Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.724
Filtrar
1.
A A Pract ; 15(11): e01544, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34784304

RESUMO

Many anesthesiologists and nurse anesthetists want to continue breastfeeding their babies when returning to work from maternity leave. The cornerstone of breast milk supply maintenance is breast milk pumping sessions at regular intervals. These breast milk pumping sessions require time and private space for lactation. We surveyed Iowa hospitals and ambulatory surgery centers and created an educational spreadsheet to guide inquiry and postgraduate job selection of our anesthesiology residents and nurse anesthetist students (eg, when considering future family planning). The survey and spreadsheet showed a low prevalence of dedicated lactation space for anesthesia practitioners near the surgical suites.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Aleitamento Materno , Feminino , Hospitais , Humanos , Lactente , Iowa , Lactação , Gravidez , Prevalência
2.
J Athl Train ; 56(11): 1224-1231, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34752627

RESUMO

CONTEXT: Secondary schools that offer school-sponsored athletic events should follow best-practice guidelines to provide policies that promote student health and safety. OBJECTIVE: To assess emergency preparedness from the perspective of athletic administrators (AAs) in Iowa secondary schools. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Ninety-eight AAs from Iowa completed the survey (age = 45.33 ± 10.22 years, years as an AA = 9.37 ± 8.14, years in current role = 7.72 ± 7.09). MAIN OUTCOME MEASURES(S): The 6-section survey contained with questions about access to athletic trainers (ATs), emergency action plans (EAPs), cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs), concussions, heat illness, and other general policies. Descriptive statistics (percentages and frequencies) were reported. Relative risk was calculated to compare schools with and those without access to ATs (P < .05). RESULTS: Most respondents (76.5%, n = 75/98) reported their school had access to a licensed AT. The majority had a written EAP (83.3%, n = 70/84), but fewer than half (39.2%, n = 31/79) reviewed it annually and fewer than 10% (n = 6/85) reported practicing it each year. All respondents (100%, N = 78/78) stated they had an AED on campus. All respondents (N = 77/77) indicated that they were familiar with the Iowa High School Athletic Association's (IHSAA's) concussion policy and had a concussion guideline in place. Many respondents (95.9%, n = 71/74) described being familiar with the IHSAA's heat illness policy, but more than half (62.1%, n = 41/66) noted they did not have a heat illness policy in place at their school. CONCLUSIONS: Most respondents indicated their school had access to ATs, followed the state-mandated concussion guidelines, and had an AED. Although participants reported having written EAPs in place, levels of annual EAP review and practice were low. These results suggest that schools would benefit from educational opportunities to improve safety policies.


Assuntos
Traumatismos em Atletas , Defesa Civil , Esportes , Adulto , Traumatismos em Atletas/terapia , Estudos Transversais , Humanos , Iowa , Pessoa de Meia-Idade , Políticas , Instituições Acadêmicas , Inquéritos e Questionários
3.
Am J Prev Med ; 61(5 Suppl 1): S108-S117, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34686280

RESUMO

INTRODUCTION: Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas. However, little is known about the best practices for such partnerships. Iowa TelePrEP, a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa, expanded statewide between 2017 and 2019. This qualitative evaluation assessed the barriers and facilitators to statewide expansion and the lessons learned. METHODS: Key informants from public health partners across Iowa participated in a focus group and interviews between May 2019 and November 2020. Public health partners included local health departments and disease intervention specialist/partner services programs. Qualitative data were transcribed and thematically coded. Program documents and routinely collected reporting data were reviewed to provide the context for qualitative findings. Data were analyzed in 2020. RESULTS: TelePrEP expanded in 4 phases through partnerships with 12 public health partners. Public health partners referred 708 clients with pre-exposure prophylaxis indications to telenavigation; of these, 258 were navigated to TelePrEP, and 167 initiated pre-exposure prophylaxis. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings. The barriers included the need to adapt communication and processes to varying public health partners, difficulty in engaging underserved populations, the COVID-19 pandemic, and perceived gaps in understanding client outcomes. CONCLUSIONS: Partnerships between regional telehealth programs and local health departments can expand to the state level and increase the capacity to implement pre-exposure prophylaxis in rural and small urban settings. Partnerships should consider how to balance program adaptability to local public health partners with standardization and scalability.


Assuntos
COVID-19 , Profilaxia Pré-Exposição , Humanos , Iowa , Pandemias , Pesquisa Qualitativa , SARS-CoV-2
4.
J Acoust Soc Am ; 150(3): 2131, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34598595

RESUMO

Speech perception (especially in background noise) is a critical problem for hearing-impaired listeners and an important issue for cognitive hearing science. Despite a plethora of standardized measures, few single-word closed-set tests uniformly sample the most frequently used phonemes and use response choices that equally sample phonetic features like place and voicing. The Iowa Test of Consonant Perception (ITCP) attempts to solve this. It is a proportionally balanced phonemic word recognition task designed to assess perception of the initial consonant of monosyllabic consonant-vowel-consonant (CVC) words. The ITCP consists of 120 sampled CVC words. Words were recorded from four different talkers (two female) and uniformly sampled from all four quadrants of the vowel space to control for coarticulation. Response choices on each trial are balanced to equate difficulty and sample a single phonetic feature. This study evaluated the psychometric properties of ITCP by examining reliability (test-retest) and validity in a sample of online normal-hearing participants. Ninety-eight participants completed two sessions of the ITCP along with standardized tests of words and sentence in noise (CNC words and AzBio sentences). The ITCP showed good test-retest reliability and convergent validity with two popular tests presented in noise. All the materials to use the ITCP or to construct your own version of the ITCP are freely available [Geller, McMurray, Holmes, and Choi (2020). https://osf.io/hycdu/].


Assuntos
Percepção da Fala , Feminino , Humanos , Iowa , Ruído/efeitos adversos , Fonética , Reprodutibilidade dos Testes
5.
J Environ Manage ; 299: 113647, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34523537

RESUMO

Shallow constructed ponds are abundant landscape features in the midwestern United States, suggested as an edge of field best management practice (BMP) in voluntary nutrient reduction strategies. The efficacy of such features is highly uncertain, however, and previous studies have lacked sufficient temporal resolution to determine N and P removals during critical periods of transport. We utilized high-frequency in-situ measurements and flow-weighted grab sampling to determine water and nutrient budgets for a typical constructed "farm pond" in central Iowa situated within the Iowa Southern Drift Plain. Our monitoring approach yielded insight into in-stream nitrogen processing and the relative importance of transport-vs. supply-limited N delivery. Diel patterns in NO3-N observed during early Spring, prior to canopy closure, revealed that in-stream primary production and NO3-N assimilation can influence downstream N delivery in a stream with nitrate pollution (mean annual NO3-N of nearly 5 mg/L). Analysis of discharge-concentration hysteresis for NO3-N showed a shift from transport to supply limitation for NO3-N delivery over the growing season, influenced by antecedent moisture, with wet antecedent conditions leading to supply limitation. Significant NO3-N removal (64% of 19.8 kg/ha inputs) occurred within the 4.2 ha pond (230 ha watershed), but total N removal was much lower (36% removal of 22.3 kg/ha inputs). The lower total N removal highlights the importance of both particulate N and dissolved organic N and ammonia export to the N budgets of hypereutrophic small ponds. Total P removal in the pond was only 8% of 2.3 kg/ha inputs, likely due to internal loading of recent and legacy sedimentary P within the pond. High-flow events dominated N and P inputs, during which removal efficacy of the pond was significantly diminished. Poor process performance during critical moments may partially explain lower than expected water quality improvements post-BMP implementation. Accordingly, shifting hydroclimatic regimes (e.g., frequency of intense rainfall events) will impact the efficacy of small ponds and other edge of field BMPs for nutrient reduction.


Assuntos
Lagoas , Poluentes Químicos da Água , Monitoramento Ambiental , Fazendas , Iowa , Nitrogênio/análise , Nutrientes , Fósforo/análise , Poluentes Químicos da Água/análise
6.
Iowa Orthop J ; 41(1): 111-119, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34552412

RESUMO

Background: Weightbearing computed tomography (WBCT) is a reliable and precise modality for the measurement and analysis of bone position in the foot and ankle, as well as associated deformities. WBCT to assess three dimensional relationships among bones allowed the development of new measurements, as the Foot and Ankle Offset (FAO), which has high inter and intra-rater reliability. This study reports the University of Iowa's experience utilizing WBCT for the care of foot and ankle patients by describing its utility across different orthopedic diseases in improving diagnostic assessment, aiding surgical planning, and expanding the use for objective clinical follow-up. Methods: The medical records of consecutive patients with various foot and ankle disorders that underwent WBCT examination as part of the standard of care at a single institution between November 2014 and August 2020 were retrospectively reviewed. Patient factors, including body mass index (BMI), sex, and patient comorbidities were collected. 3D coordinates for calculation of FAO were harvested using the Multiplanar Reconstruction (MPR) views were calculated from the obtained exams. Descriptive statistics were performed with Shapiro-Wilk test and the Anderson-Darling tests. Results: 1175 feet and ankles (820 patients) had a WBCT performed over the studied 68 months. 53% of the subjects were male and 47% female. 588 of the acquisitions were from the right side (50.04%) and 587 from the left side (49.96%). Diabetes was present in 15.47% of, Rheumatic diagnoses in 4.52% and smoking habits in 44.10% of patients. Mean BMI of the sample was found to be 32.47 (32.03-32.90, 95% CI). The mean Foot and Ankle Offset (FAO) encountered in the study's population was 2.43 (2.05-2.82, 95% CI; min -30.8, max 37.65; median 2.39). Conclusion: This study contains the largest cohort of WBCTs with accompanied FAO measurements to date, which can aid with establishing a new baseline FAO measurement for multiple pathological conditions. Acquiring WBCTs resulted in a variety of more specific diagnoses for patient with foot and ankle complaints. The ability to utilize WBCT for presurgical planning, the capability to provide a 3D reconstruction of patient anatomy, and its use for assessment of advanced relational foot and ankle measurements, such as FAO, demonstrate how WBCT may serve as a remarkable utility in clinical practice and has become a standard of care in our practice at the University of Iowa.Level of Evidence: IV.


Assuntos
Tornozelo , Tomografia Computadorizada por Raios X , Feminino , Humanos , Iowa , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Suporte de Carga
8.
J Agric Saf Health ; 27(2): 105-122, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-34350740

RESUMO

HIGHLIGHTS A total of 133 cases were documented in a seven-state region, with Iowa reporting 43% of the cases and asphyxiations accounting for 42% of all cases. Most victims were male (>79%) with an average age of 38 years. The overall fatality rate was 57%, and 16% of the victims were under the age of 21. Thirteen incidents involved secondary victims, including eleven incidents involving two, one incident involving three, and one incident involving four. ABSTRACT. Research was conducted to document, classify, analyze, and summarize available injury and fatality data involving facilities and equipment for livestock manure storage, handling, and transport in the seven-state region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota) served by the Central States Center for Agricultural Safety and Health (CS-CASH). Data were initially drawn from the Purdue Agricultural Confined Space Incident Database (PACSID), which contained over 2,400 individual U.S. cases of agricultural confined space related entrapment, engulfment, entanglement, asphyxiation, and falls that were documented between 1975 and 2019. Data from these cases have been partially summarized and published, but the findings did not include in-depth analysis of manure-related incidents. Approximately one in five (460) of the 2,400+ cases that were documented over 44 years involved storage, handling, or transport of livestock wastes, including exposure to toxic gases. Of these, 133 cases were documented as having occurred in the targeted seven-state region. Each case was identified and coded according to a protocol developed previously to classify incidents related to livestock manure handling, storage, and transport. Iowa and Minnesota accounted for 79% of the total, with swine operations accounting for 33% of cases when livestock type was known. Of the victims, 79% were male. Ages ranged from 1 to 85, with an average age of 38, and 15% of the victims were age 21 and under. There were 13 incidents for which two or more victims were identified, including one incident involving four victims. It is believed that historical under-reporting of incidents, especially non-fatal incidents, continues to be a barrier to achieving a more comprehensive understanding of the scope and magnitude of the problem. However, the findings are sufficient to be used in cooperation with stakeholders to enhance the content and delivery of evidence-based agricultural safety and health programs, promote safer work practices, and contribute to the development of engineering design standards. The desired outcomes of this research include more effective strategies to protect farmers and farm workers who are at high risk of manure-related injuries. The findings also provide a sufficient baseline to gauge the effectiveness of future injury prevention measures.


Assuntos
Acidentes de Trabalho , Esterco , Agricultura , Animais , Feminino , Humanos , Iowa/epidemiologia , Gado , Masculino , Suínos
9.
Health Aff (Millwood) ; 40(8): 1270-1276, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34339251

RESUMO

During the COVID-19 pandemic, safely reopening schools has been one of the most pressing public health challenges in the United States. At the beginning of the 2020-21 school year, the Centers for Disease Control and Prevention strongly encouraged schools to require mask wearing. Although teachers unions frequently supported such policies, the adoption of mask mandates was uneven. We examined whether teachers unions were associated with mask mandates, using proprietary data on school district-level unionization and mask mandates from the Iowa State Education Association, the state's main teachers union. We found that a 1-standard-deviation increase in the teachers' unionization rate was associated with a 12.5 percent relative increase in the probability that a school district adopted a mask mandate. These findings, which are robust to multiple specification checks, help illuminate an important mechanism by which labor unions have informed safety policies in schools during the COVID-19 pandemic.


Assuntos
COVID-19 , Humanos , Iowa , Máscaras , Pandemias , SARS-CoV-2 , Instituições Acadêmicas , Estados Unidos
10.
Artigo em Inglês | MEDLINE | ID: mdl-34202037

RESUMO

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC) which are potent animal carcinogens for the organs of the digestive system. We evaluated dietary intakes of nitrate and nitrite, as well as nitrate ingestion from drinking water (public drinking water supplies (PWS)), in relation to the incidence (1986-2014) of cancers of the esophagus (n = 36), stomach (n = 84), small intestine (n = 32), liver (n = 31), gallbladder (n = 66), and bile duct (n = 58) in the Iowa Women's Health Study (42,000 women aged from 50 to 75 in 1986). Dietary nitrate and nitrite were estimated using a food frequency questionnaire and a database of nitrate and nitrite levels in foods. Historical nitrate measurements from PWS were linked to the enrollment address by duration. We used Cox regression to compute hazard ratios (HR) and 95% confidence intervals (CI) for exposure quartiles (Q), tertiles (T), or medians, depending on the number of cancer cases. In adjusted models, nitrite intake from processed meats was associated with an increased risk of stomach cancer (HRQ4vsQ1 = 2.2, CI: 1.2-4.3). A high intake of total dietary nitrite was inversely associated with gallbladder cancer (HRQ4vsQ1 = 0.3, CI: 0.1-0.96), driven by an inverse association with plant sources of nitrite (HRQ4vsQ1 = 0.3, CI: 0.1-0.9). Additionally, small intestine cancer was inversely associated with a high intake of animal nitrite (HRT3vsT1 = 0.2, CI: 0.1-0.7). There were no other dietary associations. Nitrate concentrations in PWS (average, years ≥ 1/2 the maximum contaminant level) were not associated with cancer incidence. Our findings for stomach cancer are consistent with prior dietary studies, and we are the first to evaluate nitrate and nitrite ingestion for certain gastrointestinal cancers.


Assuntos
Nitritos , Neoplasias Gástricas , Dieta , Ingestão de Alimentos , Feminino , Humanos , Iowa/epidemiologia , Nitratos/análise , Nitritos/análise , Fatores de Risco , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/epidemiologia , Saúde da Mulher
11.
J Stroke Cerebrovasc Dis ; 30(9): 105963, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34247055

RESUMO

OBJECTIVE: To determine whether the intracerebral hemorrhage (ICH) score is accurate in predicting 30-day mortality in young adults, we calculated the ICH score for 156 young adults (aged 18-45) with primary spontaneous ICH and compared predicted to observed 30-day mortality rates. METHODS: We retrospectively reviewed all patients aged 18-45 consecutively presenting to the University of Iowa from 2009 to 2019 with ICH. We calculated the ICH score and recorded its individual subcomponents for each patient. Poisson regression was used to test the association of ICH score components with 30-day mortality. RESULTS: We identified 156 patients who met the inclusion criteria; mean± standard deviation (SD) age was 35±8 years. The 30-day mortality rate was 15% (n=24). The ICH score was predictive of 30-day mortality for each unit increase (p= 0.04 for trend), but the observed mortality rates for each ICH score varied considerably from the original ICH score predictions. Most notably, the 30-day mortality rates for ICH scores of 1, 2, and 3 are predicted to be 13%, 26%, and 72% respectively, but were observed in our population to be 0%, 3%, and 41%. An ICH volume of >30cc [relative risk (RR) 28, 95% confidence intervals (CI) 3-315, p=0.01] and a GCS score of <5 (RR 13, 95% CI 0.1-1176, p=0.01) were independently associated with 30-day mortality. CONCLUSIONS: The ICH score tends to overestimate mortality in young adults. ICH volume and GCS score are the most relevant items in predicting mortality at 30 days in young adults.


Assuntos
Hemorragia Cerebral/mortalidade , Técnicas de Apoio para a Decisão , Adolescente , Adulto , Fatores Etários , Hemorragia Cerebral/diagnóstico , Feminino , Escala de Coma de Glasgow , Humanos , Iowa , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Environ Monit Assess ; 193(8): 500, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34291322

RESUMO

Agricultural drainage tiles are primary contributors to NO3-N export from Iowa croplands. Saturated buffers are a relatively new conservation practice that diverts tile water into a distribution tile installed in a riparian buffer parallel to a stream with the intent of enhancing NO3-N processing within the buffer. In this study, tile NO3-N concentration reductions were characterized through two different saturated buffers at a working farm site in eastern Iowa. Study objectives were to (1) evaluate the hydrogeology and water quality patterns in the saturated buffer and (2) quantify the reduction in tile NO3-N concentration from the saturated buffer installation. Results showed that the two saturated buffers are reducing NO3-N concentrations in tile drainage water from input concentrations of approximately 15 mg/l to levels < 1.5 mg/l at the streamside well locations. The reduction occurs rapidly in the fine-textured and organic-rich alluvial soils with most of the reduction occurring within 1.5 m of the distribution line. Denitrification is hypothesized as being primarily responsible for the concentration reductions based on soil and water chemistry conditions, completion of a geophysical survey (quantifying low potential for N loss to deeper aquifers), and comparisons to other similar Iowa sites. The study provides more assurance to new adopters that this practice can be installed in many areas throughout the Midwestern Cornbelt region.


Assuntos
Monitoramento Ambiental , Rios , Agricultura , Iowa , Nitratos/análise , Nitrogênio/análise , Solo
13.
Injury ; 52 Suppl 3: S54-S59, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088467

RESUMO

INTRODUCTION: Anterior external fixation is a well-established technique for treating pelvic ring injuries, but many complications are associated with it. The subcutaneous anterior internal fixator (INFIX) technique is associated with reduced complication rates and is less uncomfortable for patients. OBJECTIVE: This study evaluated functional outcomes among patients with pelvic ring injuries treated using the INFIX method. PATIENTS AND METHODS: In this retrospective case series, patients treated using the INFIX technique were reviewed for functional outcomes, using the Iowa Pelvic Score (IPS). Thirty-four patients, of mean age 39.2 years, were evaluated after a mean follow-up of 1.2 years. RESULTS: Twenty-three of the 34 patients experienced reduction classified as excellent, and eleven as good, with no instances of moderate or poor reduction. One patient developed implant exposure and infection during follow-up. Twenty-six ultimately experienced an excellent or good functional result. The average final IPS was 79.4 (range: 48-100). CONCLUSION: Our results reinforce prior evidence that the INFIX method is safe for fixating pelvic ring lesions. Most of our patients also experienced excellent or good functional recovery, suggesting that this technique is a viable option for treating certain pelvic ring injuries.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Adulto , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Fixadores Internos , Iowa , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Estudos Retrospectivos
14.
J Registry Manag ; 48(1): 28-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34170893

RESUMO

BACKGROUND: Overall survival associated with National Comprehensive Cancer Network (NCCN) adjuvant chemotherapy treatment guideline using population-based surveillance data is limited. This study examined overall survival and compliance to the NCCN guideline for adjuvant chemotherapy. METHODS: The Midwest Ovarian Cancer Study was a collaborative project between 3 state cancer registries (Iowa, Kansas, and Missouri), Westat, and the Centers for Disease Control and Prevention. A standardized protocol was used to ascertain International Federation of Gynecology and Obstetrics (FIGO) stage-specific adjuvant chemotherapy. Primary epithelial ovarian cancers with FIGO stages IA/IB grade 3, IC, and II-IV with histologies 8000-8576 and 8930-9110 were included in this study. The Kaplan-Meier method was used to calculate survival functions. Adjusted hazard ratio (HR) was analyzed for all-cause mortality associated with NCCN compliance with adjuvant chemotherapy after adjusting for stage at diagnosis and comorbidity. RESULTS: Sixtynine percent (523 of 756 eligible) were compliant with NCCN guidelines. Compliance was significantly different by age at diagnosis and insurance type (both P < .0001). The overall survival was significantly different by age group, census tract median income, histologic subtype, and tumor grade (all P < .0001). The adjusted HR of noncompliance with adjuvant chemotherapy guideline was 3.2 (95% CI, 2.600-3.911). CONCLUSIONS: Better overall survival in patients who had received NCCN-recommended adjuvant chemotherapy was confirmed. IMPACT: The survival benefit was 7% higher over 4 years after diagnosis when considering FIGO stage-specific chemotherapy and the corresponding number of cycles. Using the chemotherapy data field that is collected by statewide cancer registries underestimated the overall survival.


Assuntos
Neoplasias Ovarianas , Carcinoma Epitelial do Ovário , Quimioterapia Adjuvante , Feminino , Humanos , Iowa , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Sistema de Registros
15.
J Med Internet Res ; 23(7): e28812, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34156964

RESUMO

BACKGROUND: The COVID-19 pandemic has changed public health policies and human and community behaviors through lockdowns and mandates. Governments are rapidly evolving policies to increase hospital capacity and supply personal protective equipment and other equipment to mitigate disease spread in affected regions. Current models that predict COVID-19 case counts and spread are complex by nature and offer limited explainability and generalizability. This has highlighted the need for accurate and robust outbreak prediction models that balance model parsimony and performance. OBJECTIVE: We sought to leverage readily accessible data sets extracted from multiple states to train and evaluate a parsimonious predictive model capable of identifying county-level risk of COVID-19 outbreaks on a day-to-day basis. METHODS: Our modeling approach leveraged the following data inputs: COVID-19 case counts per county per day and county populations. We developed an outbreak gold standard across California, Indiana, and Iowa. The model utilized a per capita running 7-day sum of the case counts per county per day and the mean cumulative case count to develop baseline values. The model was trained with data recorded between March 1 and August 31, 2020, and tested on data recorded between September 1 and October 31, 2020. RESULTS: The model reported sensitivities of 81%, 92%, and 90% for California, Indiana, and Iowa, respectively. The precision in each state was above 85% while specificity and accuracy scores were generally >95%. CONCLUSIONS: Our parsimonious model provides a generalizable and simple alternative approach to outbreak prediction. This methodology can be applied to diverse regions to help state officials and hospitals with resource allocation and to guide risk management, community education, and mitigation strategies.


Assuntos
COVID-19/epidemiologia , Simulação por Computador , Conjuntos de Dados como Assunto , Surtos de Doenças/estatística & dados numéricos , Previsões/métodos , Heurística , Setor Público , COVID-19/prevenção & controle , California/epidemiologia , Humanos , Indiana/epidemiologia , Iowa/epidemiologia , Modelos Biológicos , SARS-CoV-2
16.
Womens Health Issues ; 31(5): 503-509, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34088600

RESUMO

INTRODUCTION: Maternal mortality and morbidity rates have risen significantly, yet little research has focused on how severe maternal morbidity (SMM) is associated with future reproductive health, such as birth spacing or the likelihood of subsequent SMM. This study focuses on the risk of SMM recurrence and the association of interpregnancy intervals with SMM. METHODS: This population-based, retrospective cohort study used Iowa hospital discharge data longitudinally linked to birth certificate data between 2009 and 2014. To examine recurrence of SMM, crude and adjusted multivariable logistic regression models were generated. The associations between varying interpregnancy intervals and subsequent SMM were examined. Crude, stratified, and adjusted risk ratios and their associated 95% confidence intervals were estimated. RESULTS: A total of 36,190 women were included in this study. Women with SMM in the index delivery had significantly higher odds of SMM in the subsequent delivery (adjusted odds ratio, 8.16; 95% confidence interval, 5.45-12.24) compared with women without SMM. Women with an interpregnancy interval of less than 6 months compared with 18 months or longer were more likely to experience SMM during their subsequent delivery, although the difference was not statistically significant (adjusted odds ratio, 1.41; 95% confidence interval, 0.99, 2.03). CONCLUSIONS: This study demonstrates that women who experience SMM are at markedly increased risk of subsequent SMM. Further investigation is necessary to inform optimal interpregnancy interval recommendations based on prior maternal health outcomes.


Assuntos
Intervalo entre Nascimentos , Complicações na Gravidez , Feminino , Humanos , Iowa/epidemiologia , Idade Materna , Mortalidade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-34071402

RESUMO

Detecting environmental exposures and mitigating their impacts are growing global public health challenges. Antibody tests show great promise and have emerged as fundamental tools for large-scale exposure studies. Here, we apply, demonstrate and validate the utility of a salivary antibody multiplex immunoassay in measuring antibody prevalence and immunoconversions to six pathogens commonly found in the environment. The study aimed to assess waterborne infections in consenting beachgoers recreating at an Iowa riverine beach by measuring immunoglobulin G (IgG) antibodies against select pathogens in serially collected saliva samples. Results showed that nearly 80% of beachgoers had prior exposures to at least one of the targeted pathogens at the beginning of the study. Most of these exposures were to norovirus GI.1 (59.41%), norovirus GII.4 (58.79%) and Toxoplasma gondii (22.80%) and over half (56.28%) of beachgoers had evidence of previous exposure to multiple pathogens. Of individuals who returned samples for each collection period, 6.11% immunoconverted to one or more pathogens, largely to noroviruses (GI.1: 3.82% and GII.4: 2.29%) and T. gondii (1.53%). Outcomes of this effort illustrate that the multiplex immunoassay presented here serves as an effective tool for evaluating health risks by providing valuable information on the occurrence of known and emerging pathogens in population surveillance studies.


Assuntos
Norovirus , Humanos , Imunoensaio , Imunoglobulina A Secretora , Iowa/epidemiologia , Saliva
18.
J Affect Disord ; 292: 471-474, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34146898

RESUMO

BACKGROUND: The purpose of this cross-sectional study was to examine the effect of physical activity (PA) on the relationship between perceived racial discrimination and major depressive disorder (MDD) in African Americans. METHODS: 645 African Americans (mean age 45 years) were interviewed on their perceived racial discrimination, PA, and past 12-month MDD. Participants were categorized into tertiles (lower, middle, upper) of racial discrimination as well as "active" or "inactive" groups based on the US PA guidelines. Odds ratios and 95% confidence intervals (CIs) were calculated for MDD prevalence across discrimination tertiles stratified by PA group after adjusting for potential confounders. RESULTS: The upper (higher) discrimination group had 2.99 (95% CIs 1.03-8.67) increased odds of MDD compared with the lower group after adjusting for potential confounders. The stratified analysis indicated that the increased odds of MDD in the upper discrimination group were observed only among the inactive group (5.19 [1.08-24.87]) after adjusting for age and sex. The association between discrimination and MDD was not significant among active participants. LIMITATIONS: Limitations include generalizability since participants were predominantly women and recruited solely from Iowa or Georgia; the low number of MDD cases in some groups; and that causation cannot be inferred from this cross-sectional study. CONCLUSION: Not meeting the PA guidelines may be associated with higher depression among African Americans experiencing higher levels of perceived racial discrimination.


Assuntos
Transtorno Depressivo Maior , Racismo , Afro-Americanos , Estudos Transversais , Depressão , Transtorno Depressivo Maior/epidemiologia , Exercício Físico , Feminino , Georgia , Humanos , Iowa , Pessoa de Meia-Idade
19.
West J Emerg Med ; 22(3): 498-509, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34125019

RESUMO

INTRODUCTION: Rural areas have higher rates of firearm-related unintentional and suicide deaths. Having access to a firearm greatly increases suicide risk. Safe firearm storage can be a major factor in preventing these tragedies. In this study we evaluated firearm exposure and storage practices in rural adolescents' homes. METHODS: An anonymous survey was administered to a convenience sample of attendees at the 2019 Iowa FFA (formerly Future Farmers of America) Leadership Conference. We performed descriptive, bivariate and multivariable logistic regression analyses. RESULTS: A total of 1,382 adolescents participated; 51% were males and 49% were females. Respondents were 13-18 years old, and 53% lived on a farm, 18% in the country/not on a farm, and 29% in town. Almost all (96%) self-identified as White/Caucasian. In their homes, 84% reported having rifles/shotguns, 58% reported having handguns, and 56% reported having both rifles/shotguns and handguns. Males were significantly more likely than females to report having firearms in their home (P<0.001). The likelihood of having rifles/shotguns was greater if living on a farm (odds ratio (OR) 4.19, 95% confidence interval (CI), 2.99-5.88) or in the country/not a farm (OR 2.74, 95% CI, 1.78-4.24) compared to those in town. Similarly, the presence of handguns in the home was increased if living on a farm compared to in town (OR 1.70, 95% CI 1.32-2.18). Rifles/shotguns and handguns were stored unlocked and/or loaded at least some of the time in 62% and 58% of homes, respectively. Those who lived on farms compared to in towns were more likely to have rifles/shotguns (OR 1.83, 95% CI 1.35-2.46) and handguns (OR 1.58, 95% CI 1.10-2.27) stored unlocked. For homes with unlocked rifles/shotguns, 46% stored ammunition unlocked. For homes with unlocked handguns, 38% stored ammunition unlocked. Among those aware of firearm storage in their home, 82% (802/974) reported at least one firearm stored either unlocked and/or loaded at least some of the time. CONCLUSION: The vast majority of rural adolescents we surveyed live in homes with firearms, and a large proportion of those firearms are not stored safely. Widespread efforts are needed to educate rural families about the importance of proper firearm and ammunition storage.


Assuntos
Armas de Fogo/estatística & dados numéricos , Propriedade/estatística & dados numéricos , População Rural , Segurança , Ferimentos por Arma de Fogo/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Iowa , Masculino , Vigilância da População , Suicídio/prevenção & controle , Inquéritos e Questionários , Violência
20.
Sci Total Environ ; 793: 148476, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34174595

RESUMO

Natural disasters, such as flooding, can cause severe social, environmental, and economic damage to a community. Transportation infrastructure plays an essential role in flood response and recovery efforts. However, flooding may disturb road functionality and generate direct and indirect adverse impacts, including the loss of access to essential services. This paper presents a comprehensive analysis of flood impacts on road network topology and accessibility to amenities for major communities in the State of Iowa using graph-theoretic methods, including single-source shortest path analyses. We assessed the disruption of transportation networks on the accessibility to critical amenities (e.g., hospitals) under 100 and 500-year flood scenarios. Our analysis methodology leads toward the development of an integrated real-time decision support system that will allow decision-makers to explore "what if" flood scenarios to identify vulnerable areas and population in their authority. These analyses could promote possible improvements (e.g., temporary relocation of critical services) to mitigate the consequences of road system failure during flooding. Due to varying environmental conditions at specific locations and effects on road topology under flood events, the results show differential impacts in edge and node losses as well as access to critical services. Results indicate that floods can lead to edge losses of up to 18%, and not only large cities but also some small cities can experience significant vulnerability to flooding. Some new or reconstructed bridges have failed to operate during analyzed flood events. During the 100 and 500-year flood return periods, the total number of inaccessible bridges within the selected cities is 184 and 294, respectively. Our work found that the shortest path length to the closest critical amenity under baseline condition can flip to the second or higher-orders during flooding. Many critical amenities have been found at risk of flooding in the studied cities.


Assuntos
Inundações , Transportes , Cidades , Iowa
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...