Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.346
Filtrar
1.
Med J Aust ; 216(10): C1-C2, 2022 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-35665509
2.
JAMA Netw Open ; 5(6): e2216355, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35737390

RESUMO

Importance: Racial and ethnic disparities in postpartum care access have been well identified in the United States. Such disparities could be exacerbated by the COVID-19 pandemic because of amplified economic distress and compromised social capital among pregnant women who belong to racial or ethnic minority groups. Objective: To examine whether the COVID-19 pandemic is associated with an increase in the existing racial and ethnic disparity in postpartum care access. Design, Setting, and Participants: This was a retrospective cohort study using electronic health records data. Multinomial logistic regressions in an interrupted time series approach were used to assess monthly changes in postpartum care access across Asian, Hispanic, non-Hispanic Black (hereafter, Black), non-Hispanic White (hereafter, White) women, and women of other racial groups, controlling for maternal demographic and clinical characteristics. Eligible participants were women who gave live birth at 8 hospitals in the greater Boston, Massachusetts, area from January 1, 2019, to November 30, 2021, allowing for tracking 90-day postpartum access until March 1, 2022. Exposures: Delivery period: prepandemic (January to December 2019), early pandemic (January to March 2020), and late pandemic (April 2020 to November 2021). Main Outcomes and Measures: Postpartum care within 90 days after childbirth was categorized into 3 groups: attended, canceled, and nonscheduled. Results: A total of 45 588 women were included. Participants were racially and ethnically diverse (4735 [10.4%] Asian women, 3399 [7.5%] Black women, 6950 [15.2%] Hispanic women, 28 529 [62.6%] White women, and 1269 [2.8%] women of other race or ethnicity). The majority were between 25 and 34 years of age and married and had a full-term pregnancy, vaginal delivery, and no clinical conditions. In the prepandemic period, the overall postpartum care attendance rate was 75.2%, dropping to 41.7% during the early pandemic period, and rebounding back to 60.9% in the late pandemic period. During the months in the late pandemic, the probability of not scheduling postpartum care among Black (average marginal effect [AME], 1.1; 95% CI, 0.6-1.6) and Hispanic women (AME, 1.3; 95% CI, 0.9-1.6) increased more than among their White counterparts. Conclusions and Relevance: In this cohort study of postpartum care access before and during the COVID-19 pandemic, racial and ethnic disparities in postpartum care were exacerbated following the onset of the COVID-19 pandemic, when postpartum care access recovered more slowly among Black and Hispanic women than White women. These disparities require swift attention and amelioration to address barriers for these women to obtain much needed postpartum care during this pandemic.


Assuntos
COVID-19 , Etnicidade , Boston/epidemiologia , COVID-19/epidemiologia , Estudos de Coortes , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Grupos Minoritários , Pandemias , Cuidado Pós-Natal , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
Sci Total Environ ; 840: 156625, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-35691344

RESUMO

Many techniques for estimating exposure to airborne contaminants do not account for building characteristics that can magnify contaminant contributions from indoor and outdoor sources. Building characteristics that influence exposure can be challenging to obtain at scale, but some may be incorporated into exposure assessments using public datasets. We present a methodology for using public datasets to generate housing models for a test cohort, and examined sensitivity of predicted fine particulate matter (PM2.5) exposures to selected building and source characteristics. We used addresses of a cohort of children with asthma and public tax assessor's data to guide selection of floorplans of US residences from a public database. This in turn guided generation of coupled multi-zone models (CONTAM and EnergyPlus) that estimated indoor PM2.5 exposure profiles. To examine sensitivity to model parameters, we varied building floors and floorplan, heating, ventilating and air-conditioning (HVAC) type, room or floor-level model resolution, and indoor source strength and schedule (for hypothesized gas stove cooking and tobacco smoking). Occupant time-activity and ambient pollutant levels were held constant. Our address matching methodology identified two multi-family house templates and one single-family house template that had similar characteristics to 60 % of test addresses. Exposure to infiltrated ambient PM2.5 was similar across selected building characteristics, HVAC types, and model resolutions (holding all else equal). By comparison, exposures to indoor-sourced PM2.5 were higher in the two multi-family residences than the single family residence (e.g., for cooking PM2.5 exposure, by 26 % and 47 % respectively) and were sensitive to HVAC type and model resolution. We derived the influence of building characteristics and HVAC type on PM2.5 exposure indoors using public data sources and coupled multi-zone models. With the important inclusion of individualized resident behavior data, similar housing modeling can be used to incorporate exposure variability in health studies of the indoor residential environment.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Boston , Criança , Exposição Ambiental/análise , Monitoramento Ambiental , Habitação , Humanos , Tamanho da Partícula , Material Particulado/análise
4.
Sci Data ; 9(1): 330, 2022 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725848

RESUMO

A pandemic, like other disasters, changes how systems work. In order to support research on how the COVID-19 pandemic impacted the dynamics of a single metropolitan area and the communities therein, we developed and made publicly available a "data-support system" for the city of Boston. We actively gathered data from multiple administrative (e.g., 911 and 311 dispatches, building permits) and internet sources (e.g., Yelp, Craigslist), capturing aspects of housing and land use, crime and disorder, and commercial activity and institutions. All the data were linked spatially through BARI's Geographical Infrastructure, enabling conjoint analysis. We curated the base records and aggregated them to construct ecometric measures (i.e., descriptors of a place) at various geographic scales, all of which were also published as part of the database. The datasets were published in an open repository, each accompanied by a detailed documentation of methods and variables. We anticipate updating the database annually to maintain the tracking of the records and associated measures.


Assuntos
COVID-19 , Bases de Dados Factuais , Boston/epidemiologia , COVID-19/epidemiologia , Gerenciamento de Dados , Humanos , Pandemias
5.
Sci Rep ; 12(1): 7701, 2022 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-35546594

RESUMO

According to the attention restoration theory, exposure to nature (ETN) renews one's capacity to focus attention, which decreases cognitive fatigue and therefore may increase positive emotions. Indeed, natural settings have been associated with high prevalence of happy facial expressions (HFE). However, how universal the association is, remains unclear. We explored the ETN-HFE association in Boston, US, representing a less collectivistic culture, and Yokohama, Japan, representing a more collectivistic one. Evidence from satellite images and social network data, using geoinformatics and statistical tools, revealed that individuals from both societies exhibited more happiness when they were photographed in more natural settings. These associations varied with temporal variations expressed through weekly and annual effects. In addition, we found that the presence of others was also associated with prevalence of HFE in natural settings at Yokohama and Boston but the relation was significantly stronger in Boston. Despite some relatively minor differences between the countries, these results support the universality of the association between ETN and HFE.


Assuntos
Expressão Facial , Felicidade , Boston , Emoções , Humanos , Individualidade , Japão
6.
BMC Health Serv Res ; 22(1): 683, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35597947

RESUMO

BACKGROUND: In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation. METHODS: We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR. RESULTS: Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority). CONCLUSIONS: Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators' patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload. TRIAL REGISTRATION: Clinical Trial Registration Number NCT03514433 , 5/2/2018.


Assuntos
Neoplasias da Mama , Navegação de Pacientes , Boston , Neoplasias da Mama/terapia , Feminino , Humanos , Pesquisa Qualitativa , Encaminhamento e Consulta
7.
Cell Rep Med ; 3(3): 100566, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35584658

RESUMO

Pamela Klein, Nurse Manager of Transgender Services at Boston Health Care for the Homeless Program (BHCHP) and Nurse Liaison for Boston Medical Center (BMC)'s Center for Transgender Medicine and Surgery (CTMS), shares how the COVID-19 pandemic has affected her practice and her patients and reflects on which changes in care she believes will become permanent.


Assuntos
COVID-19 , Pessoas em Situação de Rua , Boston , COVID-19/epidemiologia , Feminino , Humanos , Pandemias
8.
J Alzheimers Dis ; 87(4): 1419-1432, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35466941

RESUMO

Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer's disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson's disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/psicologia , Inteligência Artificial , Boston , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Humanos , Testes Neuropsicológicos
9.
Am J Surg Pathol ; 46(7): 963-976, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35385405

RESUMO

Kaposiform lymphangiomatosis is an uncommon generalized lymphatic anomaly with distinctive clinical, radiologic, histopathologic, and molecular findings. Herein, we document the pathology in 43 patients evaluated by the Boston Children's Hospital Vascular Anomalies Center from 1999 to 2020. The most frequent presentations were respiratory difficulty, hemostatic abnormalities, and a soft tissue mass. Imaging commonly revealed involvement of some combination of mediastinal, pulmonary, pleural, and pericardial compartments and most often included spleen and skeleton. Histopathology was characterized by dilated, redundant, and abnormally configured lymphatic channels typically accompanied by dispersed clusters of variably canalized, and often hemosiderotic, spindled lymphatic endothelial cells that were immunopositive for D2-40, PROX1, and CD31. An activating lesional NRAS variant was documented in 9 of 10 patients. The clinical course was typically aggressive, marked by hemorrhage, thrombocytopenia, diminished fibrinogen levels, and a mortality rate of 21%.


Assuntos
Células Endoteliais , Pulmão , Boston , Criança , Humanos
10.
Health Aff (Millwood) ; 41(4): 563-572, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35377754

RESUMO

Housing quality is a primary determinant of asthma disparities by race and social class in the US. We sought to assess how housing code enforcement systems in Boston, Massachusetts, address tenants' reports of asthma triggers. After adjustment for income and other neighborhood characteristics, racial demographics were significantly associated with asthma trigger incidence. For each 10 percent decrease in neighborhood proportion of White residents, trigger incidence increased by 3.14 reports per thousand residents. These disparities persisted during the study period (from 2011 through 2021), and for mold, which is an established asthma trigger, regressions showed that racial disparities are widening. The municipal response also demonstrated disparities: In neighborhoods with the fewest White residents compared to neighborhoods with the most White residents, adjusted models showed a 17 percent (3.51 days) slower median time until cases (tenant requests for inspections to the Inspectional Services Department) were closed, a 14 percent higher probability of being flagged as overdue, and a 54.4 percent lower probability of a repair. We found evidence that in Boston, despite several healthy housing initiatives, current regulatory systems are insufficient to address disparities in access to healthy housing. To reduce disparities in asthma burden, stronger inspectional standards and further enforcement policies to increase landlords' accountability and support tenants' rights to have repairs made are essential.


Assuntos
Asma , Asma/epidemiologia , Boston/epidemiologia , Habitação , Humanos , Massachusetts/epidemiologia
11.
Personal Ment Health ; 16(2): 130-137, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35474611

RESUMO

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.


Assuntos
Classificação Internacional de Doenças , Transtornos da Personalidade , Boston , Humanos , Personalidade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Reino Unido
12.
Obstet Gynecol ; 139(4): 561-570, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35271530

RESUMO

OBJECTIVE: To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment. METHODS: We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority. RESULTS: Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19-35 years), BMI (19.5-33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met "clinical quality." The difference of -2.4% (97.5% CI lower bound -5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI -0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3-79.0, P<.01), indicating greater satisfaction with the virtual experience. CONCLUSION: Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care. FUNDING SOURCE: This study was sponsored by Turtle Health. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04687189.


Assuntos
Reserva Ovariana , Boston , Feminino , Humanos , Masculino , Folículo Ovariano/diagnóstico por imagem , Ovário/diagnóstico por imagem , Ultrassonografia
13.
PLoS One ; 17(3): e0263434, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35353820

RESUMO

Little is known of the relationship between exposure to the smallest particles of air pollution and socio-demographic characteristics. This paper explores linkages between ultrafine particle (UFP) concentrations and indicators of both race/ethnicity and socioeconomic status in Boston, Massachusetts, USA. We used estimates of UFP based on a highly-resolved land-use regression model of concentrations. In multivariate linear regression models census block groups with high proportions of Asians were associated with higher levels of UFP in comparison to block groups with majority White or other minority groups. Lower UFP concentrations were associated with higher homeownership (indicating higher SES) and with higher female head of household (indicating lower socioeconomic status). One explanation for the results include the proximity of specific groups to traffic corridors that are the main sources of UFP in Boston. Additional studies, especially at higher geographic resolution, are needed in Boston and other major cities to better characterize UFP concentrations by sociodemographic factors.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Boston , Monitoramento Ambiental/métodos , Feminino , Humanos , Tamanho da Partícula , Material Particulado/análise
14.
J Pediatr Surg ; 57(7): 1441-1442, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35227494

Assuntos
Hospitais , Boston , Humanos
15.
Anesth Analg ; 134(6): 1326-1336, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35313320

RESUMO

Boston dentist William T. G. Morton secured a provisional English patent for etherization in December 1846. The full patent specification was submitted 6 months later, and the patent was sealed on June 18, 1847. The enrolled copies of the provisional and full patents, which are held in The National Archives, London, have not been previously documented in the anesthesia literature. We review the communications between Boston and London regarding the patent for etherization, the possibility that preliminary discussions and trials of etherization may have been conducted in London before the earliest known application of the discovery for a dental extraction on December 19, 1846, and the role of the American lawyer James Augustus Dorr, who was Morton's agent in the United Kingdom.


Assuntos
Anestesia , Anestesiologia , Anestesia/história , Anestesiologia/história , Boston , Londres , Reino Unido , Estados Unidos
16.
JAMA Netw Open ; 5(3): e221744, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35289860

RESUMO

Importance: Crisis standards of care (CSOC) scores designed to allocate scarce resources during the COVID-19 pandemic could exacerbate racial disparities in health care. Objective: To analyze the association of a CSOC scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area. Design, Setting, and Participants: This retrospective cohort analysis included adult patients in the intensive care unit during a regional COVID-19 surge from April 13 to May 22, 2020, at 6 hospitals in a health care network in greater Boston, Massachusetts. Participants were scored by acute severity of illness using the Sequential Organ Failure Assessment score and chronic severity of illness using comorbidity and life expectancy scores, and only participants with complete scores were included. The score was ordinal, with cutoff points suggested by the Massachusetts guidelines. Exposures: Race, ethnicity, Social Vulnerability Index. Main Outcomes and Measures: The primary outcome was proportion of patients in the lowest priority score category stratified by self-reported race. Secondary outcomes were discrimination and calibration of the score overall and by race, ethnicity, and neighborhood Social Vulnerability Index. Projected excess deaths were modeled by race, using the priority scoring system and a random lottery. Results: Of 608 patients in the intensive care unit during the study period, 498 had complete data and were included in the analysis; this population had a median (IQR) age of 67 (56-75) years, 191 (38.4%) female participants, 79 (15.9%) Black participants, and 225 patients (45.7%) with COVID-19. The area under the receiver operating characteristic curve for the priority score was 0.79 and was similar across racial groups. Black patients were more likely than others to be in the lowest priority group (12 [15.2%] vs 34 [8.1%]; P = .046). In an exploratory simulation model using the score for ventilator allocation, with only those in the highest priority group receiving ventilators, there were 43.9% excess deaths among Black patients (18 of 41 patients) and 28.6% (58 of 203 patients among all others (P = .05); when the highest and intermediate priority groups received ventilators, there were 4.9% (2 of 41 patients) excess deaths among Black patients and 3.0% (6 of 203) among all others (P = .53). A random lottery resulted in more excess deaths than the score. Conclusions and Relevance: In this study, a CSOC priority score resulted in lower prioritization of Black patients to receive scarce resources. A model using a random lottery resulted in more estimated excess deaths overall without improving equity by race. CSOC policies must be evaluated for their potential association with racial disparities in health care.


Assuntos
COVID-19/mortalidade , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Padrão de Cuidado , Idoso , Boston , COVID-19/diagnóstico , COVID-19/terapia , Cuidados Críticos , Feminino , Prioridades em Saúde , Disparidades em Assistência à Saúde , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , Índice de Gravidade de Doença , Populações Vulneráveis/estatística & dados numéricos
17.
Harm Reduct J ; 19(1): 9, 2022 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-35120531

RESUMO

OBJECTIVES: Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA). METHODS: In-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators. RESULTS: This implementation effort was facilitated by the organization's shared culture of harm reduction-which fostered shared implementation goals and beliefs about the intervention among staff persons-its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as "the Bronze Age of Drug Checking." Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic. CONCLUSIONS: For harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers-especially regressive policing policies and prohibitive costs-need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.


Assuntos
COVID-19 , Overdose de Drogas , Redução do Dano , Drogas Ilícitas , Polícia , Boston , Overdose de Drogas/prevenção & controle , Humanos , Pandemias , Violência
18.
Subst Use Misuse ; 57(5): 827-832, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35195488

RESUMO

OBJECTIVES: This study explores knowledge and utilization of, barriers to, and preferences for harm reduction services among street-involved young adults (YA) in Boston, Massachusetts. METHODS: This cross-sectional survey of YA encountered between November and December 2019 by a longstanding outreach program for street-involved YA. We report descriptive statistics on participant-reported substance use, knowledge and utilization of harm reduction strategies, barriers to harm reduction services and treatment, and preferences for harm reduction service delivery. RESULTS: The 52 YA surveyed were on average 21.4 years old; 63.5% were male, and 44.2% were Black. Participants reported high past-week marijuana (80.8%) and alcohol (51.9%) use, and 15.4% endorsed opioid use and using needles to inject drugs in the past six months. Fifteen (28.8%) YA had heard of "harm reduction", and 17.3% reported participating in harm reduction services. The most common barriers to substance use disorder treatment were waitlists and cost. Participants suggested that harm reduction programs offer peer support (59.6%) and provide a variety of services including pre-exposure prophylaxis (42.3%) and sexually transmitted infection testing (61.5%) at flexible times and in different languages, including Spanish (61.5%) and Portuguese (17.3%). CONCLUSIONS: There is need for comprehensive, YA-oriented harm reduction outreach geared toward marginalized YA and developed with YA input to reduce barriers, address gaps in awareness and knowledge of harm reduction, and make programs more relevant and inviting to YA.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Adulto , Boston , Estudos Transversais , Feminino , Redução do Dano , Humanos , Masculino , Massachusetts , Adulto Jovem
19.
Crit Care Med ; 50(5): 819-824, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35180721

RESUMO

OBJECTIVES: To determine the 30- and 90-day outcomes of COVID-19 patients receiving tracheostomy and percutaneous endoscopic gastrostomy (PEG). DESIGN: Retrospective observational study. SETTING: Multisite, inpatient. PATIENTS: Hospitalized COVID-19 patients who received tracheostomy and PEG at four Boston hospitals. INTERVENTIONS: Tracheostomy and PEG placement. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality at 30 and 90 days post-procedure. Secondary outcomes included continued device presence, place of residence, complications, and rehospitalizations. Eighty-one COVID-19 patients with tracheostomy and PEG placement were included. At 90 days post-device placement, the mortality rate was 9.9%, 2.7% still had the tracheostomy, 32.9% still had the PEG, and 58.9% were at home. CONCLUSIONS: More than nine-in-10 patients in our population of COVID-19 patients who underwent tracheostomy and PEG were alive 90 days later and most were living at home. This study provides new information regarding the outcomes of this patient population that may serve as a step in guiding clinicians, patients, and families when making decisions regarding these devices.


Assuntos
COVID-19 , Gastrostomia , Boston , Humanos , Estudos Retrospectivos , Traqueostomia
20.
Environ Res ; 209: 112893, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35131322

RESUMO

Toxic metals such as lead, cadmium, arsenic, are present at construction worksites. From work, metals can easily, unintentionally be transported to homes of workers, contaminating living spaces and affecting others including children, known as "take-home exposure." Focus has been given to minimizing lead take-home exposure but less is known about other metals. This pilot study aims to better understand the sources and predictors of metals in the home primarily of construction workers (n = 21), but also explore other workers potentially exposed [janitorial (n = 4) and auto repair (n = 2) jobs]. Greater Boston workers were recruited in 2018-2019 through collaboration with community-based organizations and worker unions serving low-income/immigrant workers. During a home visit, a dust vacuum sample was collected, a worker questionnaire was administered, and home observations were performed to determine factors that could affect home metals concentration. Thirty elements were analyzed in the dust via inductively coupled plasma coupled to atomic emission and mass spectrometry. We performed univariable and multivariable models, potential predictive factors, and multivariable mixed-effect regression analyses combining metals. Arsenic, chromium, copper, lead, manganese, nickel, and tin, commonly found in construction, were higher in construction workers' home dust compared to other workers, although not statistically significant. Sociodemographic/work/home-related variables affected home metals dust concentrations. Various work-related factors were associated with higher metal dust levels, for example: no work locker vs. locker (nickel ratio of means or ROM = 4.2, p < 0.05); mixing vs. no mixing work/personal items (nickel ROM = 1.6, p < 0.05); dusty vs. no dusty at work (copper ROM = 3.1, p < 0.05); not washing vs. washing hands after work (manganese ROM = 1.4, p < 0.05); not changing vs. changing clothes after work (cadmium ROM = 6.9, p < 0.05; copper ROM = 3.6, p < 0.05). Mixed effect regression confirmed statistical significance, which suggests a likelihood of metal mixtures carrying a "take-home" potential. Lead home interventions should evaluate other metals exposure reduction.


Assuntos
Poeira , Exposição Ocupacional , Boston , Criança , Cromo/análise , Poeira/análise , Humanos , Metais/análise , Exposição Ocupacional/análise , Projetos Piloto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...