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1.
Chemosphere ; 361: 142523, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38838865

RESUMO

Microplastic (MP) pollution has been widely reported across water matrices including in estuaries, which are important for the understanding of oceanic MPs. Estuaries can greatly alter the fate, transport, size distribution, and abundance of plastic pollution. The aim of this study was to quantify and characterize MP pollution in the Delaware Bay estuary USA, including the size distribution. Samples (N = 31) were collected from the mouth of the Delaware River to the coastal ocean including multiple frontal zones across two sampling campaigns (2019 and 2022). MP were extracted from the collected particles using wet peroxide oxidation and density separation with saturated sodium chloride. Particles collected on 500 µm mesh sieves were analyzed via Fourier transform infrared (FTIR) spectroscopy. Across all samples, 324 of the 1015 particles analyzed were MP, and 11 macroplastics were observed. MP concentrations ranged from below detection to 4.12 MP/m3 (mean 0.34 ± 0.80 MP/m3). No significant differences were observed between sampling sites; nonetheless, the two highest MP concentrations were observed when sampling along frontal zones with visible debris including macroplastics. Polyethylene (53%) and polypropylene (43%) were the most abundant polymers observed. The majority of the non-plastic particles were classified as particulate natural organic matter (82% of non-plastics). Particles from samples collected during 2022 (N = 864) also had color, morphology, and two size dimensions recorded. MP particle size was significantly associated with sampling site, with the coastal ocean sampling site generally having the smallest MPs. A correlation between total post-extraction particles and total plastic particles was observed. Aspect ratios for the plastics ranged from one to 40.7, with larger ratios for fibers, with a mean (±standard deviation) of 3.39 ± 4.72 (unitless). These aspect ratios can be used to select shape factors used to estimate the total volume of MP in the studied size range. Overall, these results can help inform fate, transport, and risk assessments related to estuarine plastic pollution.


Assuntos
Baías , Monitoramento Ambiental , Estuários , Microplásticos , Tamanho da Partícula , Poluentes Químicos da Água , Microplásticos/análise , Poluentes Químicos da Água/análise , Baías/química , Delaware , Plásticos/análise , Rios/química
2.
Womens Health (Lond) ; 20: 17455057241248399, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38778774

RESUMO

BACKGROUND: Due to high rates of unintended pregnancies in Delaware, the state launched a public health initiative in 2014 to increase access to contraceptive services. OBJECTIVES: This study was designed to assess the practice-level barriers and facilitators to providing contraceptive care, particularly long-acting reversible contraceptives (LARCs), to adolescents in primary care settings. DESIGN: This qualitative study was part of a larger process evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. METHODS: In-depth, semi-structured qualitative interviews were conducted with 16 practice administrators at 13 adolescent-serving primary care sites across the state of Delaware. A process of open, axial, and selective coding was used to analyze the data. RESULTS: Despite the interest in LARC among their adolescent patients, administrators described numerous barriers to providing LARC for adolescents including confidentiality in patient visits and billing, preceptorship, and provider discomfort and assumptions about the need for contraception among adolescent patients. CONCLUSION: Findings from this study reveal substantial barriers to providing contraception to adolescents, even in primary care practices that were committed to comprehensive contraceptive access for their adolescent patients. This study supports the need for contraceptive care to be integrated into training of pediatricians at every stage of their education. Such training must go beyond education about contraceptive options and the clinical skills necessary for LARC insertion and removal, to include counseling skills based in a reproductive justice framework. Additional changes in policies and practices for adolescent patients would further increase access to contraceptive care.


Assuntos
Serviços de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Adolescente , Feminino , Delaware , Anticoncepção/métodos , Gravidez , Gravidez na Adolescência/prevenção & controle , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Entrevistas como Assunto , Masculino
3.
J Med Entomol ; 61(4): 959-964, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38754900

RESUMO

We present an annotated checklist of fleas (Siphonaptera) known to occur in the state of Delaware based on an examination of Siphonaptera collections at the University of Delaware and the Carnegie Museum of Natural History, as well as new specimens of fleas we collected from wildlife, other hosts, and tick flags. We review published records and compile them herein with our new records, which include 3 species previously unreported from Delaware. With these additions, there are now 18 flea species from 19 avian and mammalian hosts documented from Delaware.


Assuntos
Infestações por Pulgas , Sifonápteros , Animais , Sifonápteros/classificação , Sifonápteros/fisiologia , Delaware , Infestações por Pulgas/veterinária , Infestações por Pulgas/parasitologia , Aves/parasitologia , Mamíferos/parasitologia , Distribuição Animal , Feminino , Masculino , Lista de Checagem
4.
J Urban Health ; 101(3): 595-619, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38637462

RESUMO

We conducted a randomized controlled trial to determine whether an after-school program paired with a cash transfer (a conditional cash transfer) or a cash transfer alone (an unconditional cash transfer) can help improve health and economic outcomes for young men between the ages of 14 and 17 whose parents have low incomes and who live in neighborhoods with high crime rates. We find that receiving the cash transfer alone was associated with an increase in healthy behaviors (one of our primary outcome composite measures) and that the cash transfer paired with after-school programming was associated with an improvement in the financial health of participants (one of our secondary outcome composite measures). We find no differences in spending on alcohol, marijuana, cigarettes, or other drugs between either the treatment group and the control group. Neither the cash transfer alone nor the programming plus cash transfer had statistically significant effects on our other primary composite measures (physical and mental health or school attendance and disciplinary actions), or our other secondary composite measures (criminal justice engagement or social supports) but in most cases, confidence intervals were too large to rule out meaningful effects. Results suggest that cash transfers hold promise to improve the health of youth without any indication of any adverse effects.


Assuntos
Instituições Acadêmicas , Humanos , Masculino , Adolescente , Delaware , Exposição à Violência , Comportamentos Relacionados com a Saúde , Pobreza
5.
Health Serv Res ; 59(3): e14300, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38491794

RESUMO

OBJECTIVES: To examine the effects of a comprehensive, multiyear (2015-2020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long-acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital-based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports). DATA SOURCES AND STUDY SETTING: We used Medicaid claims data between 2012 and 2019, from Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60 days postpartum among patients aged 15-44 years who were covered in a full-benefit eligibility category. STUDY DESIGN: Using difference-in-differences, we assessed changes in LARC, tubal ligation, and short-acting methods (oral contraceptive, injectable, patch/ring). LARC rates were assessed at 60 days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60 days. Analyses were conducted separately for an early-adopting high-capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later-adopting hospitals in the state. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from administrative claims. PRINCIPAL FINDINGS: The program increased postpartum LARC insertions by 60 days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early-adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later-adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded-out outpatient LARC services. We observed decreases in short-acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early-adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later-adopting hospitals. CONCLUSIONS: Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid-enrolled postpartum women with LARC claims.


Assuntos
Contracepção Reversível de Longo Prazo , Medicaid , Período Pós-Parto , Humanos , Feminino , Medicaid/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Estados Unidos , Adulto , Adolescente , Adulto Jovem , Delaware , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Maryland , Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração
6.
Am J Trop Med Hyg ; 110(5): 925-929, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38531096

RESUMO

In July and October 2023, two live triatomine bugs were found inside a home in New Castle County, Delaware. The bugs were identified as Triatoma sanguisuga, the most widespread triatomine bug species in the United States. Triatoma sanguisuga is a competent vector of Trypanosoma cruzi, the causative agent of Chagas disease. The two specimens were tested via real-time PCR (qPCR) for infection with T. cruzi, and one of the specimens was positive. Despite T. sanguisuga being endemic to the area, attainment of accurate species identification and T. cruzi testing of the bugs required multiple calls to federal, state, private, and academic institutions over several months. This constitutes the first report of T. sanguisuga infected with T. cruzi in Delaware. In addition, this is the first published report of T. sanguisuga in New Castle County, the northernmost and most densely populated county in Delaware. New Castle County still conforms to the described geographic range of T. sanguisuga, which spans from Texas to the East Coast of the United States. The T. cruzi infection prevalence of the species has not been studied in the northeastern United States, but collections in southern states have found prevalences as high as 60%. The Delaware homeowner's lengthy pursuit of accurate information about the vector highlights the need for more research on this important disease vector in Delaware.


Assuntos
Doença de Chagas , Insetos Vetores , Triatoma , Trypanosoma cruzi , Animais , Triatoma/parasitologia , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Delaware/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Trypanosoma cruzi/genética , Insetos Vetores/parasitologia , Humanos
7.
Cancer Epidemiol Biomarkers Prev ; 33(5): 646-653, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38451180

RESUMO

BACKGROUND: The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS: Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS: Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS: The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT: Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.


Assuntos
Neoplasias da Mama , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Etários , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/diagnóstico , Institutos de Câncer/estatística & dados numéricos , Área Programática de Saúde/estatística & dados numéricos , Delaware/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Incidência , Estadiamento de Neoplasias , Sistema de Registros/estatística & dados numéricos
8.
J Public Health Manag Pract ; 30(3): E112-E123, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38320288

RESUMO

BACKGROUND: Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware. METHODS: This cross-sectional study used choropleth maps to visualize the distribution of environmental, social, and cumulative risks and Moran's I statistics to assess spatial clustering of cumulative risk across the county and among individual block groups. RESULTS: Findings indicate that environmental risk rarely occurs without social risk and that environmental and social risks co-occur in distinct areas, resulting in large-scale clustering of cumulative risk. Areas of higher cumulative risk had more Black residents and people of lower socioeconomic status. CONCLUSIONS: Replicable measures of cumulative risk can show how environmental and social risks are inequitably distributed by race and socioeconomic status, as seen here in New Castle County. Such measures can support upstream approaches to reduce health disparities resulting from histories of environmental racism.


Assuntos
Exposição Ambiental , Equidade em Saúde , Humanos , Delaware/epidemiologia , Estudos Transversais , Fatores de Risco
9.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 214-222, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38226690

RESUMO

PURPOSE: Patient-reported outcomes were compared between participants who followed the treatment algorithm of the Delaware-Oslo ACL Cohort, consisting of progressive preoperative and postoperative rehabilitation, patient education, clinical testing and shared decision-making about treatment choice, and those who followed usual care 9-12 years after anterior cruciate ligament reconstruction (ACLR). METHODS: Participants with primary ACLR were included from the Norwegian arm of the Delaware-Oslo ACL Cohort and the Norwegian Knee Ligament Registry (usual care). The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores and the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) scores were compared. KOOS scores for the usual care group were converted to IKDC-SKF scores with recently published validated crosswalk. The percentages of participants with scores above predefined thresholds for patient acceptable symptom state (PASS) were also calculated. RESULTS: Eighty of 100 (80%) participants from the Delaware-Oslo ACL Cohort and 1588 of 3248 (49%) from the usual care group participated in the follow-up. Participants from the Delaware-Oslo ACL Cohort had higher KOOS subscale (p < 0.001) and IKDC-SKF scores (p < 0.001), and a higher percentage reached PASS (84%-96% vs. 62%-76%, p ≤ 0.002) for KOOS Pain, symptoms, activities of daily living and sports compared to the usual care group. No significant differences were found for KOOS quality of life scores (not significant [n.s.]) or PASS percentages (80% vs. 74%, n.s.). CONCLUSION: Participants with ACLR who followed the Delaware-Oslo ACL Cohort treatment algorithm had reduced knee symptoms, superior function and higher percentages of satisfactory outcomes than participants who followed usual care. LEVEL OF EVIDENCE: Level II.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Atividades Cotidianas , Qualidade de Vida , Delaware , Reconstrução do Ligamento Cruzado Anterior/reabilitação
10.
Am J Hypertens ; 37(2): 143-149, 2024 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-37815306

RESUMO

BACKGROUND: Higher neighborhood deprivation is associated with hypertension diagnosis in youth. In this study, we assess if there is an association between neighborhood deprivation and antihypertensive therapy prescription among insured youth with a primary hypertension diagnosis. METHODS: Using a retrospective cross-sectional design, we assessed the proportion of youth with a diagnosis of primary hypertension prescribed antihypertensive therapy. We evaluated the proportion of youth prescribed antihypertensive therapy and compared prescribing patterns by area deprivation index (ADI), age, sex, obesity diagnosis, race, ethnicity, and duration of Medicaid coverage. RESULTS: Of the 65,452 non-pregnant Delaware Medicaid recipients, 8-18 years of age, 1,145 (1.7%) had an International classification of diseases (ICD)-9/ICD-10 diagnosis of primary hypertension; 165 of the 1,145 (14%) were prescribed antihypertensive therapy. Factors associated with a greater odds of prescription by multivariable logistic regression were age, obesity diagnosis, and duration of Medicaid full benefit coverage. Odds of antihypertensive therapy prescription did not vary by race, ethnicity, or ADI. CONCLUSIONS: Antihypertensive therapy prescription rates are poor despite national guideline recommendations. Among youth receiving Delaware Medicaid between 2014 and 2019, prescription proportions were highest among youth of older age, with an obesity diagnosis, and among youth with longer duration of Medicaid benefit coverage. Although high area deprivation has been shown to be associated with the diagnosis of hypertension, high vs. low area deprivation was not associated with greater antihypertensive therapy prescription among youth with primary hypertension. Our finding of a mismatch between hypertension diagnosis and antihypertensive therapy prescription highlights a potential disparity in antihypertensive therapy prescription in youth.


Assuntos
Anti-Hipertensivos , Hipertensão , Estados Unidos/epidemiologia , Adolescente , Humanos , Anti-Hipertensivos/uso terapêutico , Medicaid , Estudos Retrospectivos , Estudos Transversais , Delaware/epidemiologia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Prescrições , Obesidade/tratamento farmacológico , Hipertensão Essencial/tratamento farmacológico
11.
J Agromedicine ; 29(3): 486-489, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38126446

RESUMO

Land grant universities in the Northeast (e.g. Delaware, Maryland, New York) have seen changes in their faculty or Extension level positions: Agricultural safety specialist positions have been left vacant or have been merged with another position with other responsibilities, which reduces the amount of time available to address safety. In response to the resulting support gap, Penn State Ag Safety and Health and the Northeast Center for Occupational Health and Safety (NEC) launched the Northeast Agricultural Safety and Health Coalition (NEASHC) in 2014. NEASHC provides extension staff and other individuals interested in safety trainings (e.g. insurers, Farm Bureau staff) with opportunities to network and learn about best practices in agricultural health and safety training. Recognizing the importance of NEASHC's role in filling this service gap in the Northeast, the NEC included support for NEASHC in its last 5-year grant cycle (2016-2022) and has continued its support for the Coalition in their current five-year center grant (2022-2027). The NEC center grant is funded by National Institute for Occupational Health and Safety (NIOSH) Grant #2 U54OH007542. NEASHC is an important component of the NEC's unified approach to worker health and safety, which is based in part on G. Sorensen's conceptual model for integrated approaches to the protection and promotion of worker safety.1 The goals for NEASHC through 2027 are as follows: expand the Coalition's reach by adding states and members; provide professional development to members; (3) offer mini-grants for outreach projects and activities; (4) develop and disseminate new resources; and (5) provide occupational safety and health (OSH) updates for agricultural populations.


Assuntos
Agricultura , Saúde Ocupacional , Humanos , Saúde Ocupacional/normas , Maryland , Fortalecimento Institucional , New York , Delaware , Universidades , Fazendeiros/estatística & dados numéricos
12.
BMC Pediatr ; 23(1): 613, 2023 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-38049756

RESUMO

BACKGROUND: The Baby Friendly Hospital Initiative was created to enhance breastfeeding, although its impact on infant healthcare utilization is unclear. Breast feeding infants are vulnerable to readmission soon after birth secondary to dehydration and hyperbilirubinemia. Breastfeeding can also protect infants from unnecessary health care utilization later in life by preventing infection. The objective of this study was to examine the impact of the Baby Friendly Hospital Initiative on readmissions and emergency department utilization among Medicaid births in Delaware. METHODS: The study was a quasi-experimental design. Medicaid claims files were used to study births at five hospitals in Delaware born between January 1, 2014, and December 31, 2018, and covered under Medicaid at time of birth. Three hospitals were designated Baby Friendly, two were not and served as controls. Outcomes included Emergency Department (ED) utilization and readmissions within 30 days and one-year of birth hospitalization. Exposure to the Baby Friendly Hospital Initiative was determined by year and hospital of birth. Logistic regression and interrupted time series segmented regression analysis with controls were used to assess the effect of Baby Friendly Hospital Initiative on healthcare utilization. RESULTS: In total, 19,695 infants were born at five hospitals with 80% (15,939) born at hospitals that were designated Baby Friendly. ED utilization and readmissions over the 1st year of life for breastfeeding related diagnosis at the Baby Friendly hospitals occurred in 240 (1.5%) and 226 (1.4%) of infants, respectively. Exposure to the Baby Friendly Hospital Initiative was associated with increased odds of all cause 30-day readmission (AOR: 1.15; 95% CI: 1.03-1.28) but not readmissions over the 1st year of life. While 30-day ED visits did not change after BFHI, one-year ED visits were reduced (0.91, 95% CI 0.86-0.97). A significant negative trend was seen over time for ED utilization post BFHI compared to controls (B: -5.90, p < 0.01). CONCLUSION: There was a small observed increase in the odds of all cause 30-day readmissions with no change in one-year readmissions after BFHI in Delaware. Although there were no observed changes in 30-day ED utilization, there was a reduction in one-year ED utilization following the implementation of the Baby Friendly Hospital Initiative in Delaware birth hospitals. Our data help to inform policy and decision making for statewide systems of care that may be used to support breast feeding.


Assuntos
Promoção da Saúde , Medicaid , Lactente , Feminino , Recém-Nascido , Humanos , Delaware , Hospitais , Aleitamento Materno , Aceitação pelo Paciente de Cuidados de Saúde
13.
Breast Cancer Res ; 25(1): 137, 2023 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-37941020

RESUMO

BACKGROUND: Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. Access to breast cancer screening was evaluated in Delaware, a state that experiences an elevated burden from breast cancer but is otherwise representative of the US in terms of race and urban-rural characteristics. We first conducted a catchment analysis of mammography facilities. Finding evidence of disparities by race and rurality, we next conducted a location-allocation analysis to identify candidate locations for the establishment of new mammography facilities to optimize equitable access. METHODS: A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines. RESULTS: The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 68% (95% CI 38-85%) fewer mammography units and 89% (95% CI 60-98%) fewer BICOEs. The more rural counties in the state accounted for 41% of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas. CONCLUSIONS: The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.


Assuntos
Neoplasias da Mama , Feminino , Humanos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia , Detecção Precoce de Câncer/métodos , Delaware , Acessibilidade aos Serviços de Saúde , Programas de Rastreamento/métodos
14.
Mar Pollut Bull ; 196: 115541, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37804673

RESUMO

High microplastic concentrations in the Delaware Bay have prompted concern regarding harm to local species. We consider the extent to which the zooplankton is exposed to bay-derived microplastics, focusing on Atlantic blue crabs (Callinectes sapidus) during offshore larval migration. We simulate regional flow fields for a spawning season in the Delaware coastal system to advect passive Lagrangian microplastic and zooplankton tracers. Microplastic exposure levels are estimated from tracer distributions. Field sampling of zooplankton and microplastic concentrations for the Delaware Bay mouth and the adjacent shelf in August 2020 is utilized to appraise model performance. Three mechanisms elevating microplastics exposure are identified: zooplankton transport into microplastic-laden tidelines, displacement of microplastics into the buoyant outflow current, and aggregation in offshore plume fronts. Organization via the above mechanisms substantially enhance microplastic exposures over zooplankton migrations (by an average factor of at least 3.8).


Assuntos
Braquiúros , Poluentes Químicos da Água , Animais , Microplásticos , Zooplâncton , Plásticos , Larva , Delaware , Monitoramento Ambiental , Poluentes Químicos da Água/análise
15.
Environ Res ; 238(Pt 2): 117194, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37748669

RESUMO

Most migratory shorebird species are declining, some are endangered, and some may be vulnerable to contaminants on long distance travel between wintering grounds and high latitude breeding grounds. We examined whether shorebirds accumulated trace elements at the Delaware Bay (New Jersey) stopover by testing the null hypothesis that there was no difference in the levels of arsenic, cadmium, chromium, lead, mercury, and selenium in blood of three species of shorebirds collected early in their stopover compared to levels in blood collected about two weeks later near the end of the stopover, before departing for breeding grounds. There were significantly higher levels of all metals and metalloids in the blood of ruddy turnstone (Arenaria interpres) later in May than earlier. There were seasonal increases in blood levels of arsenic and selenium for all three species. Chromium and lead levels also increased in red knots (Calidris canutus). These increases occurred although the birds were only present for about two weeks. Levels of arsenic, mercury, and lead in knots and selenium in sanderlings (Calidrris alba), exceeded reported effects levels. These results have potential implications for studying the refueling physiology, energetics, and feeding behavior of migratory shorebirds. However, they also suggest cause for concern because the increased contaminant loads occur in a short period, and the high metal level bolus received all in a few days may result in adverse effects.


Assuntos
Arsênio , Charadriiformes , Mercúrio , Metaloides , Selênio , Animais , New Jersey , Chumbo , Delaware , Arsênio/análise , Selênio/análise , Baías , Mercúrio/análise , Cromo
16.
J Environ Manage ; 345: 118747, 2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-37604107

RESUMO

Floodplains provide critical ecosystem services to people by regulating floodwaters and retaining sediments and nutrients. Geospatial analyses, field data collection, and modeling were integrated to quantify a portfolio of services that floodplains provide to downstream communities within the Chesapeake Bay and Delaware River watersheds. The portfolio of services included floodplain sediment and nutrient retention and flood regulation. Sediment and nutrient retention were quantified and valued for all non-tidal wadable streams in the Chesapeake Bay and Delaware River watersheds. Predicted nitrogen fluxes from measurements of streambanks and floodplain geomorphic changes were summarized at various scales (river basin, state, and county) and valued using a benefits transfer approach. Floodplain flood regulation services were assessed through a pilot study focused on the Schuylkill River watershed in the Delaware River watershed. Geospatial analysis and published flood frequency estimates were used to assess baseline and counterfactual (i.e., floodplain storage removed) scenarios. Flood regulation was valued using the Federal Emergency Management Agency's Hazus model to compare differences in structural damage to private residences under baseline and counterfactual scenarios. The estimated value of floodplain sediment and nutrient retention was $223 million United States dollars (USD) per year in the Chesapeake Bay watershed and $38 million USD per year in the Delaware River watershed. Sediment and nutrient retention benefits were offset by a streambank erosion cost of $123 million and $14 million USD annually in the Chesapeake and Delaware watersheds, respectively. In the Schuylkill River watershed floodplain flood regulation was valued at $860,000 USD per year, with an additional $7.2 million USD annually provided through floodplain sediment and nutrient retention. Together this portfolio of floodplain ecosystem services indicates that floodplains provide substantial benefits to people by trapping nutrients and storing floodwaters.


Assuntos
Ecossistema , Inundações , Humanos , Delaware , Baías , Projetos Piloto
17.
Curr Biol ; 33(11): 2350-2358.e7, 2023 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-37207647

RESUMO

The 17th-century colonization of North America brought thousands of Europeans to Indigenous lands in the Delaware region, which comprises the eastern boundary of the Chesapeake Bay in what is now the Mid-Atlantic region of the United States.1 The demographic features of these initial colonial migrations are not uniformly characterized, with Europeans and European-Americans migrating to the Delaware area from other countries and neighboring colonies as single persons or in family units of free persons, indentured servants, or tenant farmers.2 European colonizers also instituted a system of racialized slavery through which they forcibly transported thousands of Africans to the Chesapeake region. Historical information about African-descended individuals in the Delaware region is limited, with a population estimate of less than 500 persons by 1700 CE.3,4 To shed light on the population histories of this period, we analyzed low-coverage genomes of 11 individuals from the Avery's Rest archaeological site (circa 1675-1725 CE), located in Delaware. Previous osteological and mitochondrial DNA (mtDNA) sequence analyses showed a southern group of eight individuals of European maternal descent, buried 15-20 feet from a northern group of three individuals of African maternal descent.5 Autosomal results further illuminate genomic similarities to Northwestern European reference populations or West and West-Central African reference populations, respectively. We also identify three generations of maternal kin of European ancestry and a paternal parent-offspring relationship between an adult and child of African ancestry. These findings expand our understanding of the origins and familial relationships in late 17th and early 18th century North America.


Assuntos
População Negra , Migração Humana , Adulto , Criança , Humanos , População Negra/genética , Delaware , DNA Mitocondrial/genética , Genética Populacional , Haplótipos , Brancos
18.
Popul Health Manag ; 26(2): 93-99, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37071687

RESUMO

Racial and ethnic minorities are disproportionately affected by limited health literacy. Therefore, this study assessed census block health literacy level and medication adherence in Delaware among Black individuals with hypertension (HTN) receiving health care through Medicaid. This was a cross-sectional study of Black Delaware Medicaid beneficiaries (18-64 years old) from the 3 counties in Delaware (Kent, New Castle, and Sussex) from 2016 to 2019. The primary outcome was medication adherence (full adherence = 80%-100%, partial adherence = 50%-79%, and nonadherence = 0-49%) as a function of health literacy. Health literacy scores were categorized as below basic (0-184), basic (184-225), intermediate (226-309), and proficient (310-500). The results of the study showed that 18,958 participants (29%) had ≥1 HTN diagnosis during the study period. Mean area health literacy score for participants without HTN was significantly higher than participants with HTN (234.9 vs. 233.7, P < 0.0001). Men had lower odds of adherence compared with women (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.75-0.92, P < 0.001). Increased time enrolled in Medicaid decreased full adherence. Participants 21-30 and 31-50 years of age are significantly less likely to have full adherence in comparison with participants 51-64 years of age (P < 0.0001). Participants living in an area with basic level of health literacy reported lower medication adherence than those living in an area with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, P < 0.001). In conclusion, men, younger adults, increased time enrolled in Medicaid for the study period, and basic health literacy were significantly associated with low adherence to medication among 3 census blocks in Delaware.


Assuntos
Letramento em Saúde , Hipertensão , Masculino , Adulto , Estados Unidos , Humanos , Feminino , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Medicaid , Estudos Transversais , Delaware , Hipertensão/tratamento farmacológico , Adesão à Medicação
19.
Health Serv Res ; 58(4): 781-791, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37032478

RESUMO

OBJECTIVE: To examine the effects of a comprehensive contraceptive access reform, Delaware Contraceptive Access Now, on abortion-one of the most common outcomes of unintended pregnancy. DATA SOURCE: We used abortion data by state of residence from the Abortion Surveillance System, published by the Centers for Disease Control and Prevention. Our data covers 5 years prior to (2010-2014) and 5 years after the intervention (2015-2019). STUDY DESIGN: We used synthetic control methods to estimate program effects. Our design compares Delaware to a weighted average of 45 control states ("synthetic Delaware"), where the quality of the comparison is assessed by its similarity to Delaware in pre-period outcome levels and trends. DATA COLLECTION/EXTRACTION METHODS: Not applicable. We relied on secondary sources. PRINCIPAL FINDINGS: We did not find statistically significant evidence that the program reduced abortion rates (0.61 fewer abortions per 1000 women, p-value = 0.74) on average, during the intervention period. The treatment effects were slightly larger in 2016 and 2017 (1.97 fewer abortions per 1000 women but not statistically significant) and attenuated in 2018 and 2019. This does not rule out program benefits in easing barriers to contraceptive methods or in reducing unplanned births. However, findings do suggest that increasing contraceptive access might not be an adequate substitute for restricted abortion access resulting from Dobbs v. Jackson Women's Health Organization. CONCLUSIONS: Our results suggest that comprehensive efforts to improve contraceptive access may not reduce the need for accessible and affordable abortion care.


Assuntos
Aborto Induzido , Gravidez , Feminino , Humanos , Delaware , Anticoncepção , Gravidez não Planejada , Acessibilidade aos Serviços de Saúde
20.
JAMA Netw Open ; 6(3): e233012, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36920393

RESUMO

Importance: The association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied. Objective: To assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth. Design, Setting, and Participants: This cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI). Exposures: Higher area deprivation. Main Outcomes and Measures: The main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022. Results: A total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis. Conclusions and Relevance: In this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.


Assuntos
Hipertensão , Medicaid , Estados Unidos/epidemiologia , Humanos , Masculino , Adolescente , Feminino , Criança , Estudos Transversais , Delaware/epidemiologia , Obesidade , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão Essencial
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