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1.
Sci Total Environ ; 803: 149735, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-34492490

RESUMO

Currently, most regional thermal environment (RTE) studies in urban agglomerations focus on developing countries, especially China. However, there is still a lack of comparative studies on the RTEs of urban agglomerations between China and other developed countries, such as the United States. This paper used the Beijing-Tianjin-Hebei (BTH) agglomeration in China and Boswash (the highly urbanized area extending from Boston to Washington) in the United States as examples to investigate the differences in land development patterns, RTEs and their relationship between the agglomerations of China and America. The results showed that the land development patterns of BTH and Boswash were different, as evidenced by the spatial pattern of land development intensity (LDI) and impervious surface configuration. In terms of the RTE, the sub-high land surface temperature (LST) zones were aggregated in a large and compact patch in central and northern BTH. However, the sub-high zones of the cities in Boswash were relatively separate. Moreover, the land development pattern of Boswash showed a stronger relationship with the RTE than that of BTH did. Global Moran's I between the LDI and LST in Boswash was higher than that in BTH. In addition, the correlation between impervious surface configuration and LST in Boswash was stronger than that in BTH, and this correlation was more controlled by LDI in Boswash. This study also indicated that BTH should change the land development pattern to prevent the further expansion of aggregated sub-high LST zones and control the proximity of high LST zones in cities in central and southern BTH, however, Boswash should adopt some local heat management approaches (installing cool and green roofs and creating more green space) in the core areas to help reduce the very high temperatures in the already highly developed areas where the largest fraction of people live.


Assuntos
Monitoramento Ambiental , Pequim , Boston , China , Cidades , Humanos , Washington
2.
Health Aff (Millwood) ; 40(11): 1740-1748, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724415

RESUMO

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.


Assuntos
Medicaid , Patient Protection and Affordable Care Act , Governo Federal , Gastos em Saúde , Humanos , Estados Unidos , Washington
3.
J Hist Dent ; 69(2): 132-133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34734796

RESUMO

James Washington Bartlett (1839-1910, FAG Memorial #124715057) was born in Derby Line, Orleans County, Vermont to Nathaniel Bartlett (1791-1866), a harness maker, and Martha Pinkham Bartlett (1798-1847). Little is known about his youth nor his education. He was evidently preceptor trained in dentistry but we were unable to determine with whom.


Assuntos
Cardiologia , Transtornos do Desenvolvimento Sexual , Adolescente , Humanos , Masculino , Publicações , Vermont , Washington
4.
Artigo em Inglês | MEDLINE | ID: mdl-34769661

RESUMO

The Washington Group questions (WGQ) on functioning have been widely promoted as the go-to tool for disability data collection. Designed for use by government, the WGQ have been adopted by non-government organizations (NGOs) for use in programming. However, little is known about how the WGQs are being used by NGOs or how use may be contributing to disability inclusion. METHOD: This paper describes exploratory research on the use of the WGQ in NGO programming. An online survey provided an overview of adoption followed by semi-structured interviews from a purposive sample to explore data collection, analysis, and use. RESULTS: Thematic analysis showed limited inclusion outcomes directly attributable to use of the WGQ, adoption driven by individual champions rather than systematically across organizations, and challenges in data collection resulting in a wide range of prevalence rates. What information the WGQ can realistically contribute to programs was also overestimated. However, the process of using the WGQ was raising awareness on disability inclusion within program teams and communities. CONCLUSION: Acknowledging differences in emerging use by NGOs beyond the WGQ's intended purpose, alongside promoting a flexible and staged approach to adoption and use in programming, may improve utility and disability inclusion outcomes over time.


Assuntos
Pessoas com Deficiência , Governo , Humanos , Organizações , Inquéritos e Questionários , Washington
5.
MMWR Morb Mortal Wkly Rep ; 70(46): 1608-1612, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34793417

RESUMO

Population-based rates of infection with SARS-CoV-2 (the virus that causes COVID-19) and related health care utilization help determine estimates of COVID-19 vaccine effectiveness and averted illnesses, especially since the SARS-CoV-2 B.1.617.2 (Delta) variant began circulating in June 2021. Among members aged ≥12 years of a large integrated health care delivery system in Oregon and Washington, incidence of laboratory-confirmed SARS-CoV-2 infection, emergency department (ED) visits, and hospitalizations were calculated by COVID-19 vaccination status, vaccine product, age, race, and ethnicity. Infection after full vaccination was defined as a positive SARS-CoV-2 molecular test result ≥14 days after completion of an authorized COVID-19 vaccination series.* During the July-September 2021 surveillance period, SARS-CoV-2 infection occurred among 4,146 of 137,616 unvaccinated persons (30.1 per 1,000 persons) and 3,009 of 344,848 fully vaccinated persons (8.7 per 1,000). Incidence was higher among unvaccinated persons than among vaccinated persons across all demographic strata. Unvaccinated persons with SARS-CoV-2 infection were more than twice as likely to receive ED care (18.5%) or to be hospitalized (9.0%) than were vaccinated persons with COVID-19 (8.1% and 3.9%, respectively). The crude mortality rate was also higher among unvaccinated patients (0.43 per 1,000) than in fully vaccinated patients (0.06 per 1,000). These data support CDC recommendations for COVID-19 vaccination, including additional and booster doses, to protect individual persons and communities against COVID-19, including illness and hospitalization caused by the Delta variant (1).


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Vacinação/estatística & dados numéricos , Washington/epidemiologia , Adulto Jovem
6.
Sci Rep ; 11(1): 21675, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737389

RESUMO

The recent outbreak of the COVID-19 led to death of millions of people worldwide. To stave off the spread of the virus, the authorities in the US employed different strategies, including the mask mandate order issued by the states' governors. In the current work, we defined a parameter called average death ratio as the monthly average of the number of daily deaths to the monthly average number of daily cases. We utilized survey data to quantify people's abidance by the mask mandate order. Additionally, we implicitly addressed the extent to which people abide by the mask mandate order, which may depend on some parameters such as population, income, and education level. Using different machine learning classification algorithms, we investigated how the decrease or increase in death ratio for the counties in the US West Coast correlates with the input parameters. The results showed that for the majority of counties, the mask mandate order decreased the death ratio, reflecting the effectiveness of such a preventive measure on the West Coast. Additionally, the changes in the death ratio demonstrated a noticeable correlation with the socio-economic condition of each county. Moreover, the results showed a promising classification accuracy score as high as 90%.


Assuntos
COVID-19/mortalidade , COVID-19/prevenção & controle , Máscaras/tendências , California , Fidelidade a Diretrizes/tendências , Política de Saúde , Humanos , Aprendizado de Máquina , Máscaras/estatística & dados numéricos , Oregon , SARS-CoV-2/patogenicidade , Washington
7.
Am J Prev Med ; 61(5 Suppl 1): S16-S25, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34686285

RESUMO

INTRODUCTION: In 2019, the District of Columbia recorded a 20-year low rate in new HIV infections but also had near-record numbers of gonorrhea and chlamydia infections. District of Columbia Department of Health has supported numerous forms of community-based in-person screening but not direct at-home testing. METHODS: In summer 2020, the District of Columbia Department of Health launched GetCheckedDC.org for District of Columbia residents to order home-based oral HIV antibody test and urogenital, pharyngeal, and rectal chlamydia and gonorrhea tests. Initial and follow-up surveys were completed by individuals for both test modalities. RESULTS: A retrospective analysis was conducted for the first 5 months of the program. During that period, 1,089 HIV and 1,262 gonorrhea and chlamydia tests (535 urogenital, 520 pharyngeal, 207 rectal) were ordered by 1,245 District of Columbia residents. The average age was 33.1 (median=31, range=14-78) years; 51.6% of requestors identified as Black; 39.3% identified as men who have sex with men; 16.2% reported no form of insurance; and 8.1% and 10.4% reported never being testing for HIV and sexually transmitted infections, respectively. More than half of people requesting tests reported convenience and COVID-19 as the reasons. In total, 39.5% of sexually transmitted infection tests were returned; 7.22% of people testing for sexually transmitted infections received a positive result, and 10.35% of rectal tests were positive. No individuals reported a positive HIV self-test that was confirmed; 98.5% of respondents said that they would recommend the HIV self-test kit. CONCLUSIONS: Mail-out HIV and sexually transmitted infection testing was readily taken up among high-priority demographics within a diverse, urban, high-morbidity jurisdiction during the COVID-19 pandemic. Extragenital testing for gonorrhea and chlamydia should be included in all at-home screening tests given the high positivity rate.


Assuntos
COVID-19 , Infecções por Chlamydia , Gonorreia , Infecções por HIV , Minorias Sexuais e de Gênero , Doenças Sexualmente Transmissíveis , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , District of Columbia/epidemiologia , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Programas de Rastreamento , Pandemias , Serviços Postais , Estudos Retrospectivos , SARS-CoV-2 , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Washington/epidemiologia
8.
JAMA Netw Open ; 4(10): e2124946, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34633425

RESUMO

Importance: Machine learning could be used to predict the likelihood of diagnosis and severity of illness. Lack of COVID-19 patient data has hindered the data science community in developing models to aid in the response to the pandemic. Objectives: To describe the rapid development and evaluation of clinical algorithms to predict COVID-19 diagnosis and hospitalization using patient data by citizen scientists, provide an unbiased assessment of model performance, and benchmark model performance on subgroups. Design, Setting, and Participants: This diagnostic and prognostic study operated a continuous, crowdsourced challenge using a model-to-data approach to securely enable the use of regularly updated COVID-19 patient data from the University of Washington by participants from May 6 to December 23, 2020. A postchallenge analysis was conducted from December 24, 2020, to April 7, 2021, to assess the generalizability of models on the cumulative data set as well as subgroups stratified by age, sex, race, and time of COVID-19 test. By December 23, 2020, this challenge engaged 482 participants from 90 teams and 7 countries. Main Outcomes and Measures: Machine learning algorithms used patient data and output a score that represented the probability of patients receiving a positive COVID-19 test result or being hospitalized within 21 days after receiving a positive COVID-19 test result. Algorithms were evaluated using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC) scores. Ensemble models aggregating models from the top challenge teams were developed and evaluated. Results: In the analysis using the cumulative data set, the best performance for COVID-19 diagnosis prediction was an AUROC of 0.776 (95% CI, 0.775-0.777) and an AUPRC of 0.297, and for hospitalization prediction, an AUROC of 0.796 (95% CI, 0.794-0.798) and an AUPRC of 0.188. Analysis on top models submitting to the challenge showed consistently better model performance on the female group than the male group. Among all age groups, the best performance was obtained for the 25- to 49-year age group, and the worst performance was obtained for the group aged 17 years or younger. Conclusions and Relevance: In this diagnostic and prognostic study, models submitted by citizen scientists achieved high performance for the prediction of COVID-19 testing and hospitalization outcomes. Evaluation of challenge models on demographic subgroups and prospective data revealed performance discrepancies, providing insights into the potential bias and limitations in the models.


Assuntos
Algoritmos , Benchmarking , COVID-19/diagnóstico , Regras de Decisão Clínica , Crowdsourcing , Hospitalização/estatística & dados numéricos , Aprendizado de Máquina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , COVID-19/epidemiologia , COVID-19/terapia , Teste para COVID-19 , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Curva ROC , Índice de Gravidade de Doença , Washington/epidemiologia , Adulto Jovem
9.
Am J Public Health ; 111(S3): S215-S223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34709876

RESUMO

Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).


Assuntos
COVID-19 , Política de Saúde , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Saúde Pública , COVID-19/economia , COVID-19/prevenção & controle , Humanos , Saúde Mental , Vigilância da População , Desemprego/estatística & dados numéricos , Washington
10.
Int J Offender Ther Comp Criminol ; 65(15): 1629-1652, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34628957

RESUMO

The Washington State Institute for Public Policy (WSIPP) uses meta-analyses to help program administrators identify effective programs that reduce recidivism. The results are displayed as summary effect sizes. Yet, many programs are grouped within a category (such as Intensive Supervision or Correctional Education), even though the features of the programs might suggest they may be very different. The following research question was examined: What program features are related to the effect size in the WSIPP program category? Researchers at ACE! at George Mason University reviewed the studies analyzed by WSIPP and their effect sizes. The meta-regression global models showed recidivism decreased with certain program features, while other program features actually increased recidivism. A multivariate meta-regression showed substantial variation across Cognitive-Behavioral Therapy programs. These preliminary findings suggest the need to further research how differing program features contribute to client-level outcomes, and develop a scheme to better classify programs.


Assuntos
Terapia Cognitivo-Comportamental , Reincidência , Humanos , Reincidência/prevenção & controle , Washington
11.
Am J Prev Med ; 61(5 Suppl 1): S160-S169, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34686286

RESUMO

INTRODUCTION: The HIV epidemic in King County, Washington has traditionally been highly concentrated among men who have sex with men, and incidence has gradually declined over 2 decades. In 2018, King County experienced a geographically concentrated outbreak of HIV among heterosexual people who inject drugs. METHODS: Data sources to describe the 2018 outbreak and King County's response were partner services interview data, HIV case reports, syringe service program client surveys, hospital data, and data from a rapid needs assessment of homeless individuals and people who inject drugs. In 2020, the authors examined the impact of delays in molecular sequence analyses and cluster member size thresholds, for identifying genetically similar clusters, on the timing of outbreak identification. RESULTS: In 2018, the health department identified a North Seattle cluster, growing to 30 people with related HIV infections diagnosed in 2008-2019. In total, 70% of cluster members were female, 77% were people who inject drugs, 87% were homeless, and 27% reported exchanging sex. Intervention activities included a rapid needs assessment, 2,485 HIV screening tests in a jail and other outreach settings, provision of 87,488 clean syringes in the outbreak area, and public communications. A lower cluster size threshold and more rapid receipt and analyses of data would have identified this outbreak 4-16 months earlier. CONCLUSIONS: This outbreak shows the vulnerability of people who inject drugs to HIV infection, even in areas with robust syringe service programs and declining HIV epidemics. Although molecular HIV surveillance did not identify this outbreak, it may have done so with a lower threshold for defining clusters and more rapid receipt and analyses of HIV genetic sequences.


Assuntos
Infecções por HIV , Preparações Farmacêuticas , Minorias Sexuais e de Gênero , Abuso de Substâncias por Via Intravenosa , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/epidemiologia , Washington/epidemiologia
12.
Vaccine ; 39(41): 6144-6150, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34493409

RESUMO

PURPOSE: Waning of immunity after vaccination with the acellular Pertussis (aP) vaccine has been proposed as one of the main reasons for pertussis resurgence in the US. In this study, we estimated time-varying vaccine effectiveness after 5 doses of aP vaccine. METHODS: We conducted a retrospective cohort study among children 5-9 years old (born between 2008 and 2012) living in King County, Washington, USA, who participated in the Washington State Immunization Information System. We estimated time-varying vaccine effectiveness after 5 doses of aP using smoothed scaled Schoenfeld residuals obtained from fitting Cox proportional hazards models to the data as well as piecewise constant Poisson regression. RESULTS: There were 55 pertussis cases in this cohort, of whom 22 (40%) were fully-vaccinated and 33 (60%) were under-vaccinated. Vaccine effectiveness (VE) remained high for up to 42 months after the fifth dose (VE(t) = 89%; 95% CI: 64%, 97%) as estimated using survival analysis methods and up to 4 years (VE(t) = 93%; 95% CI: 67%, 98%) as estimated using Poisson regression. CONCLUSION: We did not find evidence for waning of vaccine effectiveness for up to four years after 5 doses of aP among 5 -9 years old children in King County, WA.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Criança , Pré-Escolar , Humanos , Vacina contra Coqueluche , Estudos Retrospectivos , Vacinação , Washington/epidemiologia , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
13.
Am J Ind Med ; 64(11): 941-951, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34523153

RESUMO

BACKGROUND: App-based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited occupational health research has focused on their experiences. METHODS: We surveyed 100 app-based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID-19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID-19, and barriers and facilitators to their implementation. RESULTS: Drivers expressed very high levels of concern for exposure and infection (86%-97% were "very concerned" for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS-4) was significantly higher in drivers who reported having had COVID-19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID-19. CONCLUSIONS: App-based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health-supportive policies and protections for app-based drivers. The most effective occupational and public health regulations would cover employees who may not have a traditional employer-employee relationship.


Assuntos
Condução de Veículo/psicologia , COVID-19/prevenção & controle , Doenças Profissionais/prevenção & controle , Gestão da Segurança/organização & administração , Local de Trabalho/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Doenças Profissionais/virologia , Saúde do Trabalhador , Cultura Organizacional , Percepção , SARS-CoV-2 , Transportes , Washington , Local de Trabalho/organização & administração , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-34501803

RESUMO

The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application and domain to explore these nuances and consider whether alternative combinations of questions may be valuable in reduced sets. We conducted secondary analyses of seven population-based surveys (analyses restricted to adults 18+) in Low- and Middle-Income Countries that used the WG tools. The prevalence estimates using the SS standard threshold (a lot of difficulty or higher in one or more domain) varied between 3.2% (95% Confidence Interval 2.9-3.6) in Vanuatu to 14.1% (12.2-16.2) in Turkey. The prevalence was higher using the ESF than the SS, and much higher (5 to 10-fold) using a wider threshold of "some" or greater difficulty. Two of the SS domains (communication, self-care) identified few additional individuals with functional limitations. An alternative SS replacing these domains with the psychosocial domains of anxiety and depression would identify more participants with functional limitations for the same number of items. The WG tools are valuable for collecting harmonised population data on disability. It is important that the impact on prevalence of use of different modules, thresholds and applications is recognised. An alternative SS may capture a greater proportion of people with functional domains without increasing the number of items.


Assuntos
Prevalência , Adulto , Camarões , Guatemala , Humanos , Índia , Ilhas do Oceano Índico , Nepal , Inquéritos e Questionários , Turquia , Vanuatu , Washington
16.
Am J Public Health ; 111(8): 1439-1442, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34464183

RESUMO

Improvements to correctional facilities' food environment can provide healthier food and beverage options for incarcerated individuals, a population disproportionately affected by chronic disease. This article describes efforts to increase healthy options in the commissary program at Washington State correctional facilities from 2017 to 2019, and the role of a multidisciplinary collaboration between the state's Department of Corrections, Department of Health, and Statewide Family Council. Through the development, implementation, and promotion of nutrition standards, the nutritional quality of foods and beverages in the commissary program improved.


Assuntos
Estabelecimentos Correcionais , Serviços de Alimentação/normas , Promoção da Saúde/métodos , Adulto , Feminino , Humanos , Masculino , Valor Nutritivo , Prisioneiros , Washington
17.
J Trauma Acute Care Surg ; 91(3): 457-464, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34432752

RESUMO

BACKGROUND: In addition to reflecting gas exchange within the lungs, end-tidal carbon dioxide (ETCO2) also reflects cardiac output based on CO2 delivery to the pulmonary parenchyma. We hypothesized that low prehospital ETCO2 values would be predictive of hemorrhagic shock in intubated trauma patients. METHODS: A retrospective observational study of adult trauma patients intubated in the prehospital setting and transported to a single Level I trauma center from 2016 to 2019. Continuous prehospital ETCO2 data were linked with patient care registries. We developed a novel analytic approach that allows for reflection of prehospital ETCO2 over the entire prehospital course of care. The primary outcome was hemorrhagic shock on emergency department (ED) presentation, defined as either initial ED systolic blood pressure of 90 mm Hg or less or initial Shock Index (SI) > 0.9, and transfusion of at least one unit of blood product during their ED stay. Prehospital ETCO2 less than 25 mm Hg was evaluated for predictive value of hemorrhagic shock. RESULTS: Three hundred and seven patients (82% men, 34% penetrating injury, 42% in hemorrhagic shock on ED arrival, 27% mortality) were included in the study. Patients in hemorrhagic shock had lower median ETCO2 values (26.5 mm Hg vs. 32.5 mm Hg; p < 0.001) than those not in hemorrhagic shock. Patients with prehospital ETCO2 less than 25 mm Hg were 3.0 times (adjusted odds ratio = 3.0; 95% confidence interval, 1.1-7.9) more likely to be in hemorrhagic shock upon ED arrival than patients with ETCO2 ≥ 25 mm Hg. CONCLUSION: Intubated patients with hemorrhagic shock upon ED arrival had significantly lower prehospital ETCO2 values. Incorporating ETCO2 assessment into prehospital care for trauma patients could support decisions regarding prehospital blood transfusion, and triage to higher-level trauma centers, and trauma team activation. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Dióxido de Carbono/análise , Serviços Médicos de Emergência , Choque Hemorrágico/diagnóstico , Volume de Ventilação Pulmonar , Ferimentos e Lesões/mortalidade , Adulto , Transfusão de Sangue , Feminino , Mortalidade Hospitalar/tendências , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Sistema de Registros , Estudos Retrospectivos , Choque Hemorrágico/terapia , Centros de Traumatologia , Triagem , Washington , Adulto Jovem
19.
PLoS One ; 16(8): e0255294, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34379656

RESUMO

The COVID-19 pandemic has introduced novel stressors into the lives of youth. Identifying factors that protect against the onset of psychopathology in the face of these stressors is critical. We examine a wide range of factors that may protect youth from developing psychopathology during the pandemic. We assessed pandemic-related stressors, internalizing and externalizing psychopathology, and potential protective factors by combining two longitudinal samples of children and adolescents (N = 224, 7-10 and 13-15 years) assessed prior to the pandemic, during the stay-at-home orders, and six months later. We evaluated how family behaviors during the stay-at-home orders were related to changes in psychopathology during the pandemic, identified factors that moderate the association of pandemic-related stressors with psychopathology, and determined whether associations varied by age. Internalizing and externalizing psychopathology increased substantially during the pandemic. Higher exposure to pandemic-related stressors was associated with increases in internalizing and externalizing symptoms early in the pandemic and six months later. Having a structured routine, less passive screen time, lower exposure to news media about the pandemic, and to a lesser extent more time in nature and getting adequate sleep were associated with reduced psychopathology. The association between pandemic-related stressors and psychopathology was reduced for youths with limited passive screen time and was absent for children, but not adolescents, with lower news media consumption related to the pandemic. We provide insight into simple, practical steps families can take to promote resilience against mental health problems in youth during the COVID-19 pandemic and protect against psychopathology following pandemic-related stressors.


Assuntos
COVID-19/patologia , Saúde Mental , Adaptação Psicológica , Adolescente , COVID-19/epidemiologia , COVID-19/virologia , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pandemias , SARS-CoV-2/isolamento & purificação , Sono , Estresse Psicológico , Washington/epidemiologia
20.
JAMA Netw Open ; 4(8): e2119355, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34347059

RESUMO

Importance: Although people receiving maintenance dialysis have limited life expectancy and a high burden of comorbidity, relatively few studies have examined spirituality and religious beliefs among members of this population. Objective: To examine whether there is an association between the importance of religious or spiritual beliefs and care preferences and palliative care needs in people who receive dialysis. Design, Setting, and Participants: A cross-sectional survey study was conducted among adults who were undergoing maintenance dialysis at 31 facilities in Seattle, Washington, and Nashville, Tennessee, between April 22, 2015, and October 2, 2018. The survey included a series of questions assessing patients' knowledge, preferences, values, and expectations related to end-of-life care. Data were analyzed from February 12, 2020, to April 21, 2021. Exposures: The importance of religious or spiritual beliefs was ascertained by asking participants to respond to this statement: "My religious or spiritual beliefs are what really lie behind my whole approach to life." Response options were definitely true, tends to be true, tends not to be true, or definitely not true. Main Outcomes and Measurements: Outcome measures were based on self-reported engagement in advance care planning, resuscitation preferences, values regarding life prolongation, preferred place of death, decision-making preference, thoughts or discussion about hospice or stopping dialysis, prognostic expectations, and palliative care needs. Results: A total of 937 participants were included in the cohort, of whom the mean (SD) age was 62.8 (13.8) years and 524 (55.9%) were men. Overall, 435 (46.4%) participants rated the statement about religious or spiritual beliefs as definitely true, 230 (24.6%) rated it as tends to be true, 137 (14.6%) rated it as tends not to be true, and 135 (14.4%) rated it as definitely not true. Participants for whom these beliefs were more important were more likely to prefer cardiopulmonary resuscitation (estimated probability for definitely true: 69.8% [95% CI, 66.5%-73.2%]; tends to be true: 60.8% [95% CI, 53.4%-68.3%]; tends not to be true: 61.6% [95% CI, 53.6%-69.6%]; and definitely not true: 60.6% [95% CI, 52.5%-68.6%]; P for trend = .003) and mechanical ventilation (estimated probability for definitely true: 42.6% [95% CI, 38.1%-47.0%]; tends to be true: 33.5% [95% CI, 25.9%-41.2%]; tends not to be true: 35.1% [95% CI, 27.2%-42.9%]; and definitely not true: 27.9% [95% CI, 19.6%-36.1%]; P for trend = .002) and to prefer a shared role in decision-making (estimated probability for definitely true: 41.6% [95% CI, 37.7%-45.5%]; tends to be true: 35.4% [95% CI, 29.0%-41.8%]; tends not to be true: 36.0% [95% CI, 26.7%-45.2%]; and definitely not true: 23.8% [95% CI, 17.3%-30.3%]; P for trend = .001) and were less likely to have thought or spoken about stopping dialysis. These participants were no less likely to have engaged in advance care planning, to value relief of pain and discomfort, to prefer to die at home, to have ever thought or spoken about hospice, and to have unmet palliative care needs and had similar prognostic expectations. Conclusions and Relevance: The finding that religious or spiritual beliefs were important to most study participants suggests the value of an integrative approach that addresses these beliefs in caring for people who receive dialysis.


Assuntos
Preferência do Paciente , Diálise Renal , Autorrelato , Assistência Terminal/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Religião , Espiritualidade , Inquéritos e Questionários , Tennessee , Washington
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