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1.
Front Public Health ; 12: 1286177, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38601509

RESUMO

Public health emergencies, such as the COVID-19 pandemic, elucidate the strengths, weaknesses, and significant gaps in infrastructure, compatibility and consistency in communication systems, as well as the quality of collaborative relationships, and provider and workforce capacity. They also expose longstanding patterns of mistrust in the government and healthcare systems, and inadequacy in socio-economic infrastructures. These issues resulted in higher COVID-19 infection and mortality rates, and lower vaccination rates in many rural counties across the nation, including Missouri. In response to these challenges, the COVID-19 Response Network was formed in the Southeast corner of the state. The Network was a community-academic partnership that brought together community and faith-based leaders, academicians, healthcare providers and administrators, public health practitioners, and pharmacists to facilitate collaboration on education and outreach efforts aimed at reducing vaccine inequity in the 16-county project area. Importantly, the Network also included Community Health Workers (CHWs) who worked with these different agencies and organizations and were at the heart of implementing Network activities. The intent of this study was to assess their perspectives on the factors that influenced community engagement and communication strategies, and increased vaccine uptake in rural Missouri. Qualitative methods, including in-depth interviews, were used to explore the professional and personal experiences of CHWs working at the grassroots level during an ongoing pandemic. Narrative analysis revealed effective communication and engagement strategies for increasing vaccine uptake in rural communities. For instance, fear-based messaging was perceived as coercive and met with resistance. In contrast, messages that shared personal experiences and catered to the human need to protect their loved ones were more effective. Trust in the source of information was critical. This study highlights the significance of exploring and leveraging the capacities of trusted community members like CHWs to increase the effectiveness of public health interventions in rural communities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , COVID-19/prevenção & controle , Agentes Comunitários de Saúde , Missouri , Pandemias
2.
Arch Virol ; 169(4): 77, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38517556

RESUMO

Papillomaviruses are small circular DNA viruses that infect epithelial and mucosal cells and have co-evolved with their hosts. Some papillomaviruses in mammals are well studied (especially those associated with disease). However, there is limited information on papillomaviruses associated with avian hosts. From a cloacal swab sample of a mallard (Anas platyrhynchos) sampled in Missouri, USA (6 Jan 2023), we identified a papillomavirus (7839 nt) that shares ~68% genome-wide nucleotide sequence identity with Anas platyrhynchos papillomavirus 1 (AplaPV1) from a mallard sampled in Newfoundland (Canada) and ~40% with AplaPV2 from a mallard sampled in Minnesota (USA) with mesenchymal dermal tumors. The papillomavirus we identified shares 73.6% nucleotide sequence identity in the L1 gene with that of AplaPV1 and thus represents a new AplaPV type (AplaPV3). The genome sequence of AplaPV3 shares >97% identity with three partial PV genome sequences (1316, 1997, and 4241 nt) identified in a mallard in India, indicating that that virus was also AplaPV3.


Assuntos
Aves , Patos , Animais , Missouri , Genoma , Canadá , Mamíferos
3.
Front Public Health ; 12: 1329382, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38528866

RESUMO

Background: Limited information is available on geographic disparities of COVID-19 vaccination in Missouri and yet this information is essential for guiding efforts to improve vaccination coverage. Therefore, the objectives of this study were to (a) investigate geographic disparities in the proportion of the population vaccinated against COVID-19 in Missouri and (b) identify socioeconomic and demographic predictors of the identified disparities. Methods: The COVID-19 vaccination data for time period January 1 to December 31, 2021 were obtained from the Missouri Department of Health. County-level data on socioeconomic and demographic factors were downloaded from the 2020 American Community Survey. Proportions of county population vaccinated against COVID-19 were computed and displayed on choropleth maps. Global ordinary least square regression model and local geographically weighted regression model were used to identify predictors of proportions of COVID-19 vaccinated population. Results: Counties located in eastern Missouri tended to have high proportions of COVID-19 vaccinated population while low proportions were observed in the southernmost part of the state. Counties with low proportions of population vaccinated against COVID-19 tended to have high percentages of Hispanic/Latino population (p = 0.046), individuals living below the poverty level (p = 0.049), and uninsured (p = 0.015) populations. The strength of association between proportion of COVID-19 vaccinated population and percentage of Hispanic/Latino population varied by geographic location. Conclusion: The study findings confirm geographic disparities of proportions of COVID-19 vaccinated population in Missouri. Study findings are useful for guiding programs geared at improving vaccination coverage and uptake by targeting resources to areas with low proportions of vaccinated individuals.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Missouri/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Retrospectivos , Vacinação
4.
Mo Med ; 121(1): 81-86, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38404434

RESUMO

Opioid use disorder (OUD) represents a growing public health crisis in Missouri and nationwide. Reversing the trend of rising OUD-associated morbidity and mortality will require implementing evidence-based approaches grounded in public health principles. Key evidence-based interventions include medications for opioid use disorder, naloxone distribution, overdose education, and syringe services programs. The increasing presence of fentanyl and xylazine in the drug supply represent new challenges to the OUD crisis in Missouri. Optimal implementation of evidence-based interventions will require action at the individual physician, community, and state policy level.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Humanos , Analgésicos Opioides/efeitos adversos , Missouri/epidemiologia , Saúde Pública , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle
5.
Mo Med ; 121(1): 10-13, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38404438
6.
J Epidemiol Community Health ; 78(5): 296-302, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38302278

RESUMO

INTRODUCTION: Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. METHODS: We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. RESULTS: We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. CONCLUSION: Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Humanos , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Missouri/epidemiologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Censos , 60530 , Material Particulado/efeitos adversos , Material Particulado/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Progressão da Doença , Pobreza , Serviço Hospitalar de Emergência
7.
J Public Health Manag Pract ; 30(2): 176-182, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37831663

RESUMO

BACKGROUND: As the COVID-19 pandemic progressed across the United States, older adults living in nursing home (NH) facilities were disproportionately affected because of living in communal spaces with close proximity to others, age-related medical conditions, and constant contact with staff who may support multiple clients and facilities. While these populations are particularly at risk, there has been limited research focused on the management of the potential vectors of COVID-19 infection. METHODS: Data from the Centers for Medicare & Medicaid Services (CMS) COVID-19 reporting system assessing weekly observations of COVID-19 case counts among NH residents and COVID-19 vaccination rates among NH staff and residents in the states of Missouri and Illinois (n = 877) from May 24, 2021, to August 28, 2021, were used. This ecological study, using results from the CMS COVID-19 reporting system, local COVID-19 rates, and NH-level demographic characteristics, conducted a zero inflation mode to determine the association between NH staff vaccine uptake and COVID-19 cases among NH residents. RESULTS: Among the total 11 195 weekly observations within the NH facilities, zero cases of COVID-19 were reported during 10 683 (95%) of those weeks, supporting the use of a zero-inflated model. Results show that staff vaccination rates were significantly associated with a decrease in COVID-19 mortality. This study identified that for every percentage increase in staff vaccine coverage, the rate of COVID-19 among residents decreased by 2%. DISCUSSION: These findings suggest that NH staff vaccination rates are significantly associated with the rate of COVID-19 outbreaks among NH residents. Community median income was associated with an increased likelihood of infection. Future research that explores associations with employment benefits and staff mobility, particularly in vulnerable populations, should be implemented in future vaccination strategic planning.


Assuntos
COVID-19 , Vacinas contra Influenza , Humanos , Idoso , Estados Unidos/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Missouri/epidemiologia , Pandemias/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Medicare , Casas de Saúde
8.
Am J Public Health ; 114(S1): S65-S68, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37944094

RESUMO

COVID-19 self-test kits were distributed to low-income, older adults (n = 2532) with their home-delivered or congregate meals in May 2022. Later, a convenience sample (n = 1108) were contacted for follow-up, and 606 (55%) were reached. Among 79% who remembered getting the test, only 34% already had a test kit, but nearly all liked receiving it (91%) and reported they would use or had used it (93%). Partnering with meal-delivery service providers was feasible to increase access to COVID-19 self-tests for low-income older adults. (Am J Public Health. 2024;114(S1):S65-S68. https://doi.org/10.2105/AJPH.2023.307485).


Assuntos
COVID-19 , Pacientes Domiciliares , Humanos , Idoso , Missouri , Autoteste , COVID-19/diagnóstico , Pobreza
9.
J Wildl Dis ; 60(1): 151-163, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37921651

RESUMO

Frog virus 3 (FV3) and related ranaviruses are emerging infectious disease threats to ectothermic vertebrate species globally. Although the impact of these viruses on amphibian health is relatively well studied, less is understood about their effects on reptile health. We report two cases of FV3 infection, 11 mo apart, in three-toed box turtles (Terrapene mexicana triunguis) from a wildlife rehabilitation center. Case 1 had upper respiratory signs upon intake but had no clinical signs at the time of euthanasia 1 mo later. Case 2 presented for vehicular trauma, had ulcerative pharyngitis and glossitis, and died overnight. In case 1, we detected FV3 nucleic acid with qPCR in oral swabs, kidney, liver, spleen, and tongue. In case 2, we detected FV3 in an oral swab, an oral plaque, heart, kidney, lung, liver, spleen, and tongue. We also detected FV3 nucleic acid with in situ hybridization for case 2. For both cases, FV3 was isolated in cell culture and identified with DNA sequencing. Histopathologic examination of postmortem tissue from case 1 was unremarkable, whereas acute hemorrhagic pneumonia and splenic necrosis were noted in case 2. The difference in clinical signs between the two cases may have been due to differences in the temporal course of FV3 disease at the time of necropsy. Failure to detect this infection previously in Missouri reptiles may be due to lack of surveillance, although cases may also represent a novel spillover to box turtles in Missouri. Our findings reiterate previous suggestions that the range of FV3 infection may be greater than previously documented and that infection may occur in host species yet to be tested.


Assuntos
Infecções por Vírus de DNA , Ácidos Nucleicos , Ranavirus , Tartarugas , Animais , Missouri/epidemiologia , Animais Selvagens , Infecções por Vírus de DNA/veterinária
10.
J Am Pharm Assoc (2003) ; 64(1): 154-158, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37769848

RESUMO

BACKGROUND: Due to low national and local rates for annual eye exams in patients with diabetes, a pharmacist-led chronic care clinic creates a unique opportunity for pharmacists to provide digital retina scans in the primary care setting. OBJECTIVES: The primary objective is to assess the impact of a pharmacist-led digital retina scan service on rates of annual eye exams among patients with diabetes. PRACTICE DESCRIPTION: KC CARE Health Center, a federally qualified health center in Kansas City, Missouri, offers healthcare services to any member of the community regardless of insurance status. Pharmacists work in this setting to assist with management of chronic disease under a collaborative practice agreement. PRACTICE INNOVATION: A pharmacist developed a workflow process to provide digital retina scans in the primary care setting for patients with diabetes who had not had an eye exam in the past 12 months. Images of each eye are captured using a RetinaVue 700 Imager and these images are submitted to an ophthalmologist for review. EVALUATION METHODS: Rates of annual eye exams among patients with diabetes seen in the primary care clinic before and after retina scan service implementation were analyzed using a chi-squared test with an a-priori alpha of 0.05. Survey data of patient-reported barriers to follow-up were reported using descriptive statistics. RESULTS: There was a 5% increase in the annual eye exam rate of patients with diabetes seen at the clinic during the study period. The increase in rate of annual eye exam from before the intervention to after was statistically significant (P < 0.001). CONCLUSION: Implementing a pharmacist-led retina scan program in the primary care setting improved the rate of annual diabetic eye exams and demonstrated the benefit that pharmacists can have in enhancing accessibility to preventative care services.


Assuntos
Diabetes Mellitus , Farmacêuticos , Humanos , Atenção Primária à Saúde , Diabetes Mellitus/diagnóstico , Missouri , Retina
11.
J Am Acad Psychiatry Law ; 51(4): 558-565, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38065620

RESUMO

Defendants who are facing criminal charges in the United States have a constitutional right to be present at trial. This right can be voluntarily waived; for such a waiver to be valid, the defendant must be competent to waive the right to be present at trial. There have been several cases where a defendant is absent from trial because of a suicide attempt, and in these cases the courts must determine whether it is necessary to pause the criminal trial to allow for a competence hearing to take place. The U.S. Supreme Court offered guidance on this matter in its ruling in Drope v. Missouri; however, the Court did not clearly define the threshold for requiring a competence hearing when defendants attempt suicide during trial. Subsequent judicial rulings have provided insights into how courts might proceed when a criminal defendant is absent from trial following a suicide attempt. This topic has relevance to forensic psychiatry, as forensic psychiatrists may be called upon to participate in evaluations of adjudicative competence in these scenarios.


Assuntos
Competência Mental , Tentativa de Suicídio , Humanos , Estados Unidos , Psiquiatria Legal , Aplicação da Lei , Missouri
12.
Mo Med ; 120(6): 400-401, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38144935

Assuntos
Medicina , Humanos , Missouri
13.
14.
PLoS Pathog ; 19(12): e1011688, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38153929

RESUMO

Deep sequencing of wastewater to detect SARS-CoV-2 has been used during the COVID-19 pandemic to monitor viral variants as they appear and circulate in communities. SARS-CoV-2 lineages of an unknown source that have not been detected in clinical samples, referred to as cryptic lineages, are sometimes repeatedly detected from specific locations. We have continued to detect one such lineage previously seen in a Missouri site. This cryptic lineage has continued to evolve, indicating continued selective pressure similar to that observed in Omicron lineages.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , SARS-CoV-2/genética , Águas Residuárias , COVID-19/epidemiologia , Missouri/epidemiologia , Pandemias
16.
PLoS One ; 18(11): e0294737, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37992058

RESUMO

Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal and non-lethal injuries, including patients treated and discharged from the emergency department and collect additional data on firearm injuries that present to trauma centers. In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US overall. We examined the characteristics of patients from Missouri with firearm injuries in this cross-sectional study. Of the overall 17,395 patients, 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period. Patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole. Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died. Few patients received post-discharge services.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Humanos , Masculino , Feminino , Missouri/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Estudos Transversais , Assistência ao Convalescente , Alta do Paciente , Violência
17.
J Urban Health ; 100(6): 1118-1127, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37964181

RESUMO

There have been no peer-reviewed, quantitative research studies on the effectiveness of gun-free school zones. The objective of this study was to use a cross-sectional, multi-group controlled ecological study design in St. Louis, MO city that compared the counts of crimes committed with a firearm occurring in gun-free school zones compared to a contiguous area immediately surrounding the gun-free school zone (i.e., gun-allowing zones) in 2019. Gun-free school zones were measured and analyzed in two ways. In the primary analysis, boundaries of the tax parcels were used for each school as the beginning of the gun-free school zone. Results from this analysis, after adjustment for pair-matching and confounding, were null. In the secondary analysis, gun-free school zones were measured as beginning at the geographic centroid of the school's address. After adjusting for the pair-matching and confounding, this analysis showed 13.7% significantly fewer crimes committed with a firearm in gun-free school zones compared to gun-allowing zones. These results suggest that gun-free school zones are not being targeted for firearm crime in St. Louis, MO.


Assuntos
Armas de Fogo , Violência , Humanos , Missouri , Estudos Transversais , Crime , Instituições Acadêmicas
18.
J Med Entomol ; 60(6): 1183-1196, 2023 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-37862097

RESUMO

Heartland (HRTV) and Bourbon (BRBV) viruses are newly identified tick-borne viruses, isolated from serious clinical cases in 2009 and 2014, respectively. Both viruses originated in the lower Midwest United States near the border of Missouri and Kansas, cause similar disease manifestations, and are presumably vectored by the same tick species, Amblyomma americanum Linnaeus (Ixodida: Ixodidae). In this article, we provide a current review of HRTV and BRBV, including the virology, epidemiology, and ecology of the viruses with an emphasis on the tick vector. We touch on current challenges of vector control and surveillance, and we discuss future directions in the study of these emergent pathogens.


Assuntos
Ixodidae , Phlebovirus , Carrapatos , Estados Unidos , Animais , Amblyomma , Missouri
19.
Mo Med ; 120(5): 344, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37841567
20.
J Am Acad Psychiatry Law ; 51(4): 500-505, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-37704259

RESUMO

There is limited research on female sex offenders and their offending characteristics. The sociocultural description of women as being nurturing, nonaggressive and, more significantly, nonsexual has diverted the attention from female sexual offending. Although reports have shown that female sex offenders make up two percent of the whole sex offender population, the true rate is remarkably higher because the caretaking behavior of women masks their sexual offenses. The purpose of our study is to explore the characteristics of female sex offenders. We analyzed the publicly available Missouri sex offender registry database and selected all female sex offenders (n = 532) of any age who committed their crimes in Missouri and were convicted in Missouri. We found that the 532 female offenders had a mean age of 29.8 years at the time of their first offense and were convicted for a total of 992 offenses. The calculated recidivism rate was close to 0.6 percent. Moreover, 89.5 percent of offenders had strictly contact offenses, whereas five percent had strictly pornography offenses. Implications for risk assessment are discussed.


Assuntos
Criminosos , Delitos Sexuais , Humanos , Feminino , Adulto , Missouri , Comportamento Sexual , Sistema de Registros
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