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1.
Nutrients ; 13(12)2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34960068

RESUMO

Psychosocial factors may influence consumption patterns of sweet snacks and sugar sweetened beverages (SSB), which are potential risk factors for obesity among African American (AA) adolescents. We used multivariable linear and logistic regression models to examine cross-sectional associations among psychosocial factors, sweet snacks and SSB consumption, and BMI z-scores in 437 AA adolescents aged 9-14 years living in low-income neighborhoods in Baltimore City, U.S.A. Mean caloric intake from sugar was 130.64 ± 88.37 kcal. Higher sweet snacks consumption was significantly associated with lower self-efficacy (adjusted Odds Ratio (aOR) = 0.81; 95% CI = 0.71 to 0.93) and lower food intentions scores (0.43; 0.30 to 0.61). Higher SSB consumption was associated with lower outcome expectancies (aOR = 0.98; 95% CI = 0.96-0.99), lower self-efficacy (0.98; 0.96 to 0.99), and lower food intentions (0.91; 0.87 to 0.95). No significant association was found between SSB and sweet snacks consumption and weight status. Psychosocial factors may play a role in sugar consumption behaviors among AA adolescents in low-income neighborhoods. Further studies are needed to improve our understanding of causal mechanisms of this association.


Assuntos
Comportamento do Adolescente , Afro-Americanos , Dieta Saudável , Autoeficácia , Lanches , Bebidas Adoçadas com Açúcar , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Baltimore , Doces , Comportamento do Consumidor , Ingestão de Energia , Feminino , Preferências Alimentares , Comportamentos Relacionados com a Saúde , Humanos , Intenção , Masculino , Inquéritos Nutricionais , Pobreza
2.
Am J Phys Med Rehabil ; 100(11): 1027-1030, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508061

RESUMO

ABSTRACT: Rehabilitation experts play an important role in preventing hospital-acquired debility, increasing patients' abilities to safely perform activities of daily living, and facilitating discharge to the home setting for patients with COVID-19. Surges in COVID-19 hospitalization rates combined with increases in length of hospital stay and decreases in postacute care placements have necessitated the opening of COVID-19 field hospitals around the country. Most field hospitals lack the resources to offer a full suite of rehabilitation services, but there are opportunities for small teams of rehabilitation experts to increase their reach by using innovative strategies. This article describes the implementation of a small team of rehabilitation experts in a COVID-19 field hospital and strategies used by this team to maximize patient activity and mobility, facilitate timely discharge, and maximize the number of patients discharged to the home setting. Strategies include training nonclinical staff to assist with activity and mobility promotion and using a rehabilitation triage system to determine needs of individual patients and facilitate efficient resource utilization. The authors reflect on successful aspects of these strategies, as well as barriers to rehabilitation implementation, and make recommendations for other field hospitals seeking to implement rehabilitation during the COVID-19 pandemic or future health crises.


Assuntos
COVID-19/reabilitação , Unidades Móveis de Saúde/organização & administração , Atividades Cotidianas , Baltimore , Feminino , Humanos , Tempo de Internação , Masculino , Pandemias , Alta do Paciente , Recuperação de Função Fisiológica , SARS-CoV-2 , Cuidados Semi-Intensivos
3.
Psychol Aging ; 36(6): 710-717, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34516174

RESUMO

Physical fatigability, or susceptibility to physical fatigue, is strongly associated with aging, disease, and disability. Over the lifecourse, personality traits are also connected to numerous age-related vulnerabilities and resistance-yet, their longitudinal association with fatigability remains unknown. Well-functioning community-dwelling volunteers aged ≥50 (N = 995) from the Baltimore Longitudinal Study of Aging (BLSA) were assessed over an average of 2 years on personality traits (NEO-PI-R; openness, conscientiousness, extraversion, agreeableness, and neuroticism) and perceived fatigability [Borg Rating of Perceived Exertion (RPE) after a 5-min slow treadmill walk; 6 (low) to 20 (high) exertion]. Linear and multinomial logistic regression models examined cross-sectional associations [treating fatigability continuously and by RPE category: low (6-7), intermediate (8-9), and high (10+)]. Generalized estimating equations (GEE) tested longitudinal associations. All models were adjusted for demographics and comorbid conditions. In cross-sectional models, openness, ß = -.09 RPE (SE =.03); p < .01, conscientiousness, ß = -.07 (.03); p < .05, and extraversion, ß = -.10 (.03); p < .01, were negatively associated with fatigability. In parallel, lower openness, OR: .98, 95% CI [.96-1.00], conscientiousness, OR: .98, 95% CI [.96-1.00], and extraversion, OR: .97, 95% CI [.95-.99], corresponded with higher odds of having high versus low fatigability. In longitudinal models (mean follow-up time 2 ± 2 years), openness, conscientiousness, and extraversion associations remained significant and did not change over time (Trait × Year p values > .34). Together, findings suggest that personality plays a role in the perceived tolerance of fatigue in well-functioning older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Envelhecimento/psicologia , Fadiga/psicologia , Vida Independente/psicologia , Personalidade , Idoso , Baltimore , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino
4.
Nutrients ; 13(9)2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34578934

RESUMO

Policy interventions to improve food access and address the obesity epidemic among disadvantaged populations are becoming more common throughout the United States. In Baltimore MD, corner stores are a frequently used source of food for low-income populations, but these stores often do not provide a range of affordable healthy foods. This research study aimed to assist city policy makers as they considered implementing a Staple Food Ordinance (SFO) that would require small stores to provide a range and depth of stock of healthy foods. A System Dynamics (SD) model was built to simulate the complex Baltimore food environment and produce optimal values for key decision variables in SFO planning. A web-based application was created for users to access this model to optimize future SFOs, and to test out different options. Four versions of potential SFOs were simulated using this application and the advantages and drawbacks of each SFO are discussed based on the simulation results. These simulations show that a well-designed SFO has the potential to reduce staple food costs, increase corner store profits, reduce food waste, and expand the market for heathy staple foods.


Assuntos
Dieta Saudável/métodos , Política Nutricional/economia , Obesidade/prevenção & controle , Supermercados , Baltimore , Abastecimento de Alimentos , Humanos , Marketing , Política Nutricional/legislação & jurisprudência , Pobreza
6.
J Health Care Poor Underserved ; 32(3): 1584-1603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421050

RESUMO

Cisgender female sex workers (FSW) have low rates of health care utilization and persistent health disparities. The study uses baseline data from a structural intervention to understand health care access with cisgender FSW with substance use histories (N=370) in Baltimore, Maryland. The four outcome categories measuring health care access in the past six months were: no health care use/barrier to care (16% of sample), no use/no barrier (24%), use/barrier (25%), use/no barrier (36%, most able to access care). Using multinomial logistic regression, we found client-perpetrated violence, depressive symptoms, non-medical prescription opioid use, and history of drug use disclosure to providers associated with higher odds of being in groups with diminished health care access compared with use/no barrier. Colocating mental health and violence support with existing services used and trusted by FSW may remove structural and logistical barriers to care. Integrating harm reduction in health care settings can destigmatize substance use, fostering openness for substance use disclosure.


Assuntos
Profissionais do Sexo , Transtornos Relacionados ao Uso de Substâncias , Baltimore/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Violência
7.
Nutrients ; 13(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445008

RESUMO

The purpose of this study was to compare changes in bone mineral density (BMD) over a 6 month follow up (period of weight regain) in overweight, postmenopausal women having previously completed a 6 month weight loss (WL) intervention with and without aerobic exercise (AEX). Women (BMI > 25 kg/m2) underwent VO2max and DEXA scans at baseline, after 6 months of WL or AEX + WL, and at 12 months ad libitum follow up. Both groups lost ~9% body weight from 0 to 6 months and regained ~2% from 6 to 12 months, while losing ~4% of appendicular lean mass (ALM) across the 12-month study duration. VO2max increased 10% from 0 to 6 months and declined 12% from 6 to 12 months for AEX + WL, with no changes for WL. Total body (p < 0.01) and total femur (p = 0.03) BMD decreased similar between groups across time (combined groups: 0-6 months: total body: -1.2% and total femur: -1.2%; 6-12 months: total body: -0.26% and total femur: -0.09%). Less ALM loss and greater VO2max increases during the WL phase were associated with attenuated BMD loss at various anatomical sites during periods of weight regain (6-12 months) p's < 0.05). Results suggest that BMD loss may continue following WL, despite weight regain. Further, this study adds to the literature by suggesting that preventing declines in muscle quality and function during WL may attenuate the loss of BMD during weight regain. Future studies are needed to identify mechanisms underlying WL-induced bone loss so that effective practices can be designed to minimize the loss of BMD during WL and weight maintenance in older women.


Assuntos
Densidade Óssea , Dieta Saudável , Terapia por Exercício , Sobrepeso/terapia , Ganho de Peso , Perda de Peso , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Baltimore , Composição Corporal , Restrição Calórica , Feminino , Humanos , Corrida Moderada , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/fisiopatologia , Aptidão Física , Pós-Menopausa , Treinamento de Força , Fatores de Tempo , Resultado do Tratamento , Caminhada
8.
BMC Health Serv Res ; 21(1): 711, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284785

RESUMO

BACKGROUND: Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south. METHODS: The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or 'change packages', (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous 'plan-do-study-act' (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation. RESULTS: Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %. CONCLUSIONS: Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.


Assuntos
Infecções por HIV , Melhoria de Qualidade , Adolescente , Baltimore , Botsuana , Criança , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Institucionalização , Quênia/epidemiologia , Nigéria , Ruanda , Tanzânia , Zâmbia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34209951

RESUMO

This study aimed to evaluate the association of the overall nutritional quality and the weight share of specific types of foods received by food pantry clients with food pantry size and distribution method. Data on healthy food weights using the gross weight share (GWS) of select foods and the validated Food Assortment Score Tool (FAST) were collected from 75 food pantry clients in Baltimore, Maryland. The average FAST score across the study population was 63.0 (SD: 10.4). Overall, no statistically significant differences in average FAST scores by pantry size and distribution method were found. However, among client-choice pantries, clients of small pantries had higher scores (p < 0.05) while among medium pantries, clients of traditional pantries had higher scores (p < 0.01). Subgroup analysis of GWS was stratified by pantry size and distribution methods. Findings suggested multi-level, multi-component interventions combining environmental strategies are needed to enhance the healthfulness of foods received by clients. Our analysis provided data to consider further refinements of pantry interventions and planning of more rigorous research on factors influencing the effectiveness of pantry interventions.


Assuntos
Assistência Alimentar , Baltimore , Alimentos , Abastecimento de Alimentos , Humanos , Valor Nutritivo
10.
J Subst Abuse Treat ; 127: 108349, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34134866

RESUMO

Buprenorphine, an effective treatment for opioid use disorder (OUD), remains underutilized in many U.S. jails and prisons. However, use of non-prescribed (i.e., diverted) buprenorphine has been reported in these settings. The current study examined non-prescribed buprenorphine use experiences in correctional and community contexts. The study conducted face-to-face interviews with 300 adults with OUD/opioid misuse and recent incarceration, recruited in Baltimore, MD, and New York, NY (n = 150 each). Illicit/non-prescribed opioid use during incarceration was reported by 63% of participants; 39% reported non-prescribed buprenorphine. Non-prescribed buprenorphine was considered the most widely available opioid in jails/prisons in both states (81% reported "very" or "somewhat" easy to get). The average price of non-prescribed buprenorphine in jail/prison was ~10× higher than in the community (p < 0.001). Participants were more likely to endorse getting high/mood alteration as reasons for using non-prescribed buprenorphine during incarceration, but tended to ascribe therapeutic motives to use in the community (e.g., self-treatment; p < 0.001). Multivariable logistic regression analyses showed that different individual-level characteristics were associated with history of non-prescribed buprenorphine use during incarceration and in the community. Use of non-prescribed buprenorphine during incarceration was associated with younger age (p = 0.006) and longer incarceration history (p < 0.001), while use of non-prescribed buprenorphine in the community was associated with MD recruitment site (p = 0.001), not being married (p < 0.001), prior buprenorphine treatment experience (p < 0.001), and housing situation (p = 0.01). These findings suggest that different dynamics and demand characteristics underlie the use of non-prescribed buprenorphine in community and incarceration contexts, with implications for efforts to expand OUD treatment in correctional settings.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Prisioneiros , Adulto , Baltimore , Buprenorfina/uso terapêutico , Direito Penal , Humanos , New York , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
11.
Contraception ; 104(4): 367-371, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34118267

RESUMO

OBJECTIVES: To explore young men's perceived experience of coercive pregnancy behaviors by female partners, and engagement in and behavioral overlap of these occurrences in this sample. STUDY DESIGN: Heterosexually active young men aged 15 to 24 (n = 39), recruited from 3 primary care and 2 sexually transmitted disease clinics in Baltimore, MD city over a 2-week period, were surveyed on their perceived experience of and engagement in coercive pregnancy behaviors, attitudes about women, and background characteristics. RESULTS: Of 130 invited, 66 (51%) agreed to participate, 39 of whom were heterosexual young men; 87% were non-Hispanic Black and 59% were aged 20 to 24. Eleven (28%) perceived one or more coercive pregnancy behaviors by a partner and nine (23%) engaged in one or more coercive behavior. Most (58%) agreed women are responsible for birth control decisions, but 55% believed women could not be trusted to tell the truth about contraceptive use and 68% believe women would like to get pregnant. CONCLUSIONS: Over one-third of young men in this sample perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings have implications for promoting healthy relationships among young people. IMPLICATIONS: This study found over one-third of young men perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings highlight the need for research to include young men in examining coercive pregnancy behaviors. Findings also highlight the need to develop strategies to support educational and clinical approaches to address young men's role as partners in healthy contraceptive practices.


Assuntos
Homens , Parceiros Sexuais , Adolescente , Baltimore , Coerção , Anticoncepção , Feminino , Humanos , Masculino , Gravidez , Comportamento Sexual
12.
Am J Prev Med ; 61(2): e93-e101, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34039496

RESUMO

INTRODUCTION: In an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending, efforts to address the root causes of health are urgently needed. Research linking medical spending to variation in neighborhood resources is critical to building the case for increased funding for social conditions. However, few studies link neighborhood factors to medical spending. This study assesses the relationship between neighborhood social and environmental resources and medical spending across the spending distribution. METHODS: Individual-level health outcomes were drawn from a sample of Medicaid enrollees living in Baltimore, Maryland during 2016. A multidimensional index of neighborhood social and environmental resources was created and stratified by tertile (high, medium, and low). Differences were examined in individual-level medical spending associated with living in high-, medium-, or low-resource neighborhoods in unadjusted and adjusted 2-part models and quantile regression models. Analyses were conducted in 2019. RESULTS: Enrollees who live in neighborhoods with low social and environmental resources incur significantly higher spending at the mean and across the distribution of medical spending even after controlling for age, race, sex, and morbidity than those who live in neighborhoods with high social and environmental resources. On average, this spending difference between individuals in low- and those in high-resource neighborhoods is estimated to be $523.60 per person per year. CONCLUSIONS: Living in neighborhoods with low (versus those with high) resources is associated with higher individual-level medical spending across the distribution of medical spending. Findings suggest potential benefits from efforts to address the social and environmental context of neighborhoods in addition to the traditional orientation to addressing individual behavior and risk.


Assuntos
COVID-19 , Medicaid , Baltimore , Humanos , Características de Residência , SARS-CoV-2
13.
J Community Psychol ; 49(5): 994-1009, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33937999

RESUMO

There is a need to understand why some strategies work better than others for engaging vulnerable Black adolescents in prevention research, especially those who are affected by parental drug use. The current study sought to fill this gap. Thirty in-depth interviews were conducted with parents who reported a history of illicit drug use (N = 11), young adults who had a biological parent with a history of illicit drug use (N = 14), and service providers who work with families affected by illicit drug use (N = 5). Nearly all participants were Black and lived or worked in Baltimore, Maryland. Over half of the participants were female (62%). Interviews were recorded and ranged from 30 to 92 minutes in length. Data were analyzed using an inductive, content analysis approach. Four themes emerged (coined STAR): SAFE people and places minimize retraumatization; TEAMING UP with community partners increases acceptability; ADDRESSING a range of needs helps adolescents survive; and RELATABLE facilitators understand and listen to adolescents. Findings build onto and extend previous research that highlights strategies to recruit and retain vulnerable Black adolescents in prevention research.


Assuntos
Afro-Americanos , Pais , Adolescente , Baltimore , Feminino , Humanos , Adulto Jovem
14.
AIDS Behav ; 25(10): 3386-3397, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33974166

RESUMO

Female sex workers' (FSWs) risk for HIV/STIs is influenced by their work environments. While previous research has characterized vulnerability in a single workplace, many FSWs solicit clients from multiple settings. Using latent class analysis (LCA), we examined client solicitation patterns and associated HIV/STI-related behaviors (consistent condom use with clients, asking clients about HIV/STIs, and past 6-month HIV/STI testing) among 385 FSWs in Baltimore, Maryland. The LCA yielded a three-class solution: predominantly street (61.2%), mixed street/venue (23.7%), and multisource (street, venue, and online) (15.1%). Consistent condom use differed significantly (p < 0.01) by class, with the mixed street/venue having the lowest (40.6%) rate and the multisource having the highest (70.6%). Classes differed on HIV/STI testing (p < 0.01), with the predominantly street class having the lowest testing rate (56.2%) and multisource with the highest (85.7%). These findings underscore the importance of considering how solicitation patterns are linked to HIV/STI susceptibility of FSWs and adapting interventions accordingly.


Assuntos
Infecções por HIV , Profissionais do Sexo , Doenças Sexualmente Transmissíveis , Baltimore/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Fatores de Risco , Trabalho Sexual , Doenças Sexualmente Transmissíveis/epidemiologia
15.
Health Aff (Millwood) ; 40(5): 802-811, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939507

RESUMO

The accessibility of pharmacies may be an overlooked contributor to persistent racial and ethnic disparities in the use of prescription medications and essential health care services within urban areas in the US. We examined the availability and geographic accessibility of pharmacies across neighborhoods based on their racial/ethnic composition in the thirty most populous US cities. In all cities examined, we found persistently fewer pharmacies located in Black and Hispanic/Latino neighborhoods than White or diverse neighborhoods throughout 2007-15. In 2015 there were disproportionately more pharmacy deserts in Black or Hispanic/Latino neighborhoods than in White or diverse neighborhoods, including those that are not federally designated Medically Underserved Areas. These disparities were most pronounced in Chicago, Illinois; Los Angeles, California; Baltimore, Maryland; Philadelphia, Pennsylvania; Milwaukee, Wisconsin; Dallas, Texas; Boston, Massachusetts; and Albuquerque, New Mexico. We also found that Black and Hispanic/Latino neighborhoods were more likely to experience pharmacy closures compared with other neighborhoods. Our findings suggest that efforts to increase access to medications and essential health care services, including in response to COVID-19, should consider policies that ensure equitable pharmacy accessibility across neighborhoods in US cities. Such efforts could include policies that encourage pharmacies to locate in pharmacy deserts, including increases to Medicaid and Medicare reimbursement rates for pharmacies most at risk for closure.


Assuntos
COVID-19 , Farmácias , Afro-Americanos , Idoso , Baltimore , Boston , Chicago , Acesso aos Serviços de Saúde , Humanos , Illinois , Los Angeles , Massachusetts , Medicare , New Mexico , Philadelphia , SARS-CoV-2 , Texas , Estados Unidos , Wisconsin
16.
Sci Transl Med ; 13(593)2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980576

RESUMO

Effective treatment of sexually transmitted infections (STIs) is limited by diagnostics that cannot deliver results rapidly while the patient is still in the clinic. The gold standard methods for identification of STIs are nucleic acid amplification tests (NAATs), which are too expensive for widespread use and have lengthy turnaround times. To address the need for fast and affordable diagnostics, we have developed a portable, rapid, on-cartridge magnetofluidic purification and testing (PROMPT) polymerase chain reaction (PCR) test. We show that it can detect Neisseria gonorrhoeae, the pathogen causing gonorrhea, with simultaneous genotyping of the pathogen for resistance to the antimicrobial drug ciprofloxacin in <15 min. The duplex test was integrated into a low-cost thermoplastic cartridge with automated processing of penile swab samples from patients using magnetic beads. A compact instrument conducted DNA extraction, PCR, and analysis of results while relaying data to the user via a smartphone app. This platform was tested on penile swab samples from sexual health clinics in Baltimore, MD, USA (n = 66) and Kampala, Uganda (n = 151) with an overall sensitivity and specificity of 97.7% (95% CI, 94.7 to 100%) and 97.6% (95% CI, 94.1 to 100%), respectively, for N. gonorrhoeae detection and 100% concordance with culture results for ciprofloxacin resistance. This study paves the way for delivering accessible PCR diagnostics for rapidly detecting STIs at the point of care, helping to guide treatment decisions and combat the rise of antimicrobial resistant pathogens.


Assuntos
Gonorreia , Doenças Sexualmente Transmissíveis , Baltimore , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Neisseria gonorrhoeae/genética , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Uganda
17.
Sleep ; 44(9)2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-33791794

RESUMO

STUDY OBJECTIVE: To examine associations of personality dimensions and facets with insomnia symptoms in a community sample of older adults. METHODS: We studied 1049 participants aged 60-97 years in the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R), and insomnia symptom severity was measured by the Women's Health Initiative Insomnia Rating Scale (WHIIRS). RESULTS: Adjusting for demographic characteristics, higher neuroticism, lower conscientiousness, and lower extraversion were associated with greater insomnia symptom severity. These associations remained significant for neuroticism and conscientiousness when further adjusting for depressive symptoms and comorbidities. Higher scores on neuroticism facets Anxiety, Angry Hostility, and Depression, and lower scores on conscientiousness facets Competence, Order, and Achievement Striving and on agreeableness facet Altruism were associated with greater insomnia symptom severity in fully adjusted models. Results were similar among cognitively normal older adults (N = 966), except higher scores on extraversion facets Warmth and Assertiveness associated with lower insomnia symptom severity, and agreeableness facet Altruism was unassociated. CONCLUSION: Among older adults, insomnia symptoms appear partially related to personality, with persons higher in neuroticism experiencing greater insomnia symptom severity, and those higher in conscientiousness experiencing lower insomnia symptom severity. Exploring facets of the Big-Five dimensions may provide additional insight regarding the etiology and resolution of sleep disturbance, and some of these associations may differ based on cognitive status. Future studies should investigate the hypothesis that sleep impairment mediates part of the association between specific personality traits and health-related outcomes.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Idoso , Envelhecimento , Baltimore/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Personalidade , Inventário de Personalidade , Distúrbios do Início e da Manutenção do Sono/epidemiologia
18.
PLoS One ; 16(4): e0249414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793642

RESUMO

In response to the pandemic in early 2020, cities implemented states of emergency and stay at home orders to reduce virus spread. Changes in social dynamics due to local restrictions impacted human behavior and led to a shift in crime dynamics. We analyze shifts in crime types by comparing crimes before the implementation of stay at home orders and the time period shortly after these orders were put in place across three cities. We find consistent changes across Chicago, Baltimore, and Baton Rouge with significant declines in total crimes during the time period immediately following stay at home orders. The starkest differences occurred in Chicago, but in all three cities the crime types contributing to these declines were related to property crime and statutory crime rather than interpersonal crimes.


Assuntos
COVID-19 , Crime/estatística & dados numéricos , Pandemias , Quarentena , Baltimore , Chicago , Humanos , Louisiana
19.
J Acquir Immune Defic Syndr ; 87(5): 1145-1153, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-33883471

RESUMO

BACKGROUND: Reducing HIV incidence requires addressing persistent racial/ethnic disparities in HIV burden. Our goal was to evaluate preexposure prophylaxis (PrEP) delivery, overall and relative to community need, among 7 clinical sites participating in a health department-led demonstration project to increase PrEP in Baltimore city, MD. METHODS: PrEP care continuum stages (screened, indicated, referred, linked, evaluated, prescribed) were examined among HIV-negative individuals receiving services at participating sites between September 30, 2015 and September 29, 2019. Community need was defined using information on new HIV diagnoses (2016-2018). Differences in care continuum progression by demographics/priority population and comparison of demographic compositions between care continuum stages and new HIV diagnoses were examined using modified Poisson regression and χ2 tests, respectively. RESULTS: Among 25,886 PrEP-screened individuals, the majority were non-Hispanic (NH) black (81.1%, n = 20,998), cisgender male (61.1%, n = 15,825), and heterosexual (86.7%, n = 22,452). Overall, 31.1% (n = 8063) were PrEP-indicated; among whom, 56.8% (n = 4578), 15.6% (n = 1250), 10.8% (n = 868), and 9.0% (n = 722) were PrEP-referred, linked, evaluated, and prescribed, respectively. Among 2870 men who have sex with men (MSM), 18.7% (n = 538) were PrEP-prescribed. Across all groups, the highest attrition was between PrEP-referred and PrEP-linked. NH-black race (vs. NH-white) was independently associated with lower likelihood of PrEP prescription (aPR, 0.89; 95% confidence interval, 0.81 to 0.98 controlling for age/gender). Relative to the demographic composition of new HIV diagnoses, fewer NH-blacks (80.2% vs. 54.3%) and more NH-whites (10.7% vs. 30.3%) and MSM were PrEP prescribed (55.2% vs. 74.5%). CONCLUSIONS: This project showed promise delivering PrEP referrals and prescriptions overall and to MSM. Substantial improvement is needed to improve linkage overall and to decrease disparities in PrEP prescriptions among NH-blacks. Future work should focus on addressing service gaps that hinder PrEP utilization.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Disparidades em Assistência à Saúde , Profilaxia Pré-Exposição , Adulto , Baltimore/epidemiologia , Continuidade da Assistência ao Paciente , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Prev Sci ; 22(5): 621-632, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33826057

RESUMO

Initiation of non-medical prescription opioid use (NMPO) during early adolescence is tightly linked to heroin and other drug use disorders and related sequelae in later adolescence and young adulthood. Few studies explore stakeholders' perspectives on the burden and determinants of youth opioid use and barriers and facilitators to engaging youth in opioid use prevention and treatment services in urban settings with longstanding opioid epidemics. In-depth interviews were conducted with 22 stakeholders representing health and social service agencies in Baltimore, Maryland from May 2018- February 2019, to examine their perspectives on the burden and context of adolescent opioid use and identify barriers and facilitators to preventing and responding to adolescent opioid use. Transcripts were analyzed using the constant comparison method to identify themes. Most respondents described a recent uptick in opioid use independently, and in combination with other substances. As compared to heroin, NMPO was perceived to be more frequently used and less stigmatized among youth. Stakeholders perceived the process of transitioning from using NMPO to heroin as more common among White vs. Black youth and was perceived as occurring faster among White vs. Black youth. Some stakeholders believed racial differences in internal stigma against heroin use, and differential health service use among Black youth and White youth may have influenced these differences. Trauma and poverty were noted determinants of youth opioid use. Barriers to service provision included youth cognitive development, stigma and structural factors (e.g., disinvestment, lack of youth-centered and integrated services). Stakeholders perceive prevalent NMPO among Baltimore youth and identify multilevel barriers to delivering prevention, treatment and harm reduction services to this population. These findings encourage further investigation of determinants and consequences of opioid use among diverse racial/ethnic groups of youth in urban settings, and development of multilevel, youth-driven and youth-centered approaches to prevention and treatment.


Assuntos
Heroína , Transtornos Relacionados ao Uso de Opioides , Adolescente , Adulto , Afro-Americanos , Analgésicos Opioides , Baltimore , Humanos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Adulto Jovem
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