , Áreas Alagadas , Carbono/análise , Florestas , Virginia
4.
BMC Public Health ; 21(1): 1908, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674672

RESUMO

BACKGROUND: Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities. METHODS: County- and city-level cross-sectional data for 2011-2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression. RESULTS: For incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region. CONCLUSIONS: Rurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.


Assuntos
Neoplasias Colorretais , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Humanos , Fatores Socioeconômicos , Análise Espacial , Estados Unidos/epidemiologia , Virginia/epidemiologia
6.
Ticks Tick Borne Dis ; 12(6): 101822, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34555712

RESUMO

Epidemiological data often include characteristics such as spatial and/or temporal dependencies and excess zero counts, which pose modeling challenges. Excess zeros in such data may arise from imperfect detection and/or relative rareness of the disease in a given location. Here, we studied the spatio-temporal variation in annual Lyme disease cases in Virginia from 2001-2016 and modeled the disease with a spatio-temporal hierarchical Bayesian model. Using observed ecological and environmental covariates, we constructed a predictive model for the disease spread over space and time, including spatial and temporal random effects. We considered several different models and found that the negative binomial hurdle model performs the best for such epidemiological data. Among the various ecological predictors, the North-South (V component) of winds and relative humidity significantly contributed to predicting the Lyme cases. Our model results provide important insights on the spread of the disease in Virginia and the proposed modeling framework offers epidemiologists and health policymakers a useful tool for improving disease preparedness and control plans for the future.


Assuntos
Doença de Lyme/epidemiologia , Humanos , Doença de Lyme/transmissão , Modelos Estatísticos , Análise Espaço-Temporal , Virginia/epidemiologia
7.
Am J Public Health ; 111(10): 1772-1775, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529449

RESUMO

Rapid identification and management of students with COVID-19 symptoms, exposure, or disease are critical to halting disease spread and protecting public health. We describe the interdisciplinary isolation and quarantine program of a large, public university, the University of Virginia, Charlottesville. The program provided students with wraparound services, including medical, mental health, academic, and other support services during their isolation or quarantine stay. The program successfully accommodated 844 cases during the fall 2020 semester, thereby decreasing exposure to the rest of the university and the local community. (Am J Public Health. 2021;111(10):1772-1775. https://doi.org/10.2105/AJPH.2021.306424).


Assuntos
COVID-19/prevenção & controle , Quarentena/psicologia , Isolamento Social/psicologia , Estudantes/psicologia , Universidades/organização & administração , COVID-19/diagnóstico , COVID-19/transmissão , Teste de Ácido Nucleico para COVID-19 , Feminino , Humanos , Masculino , Pandemias , Equipe de Assistência ao Paciente , SARS-CoV-2 , Apoio Social , Virginia
9.
Emerg Infect Dis ; 27(9): 2459-2461, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34424178

RESUMO

A patient in Virginia, USA, who had previously undergone multiple kidney transplantations showed signs of Bordetella hinzii bacteremia and meningitis. This emerging pathogen has been increasingly identified as a clinically significant pathogen in immunosuppressed and, less frequently, immunocompetent patients. This patient was treated and recovered without further issue.


Assuntos
Bordetella , Transplante de Rim , Meningite , Humanos , Transplante de Rim/efeitos adversos , Virginia/epidemiologia
10.
Vaccine ; 39(38): 5385-5390, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34384637

RESUMO

Significant variation in human papillomavirus (HPV) vaccine coverage exists across the United States. A closer look at state and region-specific coverage is necessary to identify potentially modifiable disparities. Using ArcGIS software, we identify geospatial variation in HPV vaccine coverage in the state of Virginia and examine the relationship between various socio-demographic indicators and HPV vaccination uptake. HPV vaccination rates among adolescents 11 to 17 years as of 07/01/2018 were retrieved at the zip-code level from the Virginia Immunization Information System and chloropleth maps produced. The ArcGIS Hot Spot Analysis tool identified spatial clusters of zip codes with high and low vaccination rates. Population characteristics and socioeconomic indicators were retrieved from the 2010 United States Census and compared between statistically significant clusters of higher or lower than expected vaccination rates. Regions with significantly lower initiation rates were less populated, less educated, and had a lower median household income (MHI) with higher rates of poverty and unemployment. Among male adolescents, these areas had a significantly lower density of primary care providers and smaller African American and Hispanic populations. In contrast, regions with significantly lower series completion were more populated and had a higher MHI, but there was no difference in provider density or minority population. Ultimately, regional socioeconomic indicators are significant predictors of HPV vaccination, but have contrasting implications for series initiation and completion. Targeted interventions and safety net programs have traditionally focused on the socioeconomically disadvantaged, however it is the more affluent communities that may be struggling with series completion.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adolescente , Demografia , Humanos , Masculino , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Estados Unidos , Vacinação , Virginia
11.
Rural Remote Health ; 21(3): 6620, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34428915

RESUMO

INTRODUCTION: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes self-management programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. METHODS: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. RESULTS: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. CONCLUSION: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia's CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.


Assuntos
Diabetes Mellitus Tipo 2 , População Rural , Adulto , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Humanos , Estilo de Vida , Virginia
12.
Commun Biol ; 4(1): 872, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34354222

RESUMO

The diversity and dominant bacterial taxa in the vagina are reported to be influenced by multiple intrinsic and extrinsic factors, including but not limited to pregnancy, contraceptive use, pathogenic states, socioeconomic status, and ancestry. However, the extent to which host genetic factors influence variation in the vaginal microbiota is unclear. We used a biometrical genetic approach to determine whether host genetic factors contribute to inter-individual differences in taxa from a sample of 332 twins who self-identified as being of African (44 pairs) or European ancestry (122 pairs). Lactobacillus crispatus, a major determinant of vaginal health, was identified as heritable among European American women (narrow-sense heritability = 34.7%, P-value = 0.018). Heritability of L. crispatus is consistent with the reduced prevalence of adverse reproductive disorders, including bacterial vaginosis and preterm birth, among women of European ancestry.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hereditariedade , Lactobacillus crispatus/fisiologia , Microbiota , Vagina/microbiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Virginia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-34281057

RESUMO

About 8% of the Americans contract influenza during an average season according to the Centers for Disease Control and Prevention in the United States. It is necessary to strengthen the early warning for influenza and the prediction of public health. In this study, Spatial autocorrelation analysis and spatial scanning analysis were used to identify the spatiotemporal patterns of influenza-like illness (ILI) prevalence in the United States, during the 2011-2020 transmission seasons. A seasonal autoregressive integrated moving average (SARIMA) model was constructed to predict the influenza incidence of high-risk states. We found the highest incidence of ILI was mainly concentrated in the states of Louisiana, District of Columbia and Virginia. Mississippi was a high-risk state with a higher influenza incidence, and exhibited a high-high cluster with neighboring states. A SARIMA (1, 0, 0) (1, 1, 0)52 model was suitable for forecasting the ILI incidence of Mississippi. The relative errors between actual values and predicted values indicated that the predicted values matched the actual values well. Influenza is still an important health problem in the United States. The spread of ILI varies by season and geographical region. The peak season of influenza was the winter and spring, and the states with higher influenza rates are concentrated in the southeast. Increased surveillance in high-risk states could help control the spread of the influenza.


Assuntos
Influenza Humana , District of Columbia , Humanos , Incidência , Influenza Humana/epidemiologia , Louisiana , Mississippi , Estações do Ano , Análise Espaço-Temporal , Estados Unidos/epidemiologia , Virginia
14.
J Sch Health ; 91(9): 678-682, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34287893

RESUMO

BACKGROUND: In-school transmission of COVID-19 among K-12 students is low when mitigation layers are used, but the risk of acquiring COVID-19 during school bus transportation is not well defined. Given the operational limitations of many school districts, more data is needed to determine what mitigation is required to keep COVID-19 transmission low during bus transport. METHODS: An independent school in Virginia monitored 1154 students in grades 1 to 12 with asymptomatic PCR testing every 2 weeks from August 24, 2020 to March 19, 2021, during the highest community transmission. Fifteen buses served 462 students while operating at near capacity of 2 students in every seat, using a physical distancing minimum of 2.5 ft, universal masking, and simple ventilation techniques. RESULTS: A total of 39 individuals were present on buses during their COVID-19 infectious period, which resulted in the quarantine of 52 students. Universal testing and contact tracing revealed no transmission linked to bus transportation. CONCLUSIONS: This study demonstrates a model for the safe operation of school buses while near capacity. COVID-19 transmission can be low during student transport when employing mitigation including simple ventilation, and universal masking, at minimal physical distances and during the highest community transmission.


Assuntos
COVID-19 , Viagem , COVID-19/transmissão , Controle de Doenças Transmissíveis , Humanos , Instituições Acadêmicas , Estudantes , Virginia/epidemiologia
15.
Ticks Tick Borne Dis ; 12(5): 101773, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34229999

RESUMO

Understanding the abiotic and biotic variables affecting tick populations is essential for studying the biology and health risks associated with vector species. We conducted a study on the phenology of exotic Haemaphysalis longicornis (Asian longhorned tick) at a site in Albemarle County, Virginia, United States. We also assessed the importance of wildlife hosts, habitats, and microclimate variables such as temperature, relative humidity, and wind speed on this exotic tick's presence and abundance. In addition, we determined the prevalence of infection with selected tick-borne pathogens in host-seeking H. longicornis. We determined that the seasonal activity of H. longicornis in Virginia was slightly different from previous studies in the northeastern United States. We observed nymphal ticks persist year-round but were most active in the spring, followed by a peak in adult activity in the summer and larval activity in the fall. We also observed a lower probability of collecting host-seeking H. longicornis in field habitats and the summer months. In addition, we detected H. longicornis on several wildlife hosts, including coyote (Canis latrans), eastern cottontail (Sylvilagus floridanus), raccoon (Procyon lotor), Virginia opossum (Didelphis virginiana), white-tailed deer (Odocoileus virginianus), woodchuck (Marmota monax), and a Peromyscus sp. mouse. This latter record is the first detection of a larval H. longicornis on a North American rodent host important to the enzootic maintenance of tick-borne pathogens of humans and animals. Finally, we continued to detect the exotic piroplasm parasite, Theileria orientalis Ikeda, in H. longicornis as well as other pathogens, including Rickettsia felis, Anaplasma phagocytophilum (AP-1), and a Hepatozoon sp. previously characterized in Amblyomma americanum. These represent some of the first detections of arthropod-borne pathogens native to the United States in host-seeking H. longicornis. These data increase our understanding of H. longicornis biology in the United States and provide valuable information into the future health risks associated with this tick and pathogens.


Assuntos
Ecossistema , Interações Hospedeiro-Parasita , Interações Hospedeiro-Patógeno , Ixodidae , Animais , Feminino , Ixodidae/crescimento & desenvolvimento , Ixodidae/microbiologia , Ixodidae/parasitologia , Ixodidae/fisiologia , Larva/crescimento & desenvolvimento , Larva/microbiologia , Larva/parasitologia , Larva/fisiologia , Masculino , Ninfa/crescimento & desenvolvimento , Ninfa/microbiologia , Ninfa/parasitologia , Ninfa/fisiologia , Estações do Ano , Virginia
16.
Transplant Cell Ther ; 27(10): 869.e1-869.e9, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34224915

RESUMO

Allogeneic hematopoietic cell transplantation (HCT) is a standard therapy for patients with intermediate to high-risk acute myeloid leukemia (AML) and is associated with improved long-term disease-free survival. Disparity exists in access to HCT among different patient populations and requires further study. In this study, we compared HCT rates for AML among different regions in the state of Virginia and identified geographic and socioeconomic factors associated with the likelihood of receiving HCT. We conducted a retrospective, cohort study of patients 18 to 74 years of age diagnosed with AML in Virginia from 2013 to 2017 as reported to the Virginia Cancer Registry (VCR); the VCR was further linked with the Center for International Blood and Marrow Transplant Research database for identification of patients who had undergone HCT within 2 years of diagnosis. Socioeconomic data were generated from the VCR and the American Community Survey. Univariate and multivariable logistic regression models were used to examine selected socioeconomic factors of interest, including patient-level information such as sex, age, race, marital status, and primary insurance payer, as well as factors associated with geography, including the Social Vulnerability Index (SVI) and percentage of African Americans residing in the region. In Virginia, 818 patients were diagnosed with AML from 2013 to 2017, and, of these, 168 patients (21%) underwent HCT within 2 years of diagnosis. Median age was lower in the HCT cohort (55 years) versus the non-HCT cohort (64 years) (P < .001). There was a higher proportion of married patients in the HCT cohort (67%) versus the non-HCT cohort (53%) (P = .005). The rate of HCT varied by geographic region (P = .004). The multivariable analyses (without including SVI) showed decreased likelihood of HCT with increasing age (odds ratio [OR], .96; 95% confidence interval [CI], .95 to .98). Patients from regions that had a greater than 25% African American population were less likely to undergo HCT (OR, .58; 95% CI, .38 to .89). Patients who were not married were less likely to undergo HCT compared with married patients (OR, .56; 95% CI, .36 to .88). Patients with government-sponsored insurance as the primary payer were less likely to undergo HCT compared with patients with private insurance (OR, .49; 95% CI, .32 to .77). Patients living in Zip Code areas with a greater percentage of population with a bachelor's or graduate degree were more likely to undergo HCT (OR, 1.02; 95% CI, 1.00 to 1.03). In a separate multivariate model with SVI, patients residing in a Zip Code with higher SVI were less likely to undergo HCT (OR, .37; 95% CI, .16 to .82). From 2013 to 2017, we found that the likelihood of a patient undergoing HCT in Virginia for AML within 2 years of diagnosis was negatively associated with increasing age, percent of African Americans residing in the region, not-married relationship status, government-sponsored insurance as primary payer, higher SVI, and decreased percent of population with a bachelor's or graduate degree. Resources should be directed toward at-risk patient populations to remove barriers to improve access to HCT. The SVI can be used to identify communities at risk nationwide.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda , Pré-Escolar , Estudos de Coortes , Humanos , Leucemia Mieloide Aguda/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Virginia/epidemiologia
17.
BMC Public Health ; 21(1): 1100, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107896

RESUMO

BACKGROUND: In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to apply a unique industry-inspired marketing approach to promote fruit and vegetable sales and intake to moms and teens in two US pilot markets: Fresno, California and Hampton Roads, Virginia. The aims of this cross-sectional study were to: 1) assess brand awareness and fruit- and vegetable-related outcomes among FNV Campaign target audiences in the California and Virginia market locations; and 2) examine whether reported awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related cognitive and behavioral outcomes. METHODS: Data for this cross-sectional study were collected using an online survey administered to a non-probability convenience sample (n = 1604; February-July 2017) of youth aged 14-20 years (n = 744) and moms aged 21-36 years (n = 860) in the two pilot markets. Descriptive statistics were computed and outcomes compared between unaware and aware respondents, controlling for sociodemographic covariates. Multivariate analysis of covariance (MANCOVA) was conducted to assess whether fruit- and vegetable-related attitude, belief, and encouragement outcomes differed by FNV Campaign awareness; logistic regression was used to examine associations between FNV brand awareness and dichotomous variables (fruit- and vegetable-related behavioral intentions, trying new fruits and vegetables); and ANCOVA was used to assess associations with daily fruit and vegetable intake frequency. RESULTS: Approximately 20% (n = 315/1604) of respondents reported awareness of the FNV Campaign. Youth that reported awareness of the FNV Campaign (n = 167, 22.4%) had higher intentions to buy (p = 0.003) and eat (p = 0.009) fruits and vegetables than unaware respondents. Mothers that reported awareness of the FNV Campaign (n = 148, 17.2%) reported greater encouragement for friends and family to eat fruits and vegetables (p = 0.013) and were approximately 1.5 times more likely to report trying a new fruit or vegetable (p = 0.04) than mothers unaware of the Campaign. Daily fruit and vegetable intake frequency did not differ by Campaign awareness. CONCLUSIONS: FNV Campaign awareness was associated with limited but positive short- and intermediate-term cognitive and behavioral outcomes among target audience respondents. These findings can inform future research to enhance understanding and improve the FNV Campaign as it is expanded to new markets nationwide.


Assuntos
Frutas , Verduras , Adolescente , California , Estudos Transversais , Dieta , Comportamento Alimentar , Feminino , Humanos , Virginia
18.
BMC Public Health ; 21(1): 1215, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167503

RESUMO

BACKGROUND: Research consistently finds that, on average, firefighters gain weight over time and some data indicate that younger firefighters are more likely to gain weight than older firefighters. The purpose of this study was to estimate the 5-year weight change among younger and older US firefighters. METHODS: Data from two occupational medical exams separated by 5 years (2009-2016) were examined from a cohort of US career firefighters in Virginia (males, n = 589; females, n = 67). The cohort was grouped into two age categories (< 45 years and ≥ 45 years). Weight change subgroups were Loss (decrease of > 3% body weight), Stable (within ±3% body weight) and Gain (increase of > 3% body weight). Multinomial logistic regression models and linear regression models were conducted to examine differences in the probability of being in a particular weight change category, weight change overall and by weight change category between younger and older firefighters. RESULTS: At baseline, 25 and 35% of younger (< 45 years) and older (≥ 45 years) were obese, respectively. Younger firefighters gained significantly (P < 0.05) more weight (3.0 ± 0.2 kg) than older firefighters (0.8 ± 0.5 kg). Younger firefighters were more likely to gain weight (53% versus 39%) and less likely (10% versus 20%) to lose weight as compared to older firefighters. Smaller weight gains were associated with age and BMI with the smallest increases observed in overweight and obese firefighters ≥45 years of age. CONCLUSIONS: Health care providers should be attentive to weight gain, even among young non-obese firefighters, and counsel firefighters to avoid the additive risks of being older and heavier. In addition, weight loss/management programs should be promoted in the fire service to encourage healthy body weight and to prevent unhealthy weight gain among both young and old firefighters alike.


Assuntos
Bombeiros , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso , Virginia/epidemiologia
19.
J Environ Manage ; 294: 112914, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34119996

RESUMO

Nonpoint source (NPS) water quality trading (WQT) has been lauded as a way to reduce water pollution while mitigating costs, but NPS WQT programs often do not account for cumulative landscape-scale impacts to hydrological and ecological processes. In this work, we parameterize the landscape-scale patterns of an emerging NPS WQT market in Virginia (n = 606 transactions) and describe potential tradeoffs and synergies. We also examine program outcomes in the context of Virginia's spatially-explicit conservation and restoration priorities, and discuss ways in which NPS WQT integrates or fails to integrate with these state-level watershed management goals. These spatial and policy analyses demonstrate novel ways to evaluate NPS WQT programs. Our results reveal how NPS WQT has influenced Virginia land management patterns in practice. Specifically, we show that this program has encouraged the transfer of water quality Best Management Practices (BMPs) from urban to rural areas. Impact sites are often far from mitigation sites, at an average of 164.6 km apart measured along the stream network and most often migrated outside the 8-digit Hydrologic Unit Code watershed boundaries. We also find opportunity for improved integration with the state-level management priorities, including that an estimated 22% of the NPS WQT mitigation site area works against state priorities (for example by converting prime farmland to forest), 9% supports state priorities, and 69% neither negates nor supports state priorities. We suggest policy and management actions that can increase the integration of NPS WQT with statewide watershed management goals, and could ultimately improve environmental returns from this fast-growing program.


Assuntos
Poluição da Água , Qualidade da Água , Monitoramento Ambiental , Hidrologia , Rios , Virginia , Poluição da Água/análise
20.
Pediatr Infect Dis J ; 40(7): e272-e274, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34097664

RESUMO

The estimated severe acute respiratory syndrome coronavirus 2 seroprevalence in children was found to be 9.46% for the Washington Metropolitan area. Hispanic/Latinx individuals were found to have higher odds of seropositivity. While chronic medical conditions were not associated with having antibodies, previous fever and body aches were predictive symptoms.


Assuntos
Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19 , COVID-19/epidemiologia , Adolescente , COVID-19/etnologia , Criança , Pré-Escolar , Doença Crônica/epidemiologia , District of Columbia/epidemiologia , Feminino , Voluntários Saudáveis , Hispano-Americanos , Humanos , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Estudos Soroepidemiológicos , Virginia/epidemiologia , West Virginia/epidemiologia , Adulto Jovem
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