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1.
BMJ Open ; 12(5): e058196, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534056

RESUMO

OBJECTIVE: In 2016, Arizona enacted SB 1487 to nullify Tucson's ordinance permitting the municipality to destroy confiscated and forfeited firearms and instead require the firearms to be resold to the public through an auctioneer. Our objective was to examine whether firearm suicide rates increased in Pima County (greater Tucson area) relative to other Arizona counties following the enactment of Arizona's 2016 pre-emption law. DESIGN: An observational study of a natural policy experiment. We used a difference-in-differences approach to estimate the effects of Arizona enacting SB 1487 on firearm suicide rates in Pima County. Our statistical analyses adjusted for county-level differences in population demographics (age, gender and race) and unemployment rates, as well as a proxy for firearm availability and mental health professional shortage area status. SETTING: 9 Arizona counties from 2014 to 2019. PARTICIPANTS: A policy group was constructed using Pima County (Tucson area) observations. A comparison group was created using data from eight other Arizona counties. 54 county-year observations were analysed. INTERVENTION: SB 1487, which pre-empted Tucson law and allowed firearms that were seized/surrendered to law enforcement to be recirculated instead of destroyed. OUTCOMES AND MEASURES: Annual rates of firearm and non-firearm suicides per 100 000 persons extracted from the Centers for Disease Control and Prevention WONDER system. RESULTS: Over the study period, comparison group counties had an average of 14.87 firearm suicides per 100 000 persons per year, compared with 11.56 firearm suicides per 100 000 persons per year in Pima County. A 1.13 increase in Pima County's firearm suicides per 100 000 persons coincided with the enactment of Arizona's 2016 pre-emption law, relative to comparison group counties over the same period. CONCLUSIONS: SB 1487 was associated with higher firearm suicide rates in Pima County relative to other areas not targeted by the law, assuming fewer firearms were destroyed and more firearms re-entered the greater Tucson area through 2019.


Assuntos
Armas de Fogo , Suicídio , Arizona/epidemiologia , Homicídio , Humanos , Políticas , Iodeto de Potássio , Suicídio/prevenção & controle , Estados Unidos
2.
Artigo em Inglês | MEDLINE | ID: mdl-35409903

RESUMO

Rhipicephalus sanguineus s.l. (Latreille, 1806), the brown dog tick, is the most widely distributed tick species in the world. The two dominant lineages, a temperate group and a tropical group, are recognized as important disease vectors for both dogs and humans. The temperate and tropical lineages overlap in range in some regions of the world, including the southwestern United States, where recent outbreaks of Rocky Mountain spotted fever are linked to R. sanguineus s.l. While it is unclear to what extent they may differ in their capacity to transmit pathogens, finer-scale resolution of temperate and tropical lineage distribution may provide insight into the ecology of these two tick groups and the epidemiology of R. sanguineus s.l.-vectored diseases. Using diagnostic polymerase chain reaction assays, we examined the geospatial trends in R. sanguineus s.l. lineages throughout Arizona. We found the temperate and tropical lineages were well delineated, with some overlap in the eastern part of the state. In one county, tropical and temperate ticks were collected on the same dog host, demonstrating that the two lineages are living in sympatry in some instances and may co-feed on the same host.


Assuntos
Doenças do Cão , Rhipicephalus sanguineus , Animais , Arizona , Doenças do Cão/epidemiologia , Doenças do Cão/genética , Cães , Variação Genética , Filogenia , Rhipicephalus sanguineus/genética , Sudoeste dos Estados Unidos
3.
Hum Biol ; 93(1): 33-50, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35338701

RESUMO

The humanitarian crisis on the US-Mexico border is a long-standing and evolving crisis in which nearly 8,000 deaths have been reported in the last two decades. These deaths are largely distributed across the Arizona-Mexico and Texas-Mexico border regions, where demographic trends for immigrants attempting to cross into the United States have shifted dramatically. The demographic change and volume of immigrants seeking shelter in the United States present new challenges for the forensic practitioners entrusted with the identification of individuals who lose their lives during the final segment of their journey. Within this border context, this study investigated how genetic variation inferred from forensically significant microsatellites can provide valuable information on regions of origin for unidentified remains at the group level. To explore how to mobilize these genetic data to inform identification strategies, the authors conducted a comparative genetic analysis of identified and unidentified immigrant cases from the Arizona- and Texas-Mexico contexts, as well as 27 other Latin American groups. Allele frequencies were utilized to calculate FST, and relationships were visually depicted in a multidimensional scaling plot. A Spearman correlation coefficient analysis assessed the strength and significance of population relationships, and an agglomerative clustering analysis assessed population clusters. Results indicate that Arizona-Mexico immigrants have the strongest relationship (>80%) with groups from El Salvador, Guatemala, Mexico, and an indigenous group from southern Mexico. Texas-Mexico immigrants have the strongest relationships (>80%) with groups from Belize, Colombia, Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. These findings agree with, and are discussed in comparison with, previously reported demographic trends, population genetics research, and population history analyses. The authors emphasize the utility and necessity of coupling genetic variation research with a nuanced anthropological perspective for identification processes in the US-Mexico border context.


Assuntos
Emigrantes e Imigrantes , Genética Populacional , Arizona , Variação Genética , Humanos , América Latina , México , Texas , Estados Unidos
4.
Artigo em Inglês | MEDLINE | ID: mdl-35328956

RESUMO

Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a lack of empirical evidence on liver cancer prevention, treatment, and health interventions for American Indian populations in Arizona. Research is needed to evaluate the high rates of liver disease and cancer to inform culturally relevant interventions for liver cancer prevention. Community-engaged research that addresses structural inequality is a promising approach to improve inequities in liver cancer for American Indian people.


Assuntos
Neoplasias Hepáticas , Adulto , Arizona/epidemiologia , Atenção à Saúde , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle , Estudos Observacionais como Assunto
5.
Microbiol Spectr ; 10(2): e0148321, 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35319247

RESUMO

Coccidioidomycosis (Valley fever) is a disease caused by the fungal pathogens Coccidioides immitis and Coccidioides posadasii that are endemic to the southwestern United States and parts of Mexico and South America. Throughout the range where the pathogens are endemic, there are seasonal patterns of infection rates that are associated with certain climatic variables. Previous studies that looked at annual and monthly relationships of coccidioidomycosis and climate suggest that infection numbers are linked with precipitation and temperature fluctuations; however, these analytic methods may miss important nonlinear, nonmonotonic seasonal relationships between the response (Valley fever cases) and explanatory variables (climate) influencing disease outbreaks. To improve our current knowledge and to retest relationships, we used case data from three counties of high endemicity in southern Arizona paired with climate data to construct a generalized additive statistical model that explores which meteorological parameters are most useful in predicting Valley fever incidence throughout the year. We then use our model to forecast the pattern of Valley fever cases by month. Our model shows that maximum monthly temperature, average PM10, and total precipitation 1 month prior to reported cases (lagged model) were all significant in predicting Valley fever cases. Our model fits Valley fever case data in the region of endemicity of southern Arizona and captures the seasonal relationships that predict when the public is at higher risk of being infected. This study builds on and retests relationships described by previous studies regarding climate variables that are important for predicting risk of infection and understanding this fungal pathogen. IMPORTANCE The inhalation of environmental infectious propagules from the fungal pathogens Coccidioides immitis and Coccidioides posadasii by susceptible mammals can result in coccidioidomycosis (Valley fever). Arizona is known to be a region where the pathogen is hyperendemic, and reported cases are increasing throughout the western United States. Coccidioides spp. are naturally occurring fungi in arid soils. Little is known about ecological factors that influence the growth of these fungi, and a higher environmental burden may result in increases in human exposure and therefore case rates. By examining case and climate data from Arizona and using generalized additive statistical models, we were able to examine the relationship between disease outbreaks and climatic variables and predict seasonal time points of increased infection risk.


Assuntos
Coccidioidomicose , Animais , Arizona/epidemiologia , Coccidioides , Coccidioidomicose/epidemiologia , Humanos , Mamíferos , Estações do Ano , Estados Unidos
6.
Microb Genom ; 8(2)2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35166655

RESUMO

Clostridioides difficile is a pathogen often associated with hospital-acquired infection or antimicrobial-induced disease; however, increasing evidence indicates infections can result from community or environmental sources. Most genomic sequencing of C. difficile has focused on clinical strains, although evidence is growing that C. difficile spores are widespread in soil and water in the environment. In this study, we sequenced 38 genomes collected from soil and water isolates in Flagstaff (AZ, USA) and Slovenia in an effort targeted towards environmental surveillance of C. difficile. At the average nucleotide identity (ANI) level, the genomes were divergent to C. difficile at a threshold consistent with different species. A phylogenetic analysis of these divergent genomes together with Clostridioides genomes available in public repositories confirmed the presence of three previously described, cryptic Clostridioides species and added two additional clades. One of the cryptic species (C-III) was almost entirely composed of Arizona and Slovenia genomes, and contained distinct sub-groups from each region (evidenced by SNP and gene-content differences). A comparative genomics analysis identified multiple unique coding sequences per clade, which can serve as markers for subsequent environmental surveys of these cryptic species. Homologues to the C. difficile toxin genes, tcdA and tcdB, were found in cryptic species genomes, although they were not part of the typical pathogenicity locus observed in C. difficile, and in silico PCR suggested that some would not amplify with widely used PCR diagnostic tests. We also identified gene homologues in the binary toxin cluster, including some present on phage and, for what is believed to be the first time, on a plasmid. All isolates were obtained from environmental samples, so the function and disease potential of these toxin homologues is currently unknown. Enzymatic profiles of a subset of cryptic isolates (n=5) demonstrated differences, suggesting that these isolates contain substantial metabolic diversity. Antimicrobial resistance (AMR) was observed across a subset of isolates (n=4), suggesting that AMR mechanisms are intrinsic to the genus, perhaps originating from a shared environmental origin. This study greatly expands our understanding of the genomic diversity of Clostridioides. These results have implications for C. difficile One Health research, for more sensitive C. difficile diagnostics, as well as for understanding the evolutionary history of C. difficile and the development of pathogenesis.


Assuntos
Clostridioides/classificação , Clostridioides/genética , Clostridioides/isolamento & purificação , Antibacterianos/farmacologia , Arizona , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Clostridioides difficile/classificação , Clostridioides difficile/genética , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , Infecção Hospitalar , Farmacorresistência Bacteriana/genética , Genes Bacterianos/genética , Genoma Bacteriano , Genômica , Humanos , Filogenia , Polimorfismo de Nucleotídeo Único , RNA Ribossômico 16S , Eslovênia
7.
Artigo em Inglês | MEDLINE | ID: mdl-35162208

RESUMO

American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.


Assuntos
Nativos do Alasca , Carcinoma de Células Renais , Índios Norte-Americanos , Neoplasias Renais , Arizona/epidemiologia , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Estados Unidos
8.
Medicine (Baltimore) ; 101(8): e28917, 2022 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-35212298

RESUMO

ABSTRACT: We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Idoso , Analgésicos Opioides/uso terapêutico , Arizona/epidemiologia , Cannabis , Cocaína , Estudos Transversais , Feminino , Heroína , Pessoas em Situação de Rua/psicologia , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Health Care Poor Underserved ; 33(1): 398-406, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35153229

RESUMO

INTRODUCTION: Increased enforcement at U.S.-Mexico border-crossing sites may lead migrants to cross in remote desert areas. METHODS: We reviewed data on migrants' bodies found along the Arizona-Mexico border from 2001 to 2020. We analyzed causes of death, condition of bodies, age, and sex, and the relationship of deaths to enforcement (arrests) by U.S. Border Patrol. RESULTS: From 2001-2020, 3,378 border-crosser bodies were found in the desert. As enforcement increased, bodies were found in more remote areas and later stages of decomposition. Skeletonized bodies increased from 19% in 2001-2004 to 49.1% in 2017-2020. When the cause of death could be identified, exposure to the elements was the most common cause. Abrupt increases in arrests and deaths over the immediately preceding period of 2013-2016 occurred in 2017-2020. CONCLUSIONS: Undetermined cause of death and increased skeletonization became more common, indicating bodies are discovered later. Enforcement does not decrease individuals crossing the border; rather, individuals cross in more remote areas.


Assuntos
Emigração e Imigração , Migrantes , Arizona/epidemiologia , Humanos , México/epidemiologia
10.
Riv Psichiatr ; 57(1): 18-22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35166726

RESUMO

INTRODUCTION: Many forms of mental disorders, especially psychotic disorders are characterized also by a worsening of sexual functioning. The main aim of this study was to validate in the Italian context the Arizona Sexual Experience Scale (ASEX), a very useful international tool to assess sexual dysfunction in people suffering from mental illness. METHODS: Seventy-three patients suffering from psychotic spectrum disorders were recruited. We administered the Italian version of ASEX, adequately translated by two expert bilinguals. After 15 days we administered once again the test for test-retest reliability. RESULTS: Validation of ASEX revealed Cronbach's coefficients >0.70 in both single items as in the total score. In addition, the test-retest reliability revealed Pearson's coefficients >0.50 in the various domains. Confirmatory factor analysis revealed good fit indexes for the two factors model of ASEX (SRMR=0.54; CFI=0.974; RMSEA=0.135). DISCUSSION: This study represents the first validation in the Italian psychiatric context of a very useful specific tool for the sexual assessment in people suffering from mental illness. Our analysis after the ASEX administration revealed good psychometric characteristics in terms of confirmatory factor analysis, internal consistency, and test-retest reliability. CONCLUSIONS: On the basis of our results and consideration, we strongly suggest the use of ASEX in clinical context to assess the sexual function of patients with severe mental disorders.


Assuntos
Transtornos Psicóticos , Arizona/epidemiologia , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
11.
J Am Geriatr Soc ; 70(4): 960-967, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35141874

RESUMO

BACKGROUND: Adult residents of skilled nursing facilities (SNF) have experienced high morbidity and mortality from SARS-CoV-2 infection and are at increased risk for severe COVID-19 disease. Use of monoclonal antibody (mAb) treatment improves clinical outcomes among high-risk outpatients with mild-to-moderate COVID-19, but information on mAb effectiveness in SNF residents with COVID-19 is limited. We assessed outcomes in SNF residents with mild-to-moderate COVID-19 associated with an outbreak in Arizona during January-February 2021 that did and did not receive a mAb. METHODS: Medical records were reviewed to describe the effect of bamlanivimab therapy on COVID-19 mortality. Secondary outcomes included referral to an acute care setting and escalation of medical therapies at the SNF (e.g., new oxygen requirements). Residents treated with bamlanivimab were compared to residents who were eligible for treatment under the FDA's Emergency Use Authorization (EUA) but were not treated. Multivariable logistic regression was used to determine association between outcomes and treatment status. RESULTS: Seventy-five residents identified with COVID-19 during this outbreak met eligibility for mAb treatment, of whom 56 received bamlanivimab. Treated and untreated groups were similar in age and comorbidities associated with increased risk of severe COVID-19 disease. Treatment with bamlanivimab was associated with reduced 21-day mortality (adjusted OR = 0.06; 95% CI: 0.01, 0.39) and lower odds of initiating oxygen therapy (adjusted OR = 0.07; 95% CI: 0.02, 0.34). Referrals to acute care were not significantly different between treated and untreated residents. CONCLUSIONS: mAb therapy was successfully administered to SNF residents with COVID-19 in a large outbreak setting. Treatment with bamlanivimab reduced 21-day mortality and reduced initiation of oxygen therapy. As the COVID-19 pandemic evolves and newer immunotherapies gain FDA authorization, more studies of the effectiveness of mAb therapies for treating emerging SARS-CoV-2 variants of concern in high-risk congregate settings are needed.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Anticorpos Neutralizantes , Arizona , Humanos , Imunoterapia , Pandemias , Instituições de Cuidados Especializados de Enfermagem
12.
Artigo em Inglês | MEDLINE | ID: mdl-35055622

RESUMO

Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4-66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50-53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05-10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Adulto , Arizona/epidemiologia , Estudos Transversais , Feminino , Infecções por Helicobacter/complicações , Humanos , Masculino , Prevalência , Fatores de Risco
13.
Crit Care Med ; 50(2): 204-211, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35100193

RESUMO

OBJECTIVES: To assess disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes. DESIGN: Observational cohort study from May 5, 2018, to December 31, 2020. SETTING: Three academic medical centers in the United States. PATIENTS: Adults greater than or equal to 18 years who self-identified as White, Black, Asian, or American Indian admitted to the ICU or undergoing surgery during inpatient hospitalization with simultaneous measurements of pulse oximetry-estimated oxygen saturation and arterial blood gas-derived oxygen saturation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable models were employed to assess the relationships between race, occult hypoxemia (i.e., arterial blood gas-derived oxygen saturation < 88% despite pulse oximetry-estimated oxygen saturation ≥ 92%), and clinical outcomes of hospital mortality and hospital-free days. One-hundred twenty-eight-thousand two-hundred eighty-five paired pulse oximetry-estimated oxygen saturation-arterial blood gas-derived oxygen saturation measurements were included from 26,603 patients. Pulse oximetry-estimated oxygen saturation on average overestimated arterial blood gas-derived oxygen saturation by 1.57% (1.54-1.61%). Black, Asian, and American Indian patients were more likely to experience occult hypoxemia during hospitalization (estimated probability 6.2% [5.1-7.6%], 6.6% [4.9-8.8%], and 6.6% [4.4-10.0%], respectively) compared with White patients (3.6% [3.4-3.8%]). Black patients had increased odds of occult hypoxemia compared with White patients after adjustment (odds ratio, 1.65; 1.28-2.14; p < 0.001). Differences in occult hypoxemia between Asian and American Indian patients compared with White patients were not significant after adjustment (odds ratio, 1.53; 0.95-2.47; p = 0.077 and odds ratio, 1.31; 0.80-2.16; p = 0.288, respectively). Occult hypoxemia was associated with increased odds of mortality in surgical (odds ratio, 2.96; 1.20-7.28; p = 0.019) and ICU patients (1.36; 1.03-1.80; p = 0.033). Occult hypoxemia was associated with fewer hospital-free days in surgical (-2.5 d [-3.9 to -1.2 d]; p < 0.001) but not ICU patients (0.4 d [-0.7 to 1.4 d]; p = 0.500). CONCLUSIONS: Occult hypoxemia is more common in Black patients compared with White patients and is associated with increased mortality, suggesting potentially important outcome implications for undetected hypoxemia. It is imperative to validate pulse oximetry with expanded racial inclusion.


Assuntos
Hipóxia/diagnóstico , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Oximetria/normas , Pigmentação da Pele/fisiologia , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Arizona , Estudos de Coortes , Feminino , Florida , Humanos , Hipóxia/etnologia , Masculino , Pessoa de Meia-Idade , Minnesota , Avaliação de Resultados em Cuidados de Saúde/métodos , Oximetria/instrumentação , Oximetria/métodos , Oxigênio/análise , Oxigênio/sangue , Autorrelato/estatística & dados numéricos
14.
Am J Public Health ; 112(2): 216-219, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35080951

RESUMO

The Maricopa County Department of Public Health in Arizona investigated three COVID-19 outbreaks associated with club sports, two in tournaments and one in a hockey league. During September through November 2020, 195 team-associated and 69 secondary household contact cases were identified among 2093 athletes, coaches, and staff members; the team attack rate ranged from 6% to 72%. Outbreaks occurred during high community transmission periods in Maricopa County. Identification of contacts and characterization of prevention strategies were challenging because of limited cooperation from athletes, families, and staff. (Am J Public Health. 2022;112(2):216-219. https://doi.org/10.2105/AJPH.2021.306579).


Assuntos
COVID-19/epidemiologia , Surtos de Doenças , Esportes Juvenis , Arizona/epidemiologia , Humanos , Incidência , SARS-CoV-2 , Inquéritos e Questionários
15.
BMJ Open ; 12(1): e053403, 2022 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-35039294

RESUMO

OBJECTIVE: To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study. SETTING AND DESIGN: This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. PARTICIPANTS: Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. RESULTS: Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. CONCLUSION: When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.


Assuntos
COVID-19 , Arizona/epidemiologia , Estudos de Coortes , Humanos , Estudos Longitudinais , Estudos Prospectivos , SARS-CoV-2
16.
Public Health Rep ; 137(2): 220-225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35023417

RESUMO

The COVID-19 pandemic has disproportionately affected tribal populations, including the San Carlos Apache Tribe. Universal screening testing in a community using rapid antigen tests could allow for near-real-time identification of COVID-19 cases and result in reduced SARS-CoV-2 transmission. Published experiences of such testing strategies in tribal communities are lacking. Accordingly, tribal partners, with support from the Centers for Disease Control and Prevention, implemented a serial testing program using the Abbott BinaxNOW rapid antigen test in 2 tribal casinos and 1 detention center on the San Carlos Apache Indian Reservation for a 4-week pilot period from January to February 2021. Staff members at each setting, and incarcerated adults at the detention center, were tested every 3 or 4 days with BinaxNOW. During the 4-week period, 3834 tests were performed among 716 participants at the sites. Lessons learned from implementing this program included demonstrating (1) the plausibility of screening testing programs in casino and prison settings, (2) the utility of training non-laboratory personnel in rapid testing protocols that allow task shifting and reduce the workload on public health employees and laboratory staff, (3) the importance of building and strengthening partnerships with representatives from the community and public and private sectors, and (4) the need to implement systems that ensure confidentiality of test results and promote compliance among participants. Our experience and the lessons learned demonstrate that a serial rapid antigen testing strategy may be useful in work settings during the COVID-19 pandemic as schools and businesses are open for service.


Assuntos
Teste Sorológico para COVID-19 , COVID-19/diagnóstico , Programas de Triagem Diagnóstica , Povos Indígenas , Arizona/epidemiologia , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , SARS-CoV-2
17.
Public Health Rep ; 137(2): 213-219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35060793

RESUMO

From May through July 2020, Arizona was a global hotspot for new COVID-19 cases. In response to the surge of cases, local public health departments looked for innovative ways to form external partnerships to address their staffing needs. In collaboration with the Maricopa County Department of Public Health, the Arizona State University Student Outbreak Response Team (SORT) created and implemented a virtual call center to conduct public health case investigations for COVID-19. SORT officially launched a dedicated COVID-19 case investigation program after 3 weeks of program design and training. From June 29 through November 8, 2020, SORT recruited and trained 218 case investigators, completed 5000 case patient interviews, and closed 10 000 cases. Our team also developed process improvements to address disparities in case investigation timeliness. A strong infrastructure designed to accommodate remote case investigations, paired with a large workforce, enabled SORT to provide additional surge capacity for the county's high volume of cases. University-driven multidisciplinary case investigator teams working in partnership with state, tribal, and local public health staff members can be an effective tool for supporting a diverse and growing public health workforce. We discuss the essential design factors involved in building a university program to complement local COVID-19 response efforts, including workflows for case management, volunteer case investigator recruitment and training, secure technology platforms for conducting case investigations remotely, and robust data-tracking procedures for maintaining quality control and timely case reporting.


Assuntos
COVID-19/epidemiologia , Call Centers/organização & administração , Busca de Comunicante/métodos , Surtos de Doenças/prevenção & controle , Colaboração Intersetorial , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Arizona/epidemiologia , Humanos , Prática de Saúde Pública , SARS-CoV-2 , Estudantes , Universidades , Voluntários , Recursos Humanos/organização & administração
19.
J Med Toxicol ; 18(1): 38-42, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34665424

RESUMO

INTRODUCTION: Crotalidae immune F(ab')2 (Fab2AV) became available in the USA in 2019 for treatment of rattlesnake envenomation. In the clinical trial comparing Fab2AV to crotalidae immune polyvalent fab (FabAV), Fab2AV was associated with less late hemotoxicity. The purpose of this study was to describe outcomes following use of Fab2AV in patients with rattlesnake envenomation in Arizona. METHODS: This is an observational study of patients admitted to a medical toxicology service at two hospitals in Arizona between January 1, 2019 and December 31, 2020. Patients with rattlesnake envenomation who received Fab2AV were included. Patients who received FabAV, alone or in combination with Fab2AV, were excluded. The main outcomes of interest were antivenom dose, adverse reactions, late hemotoxicity, and hospital readmission or retreatment. RESULTS: Forty-six patients were included. The mean age was 40 years, with 15% under 12 years of age. All exhibited swelling, 20% thrombocytopenia, and 35% coagulopathy. Median time to treatment was 3 h and median total Fab2AV dose was 20 vials. Three patients had an acute reaction to Fab2AV which was non-life-threatening and resolved with antihistamines and/or steroids. In the follow-up period, one case of delayed thrombocytopenia (platelets = 108 K/mm3) and one case of recurrent thrombocytopenia (platelets = 111 K/mm3) were identified. There was no late coagulopathy. Five patients reported symptoms consistent with mild serum sickness. CONCLUSIONS: In this series of patients with rattlesnake envenomation in Arizona who were treated with Fab2AV, there were no cases of clinically significant late hemotoxicity, and no patients required late retreatment with antivenom. Acute and delayed reactions did occur in some patients but were mild and easily treated.


Assuntos
Venenos de Crotalídeos , Mordeduras de Serpentes , Adulto , Animais , Antivenenos/uso terapêutico , Arizona , Crotalus , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico
20.
J Virol ; 96(3): e0109821, 2022 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-34668771

RESUMO

Paramyxoviruses are a diverse group of negative-sense, single-stranded RNA viruses of which several species cause significant mortality and morbidity. In recent years the collection of paramyxovirus sequences detected in wild mammals has substantially grown; however, little is known about paramyxovirus diversity in North American mammals. To better understand natural paramyxovirus diversity, host range, and host specificity, we sought to comprehensively characterize paramyxoviruses across a range of diverse cooccurring wild small mammals in southern Arizona. We used highly degenerate primers to screen fecal and urine samples and obtained a total of 55 paramyxovirus sequences from 12 rodent species and 6 bat species. We also performed Illumina transcriptome sequencing (RNA-seq) and de novo assembly on 14 of the positive samples to recover a total of 5 near-full-length viral genomes. We show there are at least two clades of rodent-borne paramyxoviruses in Arizona, while bat-associated paramyxoviruses formed a putative single clade. Using structural homology modeling of the viral attachment protein, we infer that three of the five novel viruses likely bind sialic acid in a manner similar to other respiroviruses, while the other two viruses from heteromyid rodents likely bind a novel host receptor. We find no evidence for cross-species transmission, even among closely related sympatric host species. Taken together, these data suggest paramyxoviruses are a common viral infection in some bat and rodent species present in North America and illuminate the evolution of these viruses. IMPORTANCE There are a number of viral lineages that are potential zoonotic threats to humans. One of these, paramyxoviruses have jumped into humans multiple times from wild and domestic animals. We conducted one of the largest viral surveys of wild mammals in the United States to better understand paramyxovirus diversity and evolution.


Assuntos
Doenças dos Animais/epidemiologia , Doenças dos Animais/virologia , Quirópteros/virologia , Infecções por Paramyxoviridae/veterinária , Paramyxoviridae/classificação , Paramyxoviridae/genética , Sequência de Aminoácidos , Doenças dos Animais/diagnóstico , Animais , Arizona/epidemiologia , Biodiversidade , Evolução Biológica , Genoma Viral , Genômica/métodos , Geografia Médica , Sequenciamento de Nucleotídeos em Larga Escala , Especificidade de Hospedeiro , Humanos , Modelos Moleculares , Técnicas de Diagnóstico Molecular/métodos , América do Norte/epidemiologia , Filogenia , Ligação Proteica , RNA Viral , Receptores Virais/química , Receptores Virais/metabolismo , Respirovirus/classificação , Respirovirus/genética , Infecções por Respirovirus/veterinária , Roedores/virologia
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