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1.
JAMA Netw Open ; 7(6): e2414809, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38837159

RESUMO

Importance: Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited. Objective: To describe the prevalence of, factors associated with, and reasons for past-3 month cannabis use reported by primary care patients. Design, Setting, and Participants: This cross-sectional study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California. Exposures: Factors of interest included age, race and ethnicity, sex, employment status, and neighborhood Area Deprivation Index (ADI). Main Outcomes and Measures: Cannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use. Results: Among the 175 734 patients screened, the median (range) age was 47 (18-102) years; 101 657 (58.0%) were female; 25 278 (15.7%) were Asian, 21 971 (13.7%) were Hispanic, and 51 063 (31.7%) were White. Cannabis use was reported by 29 898 (17.0%), with 10 360 (34.7%) having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients (14 939 [20.0%] vs 14 916 [14.7%]) and younger patients (18-29 years, 7592 [31.0%]; ≥60 years, 4200 [8.5%]), and lower among those who lived in the most disadvantaged neighborhoods (ADI decile 9-10, 189 [13.8%]; ADI decile 1-2, 12 431 [17.4%]). The most common modes of use included edibles (18 201 [61.6%]), smoking (15 256 [51.7%]), and vaporizing (8555 [29.0%]). While 4375 patients who reported using cannabis (15.6%) did so for medical reasons only, 21 986 patients (75.7%) reported using cannabis to manage symptoms including pain (9196 [31.7%]), stress (14 542 [50.2%]), and sleep (16 221 [56.0%]). The median (IQR) number of symptoms managed was 2 (1-4), which was higher among patients who were at moderate to high risk for CUD (4 [2-6] symptoms). Conclusions and Relevance: In this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients' risk for CUD.


Assuntos
Atenção Primária à Saúde , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Adolescente , Adulto Jovem , Los Angeles/epidemiologia , Idoso de 80 Anos ou mais , Prevalência , Uso da Maconha/epidemiologia
2.
J Public Health Manag Pract ; 30: S52-S61, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870361

RESUMO

CONTEXT: In fall 2020, Community Clinic Association of Los Angeles County, in collaboration with the Los Angeles County Department of Public Health, launched a 3-year, cohort-based quality improvement (QI) coaching program to assist Federally Qualified Health Centers (FQHCs) in improving their clinical management of hypertension, high blood cholesterol, diabetes, and chronic kidney disease. PROGRAM: The QI program utilized a cohort-based coaching model in which 5 FQHCs were each assigned a practice transformation coach who provided them with guidance and support to monitor clinical quality measures. These measures were then used to facilitate changes and improvements in clinical workflows and approaches to patient care. To encourage peer learning and promote inter-organizational collaboration, the coaching team hosted quarterly cohort check-ins and an online group messaging board where the participating FQHCs could share lessons learned. Throughout the program, the FQHCs were provided trainings and resources to advance their clinical quality measures of choice. IMPLEMENTATION: To implement the program, each FQHC selected 2 clinical quality measures to focus on, completing a minimum of 1 Plan-Do-Study-Act cycle per year for each measure. Throughout, the coaches met regularly with FQHC staff to discuss progress, strategize on how best to address challenges encountered, and identify training or resource needs for their clinic sites. EVALUATION: To drive implementation of QI interventions and monitor overall progress, the FQHCs reported quarterly on the clinical quality measures being addressed. By program's end, all 5 FQHCs reached their 10% improvement goals. DISCUSSION: This QI coaching program allowed participating FQHCs to build new competencies and achieve measurable improvements in how they managed their patients' chronic diseases. This model of practice serves as a promising approach for achieving sustainable clinical improvements in these FQHCs.


Assuntos
Gerenciamento Clínico , Tutoria , Melhoria de Qualidade , Humanos , Tutoria/métodos , Tutoria/normas , Doença Crônica/terapia , Estudos de Coortes , Los Angeles , Centros Comunitários de Saúde/organização & administração
3.
J Public Health Manag Pract ; 30: S46-S51, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870360

RESUMO

Despite the availability of effective treatments, hypertension control rates remain inadequate in the United States and locally in Los Angeles County. To address this health condition, QueensCare Health Centers developed and launched a team-based hypertension management program that was led by clinical pharmacists and designed to mitigate treatment barriers encountered at the system, provider, and patient levels. System- and provider-focused strategies included incorporating self-monitored blood pressure values into the electronic health record and retraining clinicians to regularly review these values; adding a community health worker to the disease management team; and utilizing clinical pharmacists to assess and titrate medications. Patient-focused strategies included tailoring education materials to reduce literacy and linguistic barriers; providing tailored one-on-one education and support; and providing blood pressure cuffs and pedometers. This multilevel intervention serves as a practical example of how team-based care can be optimized at a Federally Qualified Health Center.


Assuntos
Hipertensão , Humanos , Hipertensão/terapia , Los Angeles , Gerenciamento Clínico , Centros Comunitários de Saúde/organização & administração
4.
Environ Pollut ; 354: 124244, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38810681

RESUMO

This study assessed the spatial variability of PM2.5 source contributions across ten sites located in the South Coast Air Basin, California. Eight pollution sources and their contributions were obtained using positive matrix factorization (PMF) from the PM2.5 compositional data collected during the two sampling campaigns (2012/13 and 2018/19) of the Multiple Air Toxics Exposure Study (MATES). The identified sources were "gasoline vehicles", "aged sea salt", "biomass burning", "secondary nitrate", "secondary sulfate", "diesel vehicles", "soil/road dust" and "OP-rich". Among them, "gasoline vehicle" was the largest contributor to the PM2.5 mass. The spatial distributions of source contributions to PM2.5 at the sites were characterized by the Pearson correlation coefficients as well as coefficients of determination and divergence. The highest spatial variability was found for the contributions from the "OP-rich" source in both MATES campaigns suggesting varying influences of the wildfires in the Los Angeles Basin. Alternatively, the smallest spatial variabilities were observed for the contributions of the "secondary sulfate" and "aged sea salt" sources resolved for the MATES campaign in 2012/13. The "soil/road dust" contributions of the sites from the 2018/19 campaign were also highly correlated. Compared to the other sites, the source contribution patterns observed for Inland Valley and Rubidoux were the most diverse from the others likely due to their remote locations from the other sites, the major urban area, and the Pacific Ocean.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Monitoramento Ambiental , Material Particulado , Los Angeles , Monitoramento Ambiental/métodos , Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Material Particulado/análise , Emissões de Veículos/análise
5.
Public Health Nutr ; 27(1): e133, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38711182

RESUMO

OBJECTIVE: Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors. DESIGN: We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages. SETTING: Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County. PARTICIPANTS: 903 adults representative of Los Angeles County households. RESULTS: Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change. CONCLUSIONS: Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy.


Assuntos
COVID-19 , Dieta , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Los Angeles/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Dieta/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Longitudinais , Verduras , Pandemias , Frutas , Características de Residência/estatística & dados numéricos , Idoso , Adulto Jovem , Comportamento Alimentar , Bebidas Adoçadas com Açúcar/estatística & dados numéricos
6.
Health Place ; 88: 103267, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38763049

RESUMO

Unsheltered homelessness is an increasingly prevalent phenomenon in major cities that is associated with adverse health and mortality outcomes. This creates a need for spatial estimates of population denominators for resource allocation and epidemiological studies. Gaps in the timeliness, coverage, and spatial specificity of official Point-in-Time Counts of unsheltered homelessness suggest a role for geospatial data from alternative sources to provide interim, neighborhood-level estimates of counts and trends. We use citizen-generated data from homeless-related 311 requests, provider-based administrative data from homeless street outreach cases, and expert reports of unsheltered count to predict count and emerging hotspots of unsheltered homelessness in census tracts across the City of Los Angeles for 2019 and 2020. Our study shows that alternative data sources can contribute timely insights into the state of unsheltered homelessness throughout the year and inform the delivery of interventions to this vulnerable population.


Assuntos
Pessoas Mal Alojadas , Humanos , Pessoas Mal Alojadas/estatística & dados numéricos , Los Angeles , Masculino , Feminino , Sistemas de Informação Geográfica , Adulto , Características da Vizinhança , Análise Espacial , Pessoa de Meia-Idade , Características de Residência/estatística & dados numéricos
7.
Prev Chronic Dis ; 21: E29, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38696254

RESUMO

We examined whether a community engagement approach and jurisdictional attributes were associated with local action to restrict the sale of flavored tobacco products in Los Angeles County during 2019-2022. We estimated crude and adjusted risk ratios to examine these associations. Jurisdictions that used an active community engagement approach to adopt a flavored tobacco ban ordinance, those with previous experience adopting other tobacco-related ordinances, and those located next to communities that have an existing tobacco retail license ordinance were more likely than jurisdictions without these attributes to adopt a new ordinance to restrict the sale of flavored tobacco products. Efforts to adopt such an ordinance were generally more successful in jurisdictions where community members were engaged and policy makers were familiar with the adoption of public health ordinances.


Assuntos
Participação da Comunidade , Produtos do Tabaco , Humanos , Los Angeles , Produtos do Tabaco/legislação & jurisprudência , Aromatizantes , Comércio/legislação & jurisprudência
8.
PLoS One ; 19(5): e0303075, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38723012

RESUMO

INTRODUCTION: Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. METHODS: We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. RESULTS: Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. DISCUSSION: In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.


Assuntos
Hipertensão , Humanos , Masculino , Hipertensão/terapia , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Adulto , Pesquisa Qualitativa , Los Angeles , Entrevistas como Assunto , Pressão Sanguínea , Feminino , Farmacêuticos/psicologia , Negro ou Afro-Americano
9.
Nicotine Tob Res ; 26(Supplement_2): S143-S146, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38817023

RESUMO

INTRODUCTION: Menthol cigarettes are disproportionately marketed and advertised in the commercial tobacco retail environment in Black communities across the United States, contributing to menthol cigarette-related disparities and lower likelihood of successful quitting among Black people who smoke. Policies restricting retail sales of menthol cigarettes are aimed at preventing initiation, promoting quitting, and reducing related disparities. METHODS: Structured phone interview surveys were conducted from January to July 2021 with commercial tobacco retailers in Los Angeles County, California, unincorporated communities with a high percentage of Black residents, eight months after a local policy restricting retail sales of menthol cigarettes and other flavored nicotine and commercial tobacco products became effective on May 20, 2020. Interviews examined menthol cigarette sales restrictions-related knowledge, attitudes, and practices. RESULTS: Among 22 retailers interviewed, most (86.4%) reported having knowledge of the local ban on menthol cigarettes, and more than half (54.5%) reported offering price promotions for menthol cigarettes. Additionally, more than half (54.5%) reported believing customers who buy menthol cigarettes would stop smoking altogether following the ban. CONCLUSIONS: Most retailers reported having knowledge of the menthol ban, yet half reported offering price promotions for menthol cigarettes. Findings suggest retail availability of menthol cigarettes in Los Angeles County unincorporated communities with a high percentage of Black residents, post ban. Public health and policy implications are discussed.


Assuntos
Comércio , Mentol , Produtos do Tabaco , Humanos , Produtos do Tabaco/economia , Produtos do Tabaco/legislação & jurisprudência , Comércio/legislação & jurisprudência , Comércio/estatística & dados numéricos , Feminino , Masculino , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , California , Conhecimentos, Atitudes e Prática em Saúde , Pessoa de Meia-Idade , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/legislação & jurisprudência , Los Angeles , Inquéritos e Questionários
10.
Nicotine Tob Res ; 26(Supplement_2): S82-S88, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38817024

RESUMO

INTRODUCTION: The commercial tobacco industry has long targeted Black communities by making menthol cigarettes not only appealing but affordable through marketing, advertising, and pricing strategies, particularly in the retail environment. Policies that focus on restricting the sale of menthol cigarettes have the potential to significantly reduce the death toll from smoking while also mitigating health inequities and advancing racial equity. However, limited qualitative research exists on the perceptions of menthol cigarette sales restrictions, including local policies, among Black adults who smoke menthol cigarettes. AIMS AND METHODS: In-depth semi-structured interviews were conducted between January and September 2021 with self-identified non-Hispanic Black adults who reported current menthol cigarette use (n = 26). Participants were asked open-ended questions about awareness and perceptions of the Los Angeles County law banning the retail sale of menthol cigarettes in unincorporated communities, including how it influences their smoking and purchasing behaviors. RESULTS: We used three thematic categories to structure the results: (1) Are People Aware of Local Menthol Cigarette Sales Restrictions? Levels of Awareness and Strategies to Increase Awareness, (2) Why Ban Menthol? Concerns About Equity and Fairness, and (3) Will Menthol Cigarette Bans Decrease Smoking? Mixed Perceptions About Potential Impact. Most participants (88.5%) had heard about the menthol ban in their communities. Participants described ambivalence towards the ban and identified several factors that hinder support, participation, and well-being, including uncertainty regarding the rationale for banning menthol cigarettes; perceptions that the ban specifically targets Black communities; and concerns regarding government overreach and constraining individual choice. Participants had differing views on whether the ban would likely help them and others who smoke menthol cigarettes reduce or quit smoking. Participants also described situations in which they would purchase menthol cigarettes in another state, country, online, or in the illicit market. Furthermore, participants often viewed the ban as perpetuating criminalization and over-policing of Black communities-arguments used by the commercial tobacco industry to oppose menthol bans. CONCLUSIONS: Our community-based sample of Black adults who smoke menthol cigarettes face challenges and concerns about local menthol bans. Community-centered interventions, messages, and materials about racial equity in menthol bans, access to free cessation services, and countering commercial tobacco industry interference, in addition to measurable steps toward rectifying injustice from the commercial tobacco industry and repeated exemptions of menthol cigarettes from federal legislation through tangible reparations, would be helpful to this community. IMPLICATIONS: We sought to add to the literature on flavored nicotine and commercial tobacco policies in the United States by centering the voices of Black adults who smoke menthol cigarettes regarding their awareness, perceptions, and opinions of local laws restricting menthol cigarette retail sales and how such polices influence their smoking and purchasing behaviors. Our findings suggest that Black adults who smoke menthol cigarettes are aware of local laws restricting menthol cigarette retail sales and are ambivalent about the rationale. Our findings have implications for the development and delivery of equity-focused strategies and resources to increase awareness of and rationale for the ban; counter commercial tobacco industry interference; and facilitate smoking cessation among Black adults who experience more combustible tobacco-related morbidity and mortality than their racial/ethnic counterparts. By understanding this relevance, we can also recognize how individual awareness and perceptions are moored within and contextualized by broader social structures and systemic inequities that warrant policy considerations.


Assuntos
Negro ou Afro-Americano , Comércio , Mentol , Pesquisa Qualitativa , Produtos do Tabaco , Humanos , Masculino , Feminino , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Produtos do Tabaco/legislação & jurisprudência , Produtos do Tabaco/economia , Pessoa de Meia-Idade , Los Angeles , Comércio/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Adulto Jovem , Fumantes/psicologia , Fumantes/estatística & dados numéricos
11.
PLoS One ; 19(5): e0295476, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38809860

RESUMO

In response to biodiversity loss and biotic community homogenization in urbanized landscapes, there are increasing efforts to conserve and increase biodiversity within urban areas. Accordingly, around the world, previously extirpated species are (re)colonizing and otherwise infiltrating urban landscapes, while other species are disappearing from these landscapes. Tracking the occurrence of traditionally urban intolerant species and loss of traditionally urban tolerant species should be a management goal of urban areas, but we generally lack tools to study this phenomenon. To address this gap, we first used species' occurrences from iNaturalist, a large collaborative dataset of species observations, to calculate an urban association index (UAI) for 967 native animal species that occur in the city of Los Angeles. On average, the occurrence of native species was negatively associated with our composite measure of urban intensity, with the exception of snails and slugs, which instead occur more frequently in areas of increased urban intensity. Next, we assessed 8,348 0.25 x 0.25 mile grids across the City of Los Angeles to determine the average grid-level UAI scores (i.e., a summary of the UAIs present in a grid cell, which we term Community Urban Tolerance Index or CUTI). We found that areas of higher urban intensity host more urban tolerant species, but also that taxonomic groups differ in their aggregate tolerance of urban areas, and that spatial patterns of tolerance vary between groups. The framework established here has been designed to be iteratively reevaluated by city managers of Los Angeles in order to track the progress of initiatives to preserve and encourage urban biodiversity, but can be rescaled to sample different regions within the city or different cities altogether to provide a valuable tool for city managers globally.


Assuntos
Biodiversidade , Cidades , Animais , California , Los Angeles , Conservação dos Recursos Naturais/métodos , Urbanização , Ecossistema
12.
AORN J ; 119(6): 412-420, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38804742

RESUMO

Processes for intravesical chemotherapy after transurethral resection of nonmuscle invasive bladder tumors may lack standardization. In 2019, at a large health care system in Los Angeles, California, five incident reports involving chemotherapeutic agent spills from urinary catheters after bladder tumor procedures necessitated a quality improvement project. The project lead determined that a cost-effective alternative device for securing the chemotherapeutic agent in the bladder was needed at four surgical locations of the health care system. In addition, a review of the literature and an observational assessment revealed lack of adherence to standard and recommended processes for using personal protective equipment (PPE) when handling hazardous medications. After revising existing processes, acquiring a cost-effective clamp and recommended chemotherapy PPE, instructing personnel on the clamping process and use of PPE, and implementing use of the clamp, there have been no spills associated with intravesical chemotherapy across the four surgical locations.


Assuntos
Neoplasias da Bexiga Urinária , Humanos , Administração Intravesical , Neoplasias da Bexiga Urinária/tratamento farmacológico , Antineoplásicos/administração & dosagem , Equipamento de Proteção Individual/normas , Los Angeles , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas , Melhoria de Qualidade
13.
J Drugs Dermatol ; 23(5): 306-310, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38709694

RESUMO

BACKGROUND: There are no guidelines on when to more strongly recommend sentinel lymph node biopsy (SLNB) for T1b melanomas. OBJECTIVE: To examine whether anatomic locations of T1b melanomas and patient age influence metastases. METHODS: We conducted a retrospective study using data from two hospitals in Los Angeles County from January 2010 through January 2020. RESULTS: Out of 620 patients with primary melanomas, 566 melanomas were staged based on the American Joint Committee on Cancer 8th edition melanoma staging. Forty-one were T1b, of which 13 were located on the face/ear/scalp and 28 were located elsewhere. T1b melanomas located on the face/ear/scalp had an increased risk of lymph node or distant metastasis compared with other anatomic sites (31% vs 3.6%, P=0.028). For all melanomas, the risk of lymph node or distant metastasis decreased with age of 64 years or greater (P<0.001 and P=0.034). For T1b melanomas, the risk of distant metastasis increased with increasing age (P=0.047). LIMITATIONS: Data were from a single county.  Conclusion: T1b melanomas of the face/ear/scalp demonstrated a higher risk of lymph node or distant metastasis and may help guide the recommendation of SLNB, imaging, and surveillance. Younger patients may be more strongly considered for SLNB and older patients with T1b melanomas may warrant imaging.  J Drugs Dermatol. 2024;23(5):306-310. doi:10.36849/JDD.7667.


Assuntos
Metástase Linfática , Melanoma , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas , Humanos , Melanoma/patologia , Melanoma/diagnóstico , Melanoma/epidemiologia , Estudos Retrospectivos , Feminino , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Masculino , Pessoa de Meia-Idade , Idoso , Fatores Etários , Metástase Linfática/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Los Angeles/epidemiologia , Adulto Jovem
14.
PLoS One ; 19(5): e0303439, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38739626

RESUMO

Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms.


Assuntos
Emprego , Habitação , Pessoas Mal Alojadas , Renda , Transtornos Relacionados ao Uso de Substâncias , Humanos , Pessoas Mal Alojadas/estatística & dados numéricos , Pessoas Mal Alojadas/psicologia , Masculino , Feminino , Emprego/estatística & dados numéricos , Renda/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem , Adulto , Depressão/epidemiologia , Los Angeles/epidemiologia , Adolescente
15.
JAMA Netw Open ; 7(5): e2411987, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38767917

RESUMO

Importance: Recent studies in Canadian and Mexican populations suggest an association of higher prenatal fluoride exposure with poorer neurobehavioral development, but whether this association holds for US-based populations is unknown. Objective: To examine associations of third trimester maternal urinary fluoride (MUF) with child neurobehavior at age 3 years in the US. Design, Setting, and Participants: This prospective cohort study utilized urine samples archived from 2017 to 2020 and neurobehavioral data assessed from 2020 to 2023 from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, which consisted of predominately Hispanic women residing in Los Angeles, California. Cohort eligibility criteria at recruitment included being 18 years of age or older, less than 30 weeks' gestation, and a fluent English or Spanish speaker. Exclusion criteria included having a disability preventing participation or provision of informed consent, being HIV positive or incarcerated, and having a multiple gestation pregnancy. There were 263 mother-child pairs who completed the 3-year study visit. In this analysis, women who reported prenatal smoking were excluded. Data analysis was conducted from October 2022 to March 2024. Exposure: Specific gravity-adjusted MUF (MUFSG), a biomarker of prenatal fluoride exposure. Main Outcomes and Measures: Neurobehavior was quantified using the Preschool Child Behavior Checklist (CBCL), which included composite scores for Total Problems, Internalizing Problems, and Externalizing Problems. CBCL composite T scores range from 28 to 100. T scores from 60 to 63 are in the borderline clinical range, whereas scores above 63 are in the clinical range. Linear and logistic regression models adjusted for covariates were conducted. Results: A total of 229 mother-child pairs (mean [SD] maternal age, 29.45 [5.67] years; 116 female children [50.7%] and 113 male children [49.3%]) who had MUFSG measured were included in the study. Median (IQR) MUFSG was 0.76 (0.51-1.19) mg/L, and 32 participants (14.0%) had a Total Problems T score in the borderline clinical or clinical range. A 1-IQR (0.68 mg/L) increase in MUFSG was associated with nearly double the odds of the Total Problems T score being in the borderline clinical or clinical range (odds ratio, 1.83; 95% CI, 1.17-2.86; P = .008), as well as with a 2.29-point increase in T score for the Internalizing Problems composite (B = 2.29; 95% CI, 0.47-4.11; P = .01) and a 2.14-point increase in T score for the Total Problems composite (B = 2.14; 95% CI, 0.29-3.98; P = .02). Conclusions and Relevance: In this prospective cohort study of mother-child pairs in Los Angeles, California, prenatal fluoride exposure was associated with increased neurobehavioral problems. These findings suggest that there may be a need to establish recommendations for limiting fluoride exposure during the prenatal period.


Assuntos
Fluoretos , Efeitos Tardios da Exposição Pré-Natal , Humanos , Feminino , Gravidez , Pré-Escolar , Fluoretos/urina , Fluoretos/efeitos adversos , Estudos Prospectivos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Masculino , Exposição Materna/efeitos adversos , Exposição Materna/estatística & dados numéricos , Desenvolvimento Infantil/efeitos dos fármacos , Comportamento Infantil/efeitos dos fármacos , Terceiro Trimestre da Gravidez/urina , Los Angeles/epidemiologia
16.
Sci Rep ; 14(1): 11851, 2024 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-38789553

RESUMO

It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.


Assuntos
COVID-19 , Deficiências do Desenvolvimento , Complicações Infecciosas na Gravidez , Efeitos Tardios da Exposição Pré-Natal , SARS-CoV-2 , Humanos , Feminino , COVID-19/epidemiologia , Gravidez , Pré-Escolar , Lactente , Masculino , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/virologia , Deficiências do Desenvolvimento/epidemiologia , SARS-CoV-2/isolamento & purificação , Brasil/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Efeitos Tardios da Exposição Pré-Natal/virologia , Adulto , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/virologia , Desenvolvimento Infantil , Los Angeles/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-38673402

RESUMO

In the early phases of the COVID-19 pandemic, vaccine accessibility was limited, impacting large metropolitan areas such as Los Angeles County, which has over 10 million residents but only nine initial vaccination sites, which resulted in people experiencing long travel times to get vaccinated. We developed a mixed-integer linear model to optimize site selection, considering equitable access for vulnerable populations. Analyzing 277 zip codes between December 2020 and May 2021, our model incorporated factors such as car ownership, ethnic group disease vulnerability, and the Healthy Places Index, alongside travel times by car and public transit. Our optimized model significantly outperformed actual site allocations for all ethnic groups. We observed that White populations faced longer travel times, likely due to their residences being in more remote, less densely populated areas. Conversely, areas with higher Latino and Black populations, often closer to the city center, benefited from shorter travel times in our model. However, those without cars experienced greater disadvantages. While having many vaccination sites might improve access for those dependent on public transit, that advantage is diminished if people must search among many sites to find a location with available vaccines.


Assuntos
COVID-19 , Vacinação em Massa , Humanos , COVID-19/prevenção & controle , Los Angeles , Vacinação em Massa/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagem , SARS-CoV-2
18.
BMC Prim Care ; 25(1): 116, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38632550

RESUMO

BACKGROUND: People living with HIV (PLWH) may be at heightened risk for cardiovascular disease (CVD). Statin use and lifestyle changes reduce the risk of CVD but remain under-prescribed among PLWH. The objective of this study was to characterize knowledge of CVD and statin use, current usage, barriers to taking statins, and information desired by PLWH to improve statin uptake among PLWH in Los Angeles, CA. METHODS: Between April 2019 and April 2020, we conducted four focus group discussions (n = 37) with patients across three public community health clinics that serve PLWH in Los Angeles County, California. All clinics participated in a larger study to improve statin prescribing for PLWH. We asked about knowledge of statins, willingness to take a statin, possible barriers to statin usage, preferred information sources for health information, and desired information about statins. We utilized standard qualitative content analysis methods to identify themes. RESULTS: We found a range in the awareness of statins, with some participants reporting never having heard of statins while others had a history of statin use. There were concerns about the potential long-term effect of statin use, but participants expressed willingness to use CVD medications generally and statins specifically, especially if recommended by their healthcare provider. Participants also expressed interest in potential alternatives to statin usage such as exercising regularly and nutritious eating. CONCLUSIONS: More interventions are needed to increase statin use among PLWH to improve CVD outcomes, which also has implications for HIV progression. Clinics should aim to increase patient and provider knowledge about CVD risk and statin use for PLWH and provide shared decision-making tools that are easy to use and culturally appropriate.


Assuntos
Doenças Cardiovasculares , Infecções por HIV , Inibidores de Hidroximetilglutaril-CoA Redutases , Humanos , Estados Unidos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Los Angeles
19.
Prev Chronic Dis ; 21: E25, 2024 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-38635496

RESUMO

Introduction: Menthol tobacco products have been marketed disproportionately to communities of color for decades. Methods: In Los Angeles County, California, a health marketing campaign, which used glossy visuals and attractive people in appealing poses, reminiscent of tobacco marketing tactics, was created and implemented to educate smokers on the health risks of using menthol cigarettes. The campaign encouraged smokers to make a quit attempt by offering access to free or low-cost resources through the Kick It California quitline and the LAQuits website (laquits.com). A survey tailored for public health professionals and community members from the approximately 382,000 people in the county who smoked menthol cigarettes and were exposed to their smoke (our primary audience) was administered to generate insights about this problem. Survey data were used to finesse the campaign creative materials prior to launch. Advertisement exposures, website visits, and quitline call volume were monitored and tabulated to assess the performance of the campaign. Results: At the conclusion of its initial run (February-April 2021), the "Done with Menthol" campaign had garnered more than 66 million impressions, received approximately 56,000 clicks on its various digital media platforms, and had click-through rates that surpassed industry benchmarks. The quitline call volume for African American and Latino subgroups were 1.9 and 1.8 times higher than the average inbound call volume for corresponding months during 2018 and 2019, respectively. In its second run (May-June 2023), the campaign garnered approximately 11 million additional impressions. Conclusions: Despite having a lower budget and fewer resources than the tobacco industry, the "Done with Menthol" campaign attained excellent reach and offered free, low-cost, and accessible resources to county residents interested in tobacco use cessation.


Assuntos
Fumar , Produtos do Tabaco , Humanos , Mentol , Internet , Los Angeles , Marketing , Nicotiana
20.
Int J Hyg Environ Health ; 259: 114362, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38574449

RESUMO

BACKGROUND: A growing literature has reported associations between traffic-related air pollution and breast cancer, however there are fewer investigations into specific ambient agents and any putative risk of breast cancer development, particularly studies occurring in populations residing in higher pollution areas such as Los Angeles. OBJECTIVES: To estimate breast cancer risks related to ambient air toxics exposure at residential addresses. METHODS: We examined the relationships between ambient air toxics and breast cancer risk in the Multiethnic Cohort among 48,665 California female participants followed for cancer from 2003 through 2013. We obtained exposure data on chemicals acting as endocrine disruptors or mammary gland carcinogens from the National-Scale Air Toxics Assessment. Cox proportional hazards models were used to estimate breast cancer risk per one interquartile range (IQR) increase in air toxics exposure lagged by 5-years. Stratified analyses were conducted by race, ethnicity, and hormone receptor types. RESULTS: Among all women, increased risks of invasive breast cancer were observed with toxicants related to industries [1,1,2,2-tetrachloroethane (hazard ratio [HR] = 4.22, 95% confidence interval [95% CI] 3.18-5.60), ethylene dichloride (HR = 2.81, 95% CI 2.20-3.59), and vinyl chloride (HR = 2.27, 95% CI 1.81, 2.85); these 3 agents were correlated (r2 = 0.45-0.77)]. Agents related to gasoline production or combustion were related to increased breast cancer risk [benzene (HR = 1.32, 95% CI 1.24, 1.41), ethylbenzene (HR = 1.20, 95% CI 1.13-1.28), toluene (HR = 1.29, 95% CI 1.20-1.38), naphthalene (HR = 1.11, 95% CI 1.02-2.22), acrolein (HR = 2.26, 95% CI 1.92, 2.65)]. Higher hazard ratios were observed in African Americans and Whites compared to other racial and ethnic groups (p-heterogeneity <0.05 for traffic-related air toxics, acrolein, and vinyl acetate). CONCLUSIONS: Our findings suggest that specific toxic air pollutants may be associated with increase breast cancer risk.


Assuntos
Poluentes Atmosféricos , Neoplasias da Mama , Humanos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/induzido quimicamente , Feminino , Pessoa de Meia-Idade , Poluentes Atmosféricos/efeitos adversos , Idoso , Estudos de Coortes , Exposição Ambiental/efeitos adversos , California/epidemiologia , Adulto , Fatores de Risco , Los Angeles/epidemiologia , Modelos de Riscos Proporcionais
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