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2.
Artigo em Inglês | MEDLINE | ID: mdl-34207093

RESUMO

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities-Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3-16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1-13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.


Assuntos
Criminosos , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Cidades , Feminino , Seguimentos , Humanos , Kansas , Teste de Papanicolaou , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal
3.
J Subst Abuse Treat ; 129: 108378, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34080549

RESUMO

AIMS: During the early months of the U.S. COVID-19 outbreak, women suffered disproportionate burdens of pandemic-related psychological and economic distress. We aimed to describe the experiences of women in substance use disorder (SUD) recovery programs by (1) exploring the pandemic's impact on their lives, sobriety, and recovery capital and (2) tracking COVID-19 perceptions and preventative behaviors. METHODS: We conducted monthly semistructured interviews with women in residential and outpatient SUD recovery programs in Kansas City in April, May, and June 2020. Participants described the pandemic's impact on their life and sobriety and completed survey items on factors related to COVID-19 preventative behaviors. We interpreted qualitative themes longitudinally alongside quantitative data. RESULTS: In 64 interviews, participants (n = 24) described reduced access to recovery capital, or resources that support sobriety, such as social relationships, housing, employment, and health care. Most experienced negative impacts on their lives and feelings of stability in March and April but maintained sobriety. Four women described relapse, all attributed to pandemic stressors. Participants described relief related to societal re-opening in May and June, and increased engagement with their communities, despite rising infection rates. CONCLUSIONS: For women recovering from SUDs during COVID-19, securing recovery capital often meant assuming greater COVID-19 risk. As substance use appeared to have increased during the pandemic and COVID-19 transmission continues, public health planning must prioritize adequate and safe access to recovery capital and timely distribution of vaccines to people struggling with SUDs.


Assuntos
COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Kansas/epidemiologia , Estudos Longitudinais , Pandemias , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
5.
J Am Board Fam Med ; 34(3): 522-530, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34088812

RESUMO

INTRODUCTION: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being. METHODS: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information. RESULTS: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress. CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.


Assuntos
Ansiedade , Esgotamento Profissional , COVID-19/psicologia , Depressão/epidemiologia , Médicos de Família/psicologia , Ansiedade/epidemiologia , Esgotamento Profissional/epidemiologia , Estudos Transversais , Humanos , Kansas/epidemiologia , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
6.
Contraception ; 104(3): 262-264, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34058223

RESUMO

OBJECTIVES: To explore racial/ethnic disparities in family planning telehealth use. STUDY DESIGN: We analyzed telehealth and in-clinic visits (n = 3142) from ten family planning clinics (April 1-July 31, 2020) by race/ethnicity and month. RESULTS: Telehealth comprised 1257/3142 (40.0%) of overall visits. Telehealth was used by 242/765 (31.6%) of Black/African American and 31/106 (29.2%) multiracial patients. Patients with unknown (162/295, 54.9%), White (771/1870, 41.2%), and other (51/106, 48.1%) identities comprised the majority of telehealth visits. CONCLUSIONS: Our study found differences in telehealth use during the COVID-19 pandemic response. IMPLICATIONS: Understanding barriers and facilitators to telehealth is critical to reducing disparities in access.


Assuntos
COVID-19/prevenção & controle , Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Telemedicina/estatística & dados numéricos , Arkansas , Grupos Étnicos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Kansas , Grupos Minoritários , Missouri , Oklahoma , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
7.
Am J Public Health ; 111(6): 1035-1039, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33950714

RESUMO

We report on data we collected from a 2018 survey examining jails' human papillomavirus virus vaccine delivery capacity and on a secondary analysis we conducted to describe factors similarly associated with delivery planning for the COVID-19 vaccine. We provide recommendations for delivering the COVID-19 vaccine in jails, based on evidence from Kansas, Iowa, Nebraska, and Missouri. Our key finding is that jails have limited staff to implement vaccination and will require collaboration between jail administrators, jail medical staff, and local health departments.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Pessoal de Saúde , Programas de Imunização , Prisões Locais , Saúde Pública , COVID-19/prevenção & controle , Feminino , Humanos , Iowa , Kansas , Masculino , Missouri , Vacinas contra Papillomavirus/administração & dosagem
8.
BMC Res Notes ; 14(1): 205, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039412

RESUMO

OBJECTIVES: The main purpose of this publication is to help users (students, researchers, farmers, advisors, etc.) of weather data with agronomic purposes (e.g. crop yield forecast) to retrieve and process gridded weather data from different Application Programming Interfaces (API client) sources using R software. DATA DESCRIPTION: This publication consists of a code-tutorial developed in R that is part of the data-curation process from numerous research projects carried out by the Ciampitti's Lab, Department of Agronomy, Kansas State University. We make use of three weather databases for which specific libraries were developed in R language: (i) DAYMET (Thornton et al. in https://daymet.ornl.gov/ , 2019; https://github.com/bluegreen-labs/daymetr ), (ii) NASA-POWER (Sparks in J Open Source Softw 3:1035, 2018; https://github.com/ropensci/nasapower ), and (iii) Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS) (Funk et al. in Sci Data 2:150066, 2015; https://github.com/ropensci/chirps ). The databases offer different weather variables, and vary in terms of spatio-temporal coverage and resolution. The tutorial shows and explain how to retrieve weather data from multiple locations at once using latitude and longitude coordinates. Additionally, it offers the possibility to create relevant variables and summaries that are of agronomic interest such as Shannon Diversity Index (SDI) of precipitation, abundant and well distributed rainfall (AWDR), growing degree days (GDD), crop heat units (CHU), extreme precipitation (EPE) and temperature events (ETE), reference evapotranspiration (ET0), among others.


Assuntos
Software , Tempo (Meteorologia) , Clima , Bases de Dados Factuais , Humanos , Kansas
9.
Health Aff (Millwood) ; 40(5): 698-701, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939516

RESUMO

In Kansas City, a pioneering children's hospital system has woven family feedback into its policy-making processes.


Assuntos
Hospitais Pediátricos , Formulação de Políticas , Criança , Humanos , Kansas
10.
Life Sci ; 280: 119623, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34004246

RESUMO

AIMS: This study analyzed deployment-related exposures and risk of Persian Gulf War Illness (GWI) in women veterans from the Veterans Affairs (VA) Cooperative Studies Program 585 Gulf War Era Cohort and Biorepository (GWECB CSP#585). MAIN METHODS: We examined the associations between GW deployment-related exposures and case definitions for GWI in deployed GW women. Multivariate regression analyses controlling for demographic outcomes were performed. KEY FINDINGS: Surveys were obtained from 202 GW deployed women veterans. Self-reported exposure to smoke from oil well fires as well as chemical and biological warfare were the only exposures significantly associated with the Center for Disease Control and Prevention (CDC) GWI criteria. Seventy-nine women were excluded from the rest of the analyses as they met Kansas GW illness exclusion criteria. Eligible women who self-reported deployment-related exposure to smoke from oil wells, pyridostigmine bromide (PB) pills, pesticide cream, pesticide treated uniforms, and insect baits were significantly more likely to meet the Kansas GWI criteria (n = 123) than those unexposed and exposures were related to Kansas symptom subdomain endorsements. SIGNIFICANCE: These results suggest that women GW veterans reporting deployment related exposures of pesticide, oil well fire and PB pills are significantly more likely to meet the Kansas GWI criteria in this national cohort of GW women suggesting its utility in future studies. In addition, based on these results it appears that women exposed to particular toxicants during the war may benefit from more targeted treatment strategies dependent upon the mechanism of exposure of their toxicant induced outcomes.


Assuntos
Exposição Ambiental/efeitos adversos , Neurotoxinas/efeitos adversos , Síndrome do Golfo Pérsico/induzido quimicamente , Armas Biológicas , Substâncias para a Guerra Química/efeitos adversos , Inibidores da Colinesterase/efeitos adversos , Doença Crônica , Feminino , Guerra do Golfo , Humanos , Kansas/epidemiologia , Pessoa de Meia-Idade , Síndrome do Golfo Pérsico/epidemiologia , Praguicidas/efeitos adversos , Brometo de Piridostigmina/efeitos adversos , Fumaça/efeitos adversos , Veteranos
11.
Pediatrics ; 147(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33875537

RESUMO

BACKGROUND: The prevalence of current electronic cigarette (e-cigarette) use has increased dramatically among US youth. It is unknown how the impact of policies to curb e-cigarette use might differ across rural and urban areas. METHODS: Data were collected from an annual statewide survey of middle and high school students in Kansas. Multivariable logistic regression was performed to examine the temporal change in current e-cigarette use in 2018 and 2019 across rural and urban areas and across the areas with and without a Tobacco 21 (T21) policy that raises the minimum age of tobacco sales to 21 years. RESULTS: Of 132 803 participants, the prevalence of current e-cigarette use increased from 8.2% in 2018 to 12.6% in 2019. The increase was larger in rural areas (from 6.7% in 2018 to 13.4% in 2019, difference = 6.7%) than in urban areas (9.8%-11.9%, difference = 2.1%), with a significant interaction effect of year × urbanicity/T21 group (P < .0001). In urban areas, e-cigarette use increased significantly for middle school students in T21 areas (3.3%-4.5%; P = .01) and all students in non-T21 areas (8.1%-12.0%; P < .0001). In rural areas, the increase in e-cigarette use was significant in both T21 and non-T21 areas for all students, but the increase was smaller in T21 (7.9%-10.8%, difference = 3.0%) than in non-T21 areas (6.5%-13.7%, difference = 7.1%). CONCLUSIONS: In this study, we reported marked disparities in the increase of youth e-cigarette use, with a larger recent increase in rural than in urban areas. T21 policies appear to mitigate these increases in both rural and urban youth.


Assuntos
Uso de Tabaco/epidemiologia , Vaping/epidemiologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Kansas/epidemiologia , Masculino , Saúde da População Rural , Saúde da População Urbana
12.
PLoS One ; 16(4): e0250272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33891636

RESUMO

Between March 2014 and February 2017, host-seeking ticks were collected during the late spring and summer months seasonally, and as well as continually through all seasons from several sites in a periurban environment in Pittsburg, Kansas, located in the Central Midwestern United States. All three post-emergent life-stages of Amblyomma americanum, and the adults of three other ticks viz. Dermacentor variabilis, A. maculatum, and Ixodes scapularis were collected using the flagging method, and were taxonomically identified using morphological and molecular methods. A total of 15946 ticks were collected from these sites. A vast majority of the ticks collected over the three-year study period was A. americanum (79.01%). The three other species collected included D. variabilis (13.10%), A. maculatum (7.15%), and Ixodes scapularis (0.73%). More female ticks of each species were collected throughout the study period from all sites, and a unimodal activity period was noted for all four species. The diversity, composition, and phenology of these medically significant tick species are discussed.


Assuntos
Biodiversidade , Infestações por Carrapato , Carrapatos/classificação , Animais , Feminino , Kansas/epidemiologia , Estações do Ano , Infestações por Carrapato/epidemiologia , Infestações por Carrapato/veterinária
13.
Am J Infect Control ; 49(9): 1183-1185, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33839188

RESUMO

We identified a cluster of extensively drug-resistant, carbapenemase gene-positive, carbapenem-resistant Acinetobacter baumannii (CP-CRAB) at a teaching hospital in Kansas City. Extensively drug-resistant CRAB was identified from eight patients and 3% of environmental cultures. We used patient cohorting and targeted environmental disinfection to stop transmission. After implementation of these measures, no additional cases were identified.


Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Infecção Hospitalar , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/prevenção & controle , Acinetobacter baumannii/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Carbapenêmicos/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla , Hospitais Comunitários , Humanos , Kansas/epidemiologia , Testes de Sensibilidade Microbiana , beta-Lactamases/genética
14.
BMC Health Serv Res ; 21(1): 309, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827560

RESUMO

BACKGROUND: Correctional facilities are an underutilized venue for reaching young adults who have not vaccinated for human papillomavirus (HPV). The objective of this study was to identify factors that are associated with jail and local health department (LHD) interest in partnering to offer HPV vaccinations to young adults in jail. METHODS: Consolidated framework for implementation research (CFIR)-guided surveys were conducted with jail administrators in Iowa, Kansas, Missouri, and Nebraska, September 2017-October 2018. Jail survey data were analyzed using chi square distribution and relative risk regression. Using data from sister surveys conducted with LHD administrators in the same counties (results previously reported), we identified characteristics of counties in which both the jail and LHD indicated interest in collaborating to offer HPV vaccinations in the jail. RESULTS: Jail survey response was 192/347 (55.3%). Surveys with LHDs yielded 237/344 (68.9%) responses. Eleven communities were identified where both the jail and LHD expressed interest. Only "any vaccines provided in jail" predicted shared interest (RR: 5.36; CI: 2.52-11.40; p < .01). For jail administrators, offering other vaccines was 3 times (CI:1.49-6.01; p < .01) and employing a nurse 1.65 times more likely (CI: 1.20-2.28; p < .01) to predict interest in collaborating to offer HPV vaccination. Open-ended responses indicated that managing linkages and stakeholder investment were areas of emphasis where collaborations to provide vaccinations in the jails had been previously implemented. CONCLUSIONS: Interest in jail-LHD partnerships to provide HPV vaccinations in jails exists in the Midwest but will require building-out existing programs and linkages and identifying and strengthening shared values, goals, and benefits at all levels.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Humanos , Iowa , Prisões Locais , Kansas , Missouri , Infecções por Papillomavirus/prevenção & controle , Vacinação , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-33923555

RESUMO

Sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS), are the number one cause of death in infants between 28 days and one year of life. Nearly half of families experiencing a sleep-related infant death in Kansas were involved with the Department of Children and Families Child Protective Services (CPS), making CPS staff a priority for safe sleep training. This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs' knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. CPS staff had significantly lower baseline knowledge on the 10-item pretest (t = 3.33, p = 0.002), but both CPS and other attendees showed significant improvement by posttest (t = 8.53, p < 0.001 and t = 4.44, p < 0.001, respectively). Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees. Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.


Assuntos
Serviços de Proteção Infantil , Morte Súbita do Lactente , Criança , Humanos , Lactente , Cuidado do Lactente , Kansas , Sono , Morte Súbita do Lactente/prevenção & controle , Estados Unidos
16.
Life Sci ; 278: 119454, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33811897

RESUMO

AIMS: This study characterizes Gulf War Illness (GWI) among U.S. veterans who participated in the Gulf War Era Cohort and Biorepository (GWECB). MAIN METHODS: Mailed questionnaires were collected between 2014 and 2016. Self-reported GWI symptoms, symptom domain criteria, exclusionary diagnoses, and case status were examined based on the originally published Kansas and Centers for Disease Control (CDC) definitions in the GWECB cohort (n = 849 deployed to Gulf and n = 267 non-deployed). Associations among GWI and deployment status, demographic, and military service characteristics were examined using logistic regression. KEY FINDINGS: Among deployed veterans in our sample, 39.9% met the Kansas criteria and 84.2% met the CDC criteria for GWI. Relative to non-deployed veterans, deployed veterans had a higher odds of meeting four GWI case status-related measures including the Kansas symptom criteria (aOR = 2.05, 95% CI = 1.50, 2.80), Kansas GWI case status (aOR = 1.42, 95% CI = 1.05, 1.93), the CDC GWI case status (aOR = 1.57, 95% CI = 1.07, 2.29) and the CDC severe criteria (aOR = 2.67, 95% CI = 1.79, 3.99). Forty percent met the Kansas exclusionary criteria, with no difference by deployment status. Some symptoms were nearly universally endorsed. SIGNIFICANCE: This analysis provides evidence of a sustained, multisymptom illness in veterans who deployed to the Persian Gulf War compared to non-deployed Gulf War era veterans nearly 25 years later. Differences in symptoms attributed to GWI by deployment status have diminished since initial reports, suggesting the need to update GWI definitions to account for aging-related conditions and symptoms. This study provides a foundation for future efforts to establish a single GWI case definition and analyses that employ the biorepository.


Assuntos
Síndrome do Golfo Pérsico/classificação , Síndrome do Golfo Pérsico/diagnóstico , Veteranos/estatística & dados numéricos , Adulto , Idoso , Centers for Disease Control and Prevention, U.S. , Estudos de Coortes , Feminino , Guerra do Golfo , Humanos , Kansas , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Militares , Síndrome do Golfo Pérsico/epidemiologia , Avaliação de Sintomas , Estados Unidos
17.
J Midwifery Womens Health ; 66(4): 512-519, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33661560

RESUMO

INTRODUCTION: Little is known about the nurse-midwifery workforce in rural Kansas hospitals, despite Kansas facing a shortage of primary care physicians providing maternity care rurally. This study investigated the current number of hospitals with certified nurse-midwives (CNMs) with privileges to attend births in Kansas hospitals located in frontier, rural, and densely settled rural counties and anticipated trends in the size of the CNM workforce at hospitals over the next 5 years. METHODS: Electronic surveys were distributed to senior hospital administrators at 94 hospitals in rural Kansas from June to July 2019. The survey included both open and closed-ended questions related to scope of CNM privileges, collaborative agreements, and forecasted trends in the CNM workforce in rural Kansas. RESULTS: Fifty-six hospitals completed the survey. Only one hospital reported having CNM-attended births. Twenty-eight of 37 hospital administrators agreed CNMs should have collaborative agreements with physicians. Most respondents did not anticipate the number of CNMs with privileges to increase at their hospitals over the next 5 years. DISCUSSION: Future research should focus on understanding the factors limiting CNM expansion in rural Kansas, because CNMs represent an untapped, additional maternity care workforce for rural Kansas.


Assuntos
Serviços de Saúde Materna , Tocologia , Enfermeiras Obstétricas , Feminino , Hospitais Rurais , Humanos , Kansas , Gravidez , Inquéritos e Questionários
18.
Am J Emerg Med ; 45: 61-64, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33667750

RESUMO

INTRODUCTION: Posterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions. METHODS: This was a retrospective, observational study that evaluated patients seen in the Emergency Department (ED) in an urban tertiary care center with the diagnosis of PRES or RPLS from 1/1/2008 to 1/1/2018. The Health System's Electronic Medical Record was used to collect data. Search criteria included any patient diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) or Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and excluded patients under 18 years of age, transfer patients, or patients that were not evaluated in our emergency department. RESULTS: We identified 98 patients based on our initial search criteria. After a chart review, 27 patients met our predefined eligibility criteria. In patients with confirmed diagnosis of PRES, the majority were female (70%) and 37% were either on an immunomodulator or undergoing chemotherapy at the time of presentation. 67% of patients presented with altered mental status, 41% had a focal neurologic deficit, and 37% had a witnessed seizure prior to diagnosis. Headache (48%), nausea (33%), and vision changes (30%) were the next most common reported symptoms. The majority of patients were hypertensive at time of presentation (82%) and many had a past medical history of hypertension (78%); twelve were given anti-hypertensive medications. 33% of the patients were admitted to the ICU and 26% died. There were no statistical associations found between documented ED interventions and the outcome of mortality. CONCLUSION: PRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.


Assuntos
Serviço Hospitalar de Emergência , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Humanos , Kansas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Eur J Heart Fail ; 23(4): 567-577, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33728762

RESUMO

AIMS: We sought to analyse quality of life (QoL) measures derived from two questionnaires widely used in clinical trials, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL 5 dimensions (EQ-5D), and to compare their prognostic value in men and women with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: From the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) we compared KCCQ and EQ-5D at baseline and after 9 months in 1276 men and 373 women with new-onset or worsening symptoms of HFrEF, who were sub-optimally treated and in whom there was an anticipated up-titration of guideline-derived medical therapies. Women had significantly worse baseline QoL (median) as compared with men, both when assessed with KCCQ overall score (KCCQ-OS, 44 vs. 53, P < 0.001) and EQ-5D utility score (0.62 vs. 0.73, P < 0.001). QoL improved equally in women and men at follow-up. All summary measures of QoL were independently associated with all-cause mortality, with KCCQ-OS showing the most remarkable association with mortality up to 1 year compared to the EQ-5D scores (C-statistic 0.650 for KCCQ-OS vs. 0.633 and 0.599 for EQ-5D utility score and EQ-5D visual analogue scale, respectively). QoL was associated with all outcomes analysed, both in men and women (all P for interaction with sex >0.2). CONCLUSION: Amongst patients with HFrEF, women reported significantly worse QoL than men. QoL was independently associated with subsequent outcome, similarly in men and women. The KCCQ in general, and the KCCQ-OS in particular, showed the strongest independent association with outcome.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Feminino , Humanos , Kansas , Masculino , Qualidade de Vida , Volume Sistólico , Inquéritos e Questionários
20.
J Clin Microbiol ; 59(6)2021 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-33692140

RESUMO

Picornaviruses, including Enterovirus species A to D (EV) and Parechovirus species A (PeV-A), are the leading reported causes of pediatric central nervous system infections in the United States. We investigated the molecular epidemiology of EV and PeV-A over 10 years in cerebrospinal fluid (CSF) collected from children seen at Children's Mercy-Kansas City (CMKC) from 2007 through 2016. The overall prevalence for EV was 16% (862/5,362) and 7% (271/4,016) for PeV. Among all picornavirus CSF detections, EV was 76%, and PeV-A was 24%. Multiple EV types cocirculated each year, with a total of 31 EV types detected in the 10-year period; the majority belonged to EV-B species (96%). Two PeV-A types were detected; PeV-A3 was the dominant PeV-A type (95%). The top five picornaviruses (PeV-A3, 26%; E30, 11%; E6, 10%; E18, 9%; E9, 7%) in the CSF of infants accounted for two-thirds of all detections, and PeV-A3 was the leading picornavirus detected. Routine testing and reporting of PeV-A in addition to EV, especially in children under 6 months old with acute febrile illnesses, could reduce hospital stays and antibiotic usage.


Assuntos
Infecções do Sistema Nervoso Central , Infecções por Enterovirus , Enterovirus , Parechovirus , Infecções por Picornaviridae , Criança , Enterovirus/genética , Infecções por Enterovirus/epidemiologia , Humanos , Lactente , Kansas , Missouri , Parechovirus/genética , Infecções por Picornaviridae/epidemiologia
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