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1.
Adv Mind Body Med ; 36(1): 4-12, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476747

RESUMO

Background: Preexisting patient characteristics may influence the outcome of mindfulness training, and a composite predictive index may be most informative in predicting outcome. Primary Study Objective: To develop a predictive index from baseline patient characteristics to determine which characteristics are associated with improvement following mindfulness-based stress reduction (MBSR) vs health education and to examine whether intreatment variables-reflecting adherence to the mindfulness intervention-predicted clinical outcome. Methods: In a secondary data analysis, a composite moderator statistical approach created a predictive index from baseline participant characteristics that were associated with clinical global impressions improvement following intervention. Setting: Data come from a 2-site, randomized controlled trial which took place in medical centers in St Louis, Missouri, and San Diego, California. Participants: Included 103 older adults with anxiety and/or depressive disorders randomized to either 8 sessions of MBSR or health education classes. Intervention: MBSR was delivered in 8 sessions of 2 hours each by credentialed health care providers. The control condition consisted of health education classes designed to match the length and timing of the MBSR sessions. Primary Outcome Measures: The Clinical Global Impressions-Improvement scale was used to measure symptom improvement and was assigned by a blind rater. Results: The combined moderator approach generated a predictive index with a moderate effect size (0.46; 95% CI: 0.35, 0.57). Individuals who demonstrated improvement on the scale following MBSR were more likely to be younger, female, with lower psychological symptom severity, and less likely to have a diagnosis of depression or to be taking selective serotonin reuptake inhibitors. Discussion: Baseline characteristics predicted clinical response with MBSR in older adults. These predictive factors, if replicated and validated, could determine which patients are most likely to benefit from mindfulness training and lead to personalized strategies to maximize outcomes. The study was registered on ClinicalTrials.gov (identifier: NCT01693874).


Assuntos
Atenção Plena , Idoso , Ansiedade , Transtornos de Ansiedade , Feminino , Humanos , Missouri , Estresse Psicológico/terapia
2.
BMJ Open ; 12(4): e058510, 2022 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379639

RESUMO

OBJECTIVES: Men who have sex with men who use pre-exposure prophylaxis (PrEP) have not traditionally been targets for human papillomavirus (HPV) vaccine programmes, despite their high risk for HPV-related cancers and HPV vaccine being approved by the U.S. Food and Drug Administration (FDA) for people up to age 45. The objective of this study was to assess attitudes and barriers towards HPV vaccine for adult PrEP users in the primary care context. METHODS: Semistructured phone interviews of 16 primary care patients taking PrEP in the Kansas City metropolitan area were conducted, with interviews assessing HPV vaccination status, and attitudes, beliefs and perceived barriers surrounding HPV vaccine. Interview notes were open-coded by student authors, and themes were generated through code review and consensus. Data were then analysed using thematic analysis. RESULTS: The results showed that most patients believed that preventative health was important and felt the HPV vaccine was important. Most patients were open to vaccination if recommended by their primary care physician and covered by insurance. Most participants believed HPV infection to be far worse in women, and there were gaps in knowledge surrounding HPV and its effects in men. CONCLUSIONS: While more research is needed to better understand facilitators of a linkage between PrEP and HPV vaccine in clinical settings for groups at high risk for HPV-related cancers, getting primary care providers involved in educating high-risk patients about the importance of HPV vaccination and actively recommending the vaccine to those patients has the potential to prevent HPV-related cancers.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Minorias Sexuais e de Gênero , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Humanos , Kansas , Masculino , Pessoa de Meia-Idade , Missouri , Vacinas contra Papillomavirus/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Vacinação
4.
J Am Heart Assoc ; 11(6): e022625, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35229615

RESUMO

Background Excess mortality from cardiovascular disease during the COVID-19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12-hospital health system to examine changes in volume, patient age and comorbidities, treatment (right- and left-heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID-19 pandemic compared with pre-COVID-19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID-19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID-19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST-segment elevation. There were no differences in right-heart catheterization for patients with HF or in left heart catheterization for patients with AMI. In-hospital mortality increased for AMI during COVID-19 (odds ratio [OR], 1.46; 95% CI, 1.21-1.76), particularly among the ST-segment-elevation myocardial infarction subgroup (OR, 2.57; 95% CI, 2.24-2.96), but was unchanged for HF (OR, 1.02; 95% CI, 0.89-1.16). Conclusions Cardiovascular volume decreased during COVID-19. Despite similar patient age and comorbidities and in-hospital treatments during COVID-19, mortality increased for patients with AMI but not patients with HF. Given that AMI is a time-sensitive condition, delay or deferral of care rather than changes in hospital care delivery may have led to worse cardiovascular outcomes during COVID-19.


Assuntos
COVID-19/psicologia , Insuficiência Cardíaca , Infarto do Miocárdio , COVID-19/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Humanos , Missouri , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
5.
J Subst Abuse Treat ; 138: 108747, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35248406

RESUMO

BACKGROUND: Recovery housing plays an important role in supporting individuals in their recovery by building recovery capital and providing stable living environments; however, the extent to which medications for opioid use disorder (MOUD), the gold standard for OUD treatment, are accepted in recovery housing settings is unclear. The purpose of this study, as part of a larger statewide evaluation of Missouri recovery homes, was to identify the extent to which Missouri recovery houses were accepting of methadone, buprenorphine, and naltrexone as well as the extent to which the acceptance of each medication was linked to whether the recovery home encouraged tapering off MOUDs. METHODS: Sixty-four recovery housing managers and/or staff, out of 66 eligible recovery homes in Missouri completed the survey. RESULTS: Results indicated that methadone was the least accepted medication for long-term use followed by buprenorphine and then naltrexone. Recovery houses that had significantly lower overall acceptance of methadone encouraged tapering; however, the overall acceptance for buprenorphine and naltrexone was not significantly related to the encouragement of tapering off MOUDs. CONCLUSION: This work highlights the need to develop reliable instruments to measure and assess MOUD-capable recovery homes and to increase knowledge and acceptance of MOUD within recovery home settings.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Habitação , Humanos , Metadona/uso terapêutico , Missouri , Naltrexona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
6.
Child Abuse Negl ; 130(Pt 2): 105563, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35221135

RESUMO

BACKGROUND: Throughout my graduate coursework, several classes focused on trauma. Considering my experiences, I searched to gain insight into group level trauma adoptees face due to our unique status and common societal factors that influence adoption. Exploring the trauma literature, I found that none of the terms quite represented the complex characteristics of adoption. OBJECTIVE: Realizing the limitations of current trauma definitions, I sought to name group trauma for adoptees and thereby legitimize and validate my and other adoptees' experiences. PARTICIPANTS AND SETTING: I am the sole participant. The research was conducted in St. Louis, Missouri. METHODS: In this autoethnography, I recount academic experiences that have shaped my emerging and interconnected identities as an adoptee and social worker. I analyze the traumatic and empowering impacts of gaining more information about adoption as a politically and economically influenced system. RESULTS: Examining my intertwined adoption and academic journeys, I propose a trauma and healing of consciousness framework to understand trauma for groups of individuals like adoptees whose trauma is not recognized using historical, collective, or intergenerational models. CONCLUSIONS: The term trauma of consciousness expands existing theories of trauma while including social groups for whom group trauma was not previously recognized. Understanding the trauma of consciousness is imperative because healing cannot begin until the existence of the trauma is recognized. Further exploration on the trauma of consciousness is needed to recognize its impact and to develop creative interventions that can provide hope and enable people to move forward.


Assuntos
Adoção , Estado de Consciência , Humanos , Missouri
7.
JAMA Netw Open ; 5(2): e2146312, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35103791

RESUMO

Importance: Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. Objective: To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. Design, Setting, and Participants: A decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer's perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from October 3, 2020, to January 20, 2021, and analyzed from November 15, 2020, to April 25, 2021. Exposures: Two treatment strategies, SCRT-TNT vs LCCRT with adjuvant chemotherapy, were compared. Main Outcomes and Measures: Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Both costs and QALYs were discounted at 3% annually. Willingness-to-pay threshold was set at $50 000/QALY. Results: During the 5-year horizon, the total cost was $41 355 and QALYs were 2.21 for SCRT-TNT; for LCCRT, the total cost was $54 827 and QALYs were 2.12, resulting in a negative incremental cost-effectiveness ratio (-$141 256.77). The net monetary benefit was $69 300 for SCRT-TNT and $51 060 for LCCRT. Sensitivity analyses using willingness to pay at $100 000/QALY and $150 000/QALY demonstrated the same conclusion. Conclusions and Relevance: These findings suggest that SCRT-TNT followed by TME incurs lower cost and improved QALYs compared with conventional LCCRT followed by TME and adjuvant chemotherapy. These data offer further rationale to support SCRT-TNT as a novel cost-saving treatment paradigm in the management of locally advanced rectal cancer.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/economia , Análise Custo-Benefício , Terapia Neoadjuvante/economia , Neoplasias Retais/terapia , Quimiorradioterapia/estatística & dados numéricos , Missouri , Terapia Neoadjuvante/estatística & dados numéricos
9.
BMC Public Health ; 22(1): 321, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-35168588

RESUMO

BACKGROUND: There is evidence of geographic disparities in COVID-19 hospitalization risks that, if identified, could guide control efforts. Therefore, the objective of this study was to investigate Zip Code Tabulation Area (ZCTA)-level geographic disparities and identify predictors of COVID-19 hospitalization risks in the St. Louis area. METHODS: Hospitalization data for COVID-19 and several chronic diseases were obtained from the Missouri Hospital Association. ZCTA-level data on socioeconomic and demographic factors were obtained from the American Community Survey. Geographic disparities in distribution of COVID-19 age-adjusted hospitalization risks, socioeconomic and demographic factors as well as chronic disease risks were investigated using choropleth maps. Predictors of ZCTA-level COVID-19 hospitalization risks were investigated using global negative binomial and local geographically weighted negative binomial models. RESULTS: COVID-19 hospitalization risks were significantly higher in ZCTAs with high diabetes hospitalization risks (p < 0.0001), COVID-19 risks (p < 0.0001), black population (p = 0.0416), and populations with some college education (p = 0.0005). The associations between COVID-19 hospitalization risks and the first three predictors varied by geographic location. CONCLUSIONS: There is evidence of geographic disparities in COVID-19 hospitalization risks that are driven by differences in socioeconomic, demographic and health-related factors. The impacts of these factors vary by geographical location implying that a 'one-size-fits-all' approach may not be appropriate for management and control. Using both global and local models leads to a better understanding of geographic disparities. These findings are useful for informing health planning to identify geographic areas likely to have high numbers of individuals needing hospitalization as well as guiding vaccination efforts.


Assuntos
COVID-19 , Hospitalização , Humanos , Missouri/epidemiologia , Modelos Estatísticos , SARS-CoV-2
10.
PLoS One ; 17(1): e0260262, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35089919

RESUMO

BACKGROUND: Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts. METHODS: We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors. RESULTS: As of September 10, 2020 there were 73,635 confirmed COVID-19 cases in the State of Missouri. Among the 64,526 case records (87.7% of all cases) that merged with prior demographic and health care utilization data, 12,946 (20.1%) were Non-Hispanic (NH) Black, 44,550 (69.0%) were NH White, 3,822 (5.9%) were NH Other/Unknown race, and 3,208 (5.0%) were Hispanic. Raw cumulative case rates for NH Black individuals were 1,713 per 100,000 population, compared with 2,095 for NH Other/Unknown, 903 for NH White, and 1,218 for Hispanic. Cumulative COVID-19-related death rates for NH Black individuals were 58.3 per 100,000 population, compared with 38.9 for NH Other/Unknown, 19.4 for NH White, and 14.8 for Hispanic. In a model that included insurance source, history of a social determinant billing code in the patient's claims, census block travel change, population density, Area Deprivation Index, and clinical comorbidities, NH Black race (OR 1.75, 1.51-2.04, p<0.001) and NH Other/Unknown race (OR 1.83, 1.36-2.46, p<0.001) remained strongly associated with mortality. CONCLUSIONS: In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19.


Assuntos
COVID-19/mortalidade , Disparidades nos Níveis de Saúde , Adulto , COVID-19/epidemiologia , COVID-19/etnologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Análise de Regressão , Fatores Socioeconômicos
11.
Med Anthropol ; 41(2): 228-242, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35050816

RESUMO

The National Cancer Institute recently identified rural cancer disparities as a priority issue, dedicating resources to rural cancer prevention, presenting opportunities and also risks. We bring an anthropological concept, social navigation, to bear on a popular public health intervention, patient navigation, increasingly proposed as an "evidence-based" approach to reducing health disparities. Our study of mammography in the Missouri Bootheel demonstrates how such interventions elide the shifting terrain and slow violence of rural health care where people must improvise care through trying out or sticking with providers, negotiating self-advocacy and deference, or changing screening timelines amidst structural constraints and rural stereotypes.


Assuntos
Neoplasias da Mama , Navegação de Pacientes , Antropologia Médica , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Missouri
12.
Pediatrics ; 149(2)2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34977942

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk. METHODS: We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess suicide risk among all patients 12 to 24 years of age at a children's hospital. We compared demographics, encounter type (telehealth or face-to-face [F2F]), and screening results from April to June 2020 (T2) to those from April to June 2019 (T1). RESULTS: Fewer patients were seen at T2 than T1 (17 986 vs 24 863). A greater proportion of visits at T2 were by telehealth (0% vs 43%). The rate of positive suicide screens was higher in T2 than in T1 (12.2% vs 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15-1.35). The odds of a positive screen were greater for older patients (aOR of 1.12 for age in years; 95% CI, 1.10-1.14), female patients (aOR, 2.23; 95% CI, 2.00-2.48), patients with public versus private insurance (aOR, 1.88; 95% CI, 1.72-2.07), and lower for Black versus White patients (aOR, 0.85; 95% CI, 0.77-0.95). Rates of positive screens were highest among inpatients (20.0%), intermediate for emergency department patients (14.4%), and lowest in outpatient clinics (9.9%) (P < .05). CONCLUSIONS: Rates of positive suicide risk screens among adolescents rose in the pandemic's early months with differences related to sociodemographics and visit type. Changes in health care delivery highlight the complexities of assessing and responding to mental health needs of adolescents. Additional research might determine the effects of screening methods and patient populations on screening results.


Assuntos
COVID-19 , Pandemias , Medição de Risco , Ideação Suicida , Adolescente , Fatores Etários , Feminino , Hospitais Pediátricos , Humanos , Seguro Saúde , Masculino , Missouri/epidemiologia , Fatores Sexuais , Inquéritos e Questionários
13.
J Child Neurol ; 37(2): 105-111, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34866453

RESUMO

BACKGROUND: Early spasticity and dystonia identification in cerebral palsy is critical for guiding diagnostic workup and prompting targeted treatment early when it is most efficacious. However, differentiating spasticity from dystonia is difficult in young children with cerebral palsy. METHODS: We sought to determine spasticity and dystonia underidentification rates in children at high risk for cerebral palsy (following neonatal hypoxic-ischemic encephalopathy) by assessing how often child neurologists identified hypertonia alone versus specifying the hypertonia type as spasticity and/or dystonia by age 5 years. RESULTS: Of 168 children, 63 developed cerebral palsy and hypertonia but only 19 (30%) had their hypertonia type specified as spasticity and/or dystonia by age 5 years. CONCLUSIONS: Child neurologists did not specify the type of hypertonia in a majority of children at high risk of cerebral palsy. Because early tone identification critically guides diagnostic workup and treatment of cerebral palsy, these results highlight an important gap in current cerebral palsy care.


Assuntos
Paralisia Cerebral/diagnóstico , Distonia/fisiopatologia , Espasticidade Muscular/fisiopatologia , Medição de Risco/métodos , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Pré-Escolar , Distonia/complicações , Feminino , Humanos , Lactente , Masculino , Missouri/epidemiologia , Espasticidade Muscular/complicações , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Inquéritos e Questionários
14.
Am J Obstet Gynecol ; 226(1): 114.e1-114.e7, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34331893

RESUMO

BACKGROUND: The safest mode of delivery to use for very preterm infants is an ongoing topic of debate. There are many reasons to perform a cesarean delivery in cases of extremely preterm and very preterm infants, including indication for labor, fetal distress, maternal indications, and malpresentation. OBJECTIVE: This study aimed to determine whether cesarean delivery is associated with a considerable improvement in neonatal morbidity. STUDY DESIGN: This study is a retrospective cohort study of all singleton pregnancies, delivered from 22 to 29 weeks' gestation between 2010 and 2015, admitted for preterm labor or preterm premature rupture of membranes and excluded neonates with a delivery weight ≤500 g, multiple gestations, cases with intrauterine fetal demise, and induced terminations. The primary outcome for the study was a neonatal morbidity composite (Apgar score of <5 at 5 minutes, prolonged ventilation (>28 days), intraventricular hemorrhage, necrotizing enterocolitis, coagulopathy, discharged on home ventilator support, or discharged with enteric feeding tube). Cesarean deliveries were performed for standard obstetrical indications. Regression models were used and adjusted for nulliparity, delivery year, and presentation at the time of delivery to determine whether cesarean delivery is associated with neonatal morbidity or neonatal death. RESULTS: There were 271 eligible deliveries, which included 128 cesarean deliveries and 143 vaginal deliveries. The cesarean delivery group had fewer nulliparous patients and more fetuses presenting in breech position at the time of delivery. The overall composite neonatal morbidity occurred in 202 of the 271 (74.5%) deliveries and mortality occurred in 26 of the 271 (9.59%) deliveries. When adjusting for nulliparity, delivery year, and fetal presentation at the time of delivery, cesarean delivery was associated with a decreased risk for death in the delivery room or within 24 hours after delivery (adjusted risk ratio, 0.18; 95% confidence interval, 0.05-0.63; P=.03). Cesarean delivery was associated with an increased use of exogenous surfactant (adjusted risk ratio, 1.20; 95% confidence interval, 1.05-1.38; P=.01) and bag mask ventilation (adjusted risk ratio, 1.17; 95% confidence interval, 1.01-1.37; P=.03). In a secondary analysis that included only patients who received a complete course of steroids, there were no differences in the composite morbidity or mortality. CONCLUSION: Cesarean delivery performed for standard obstetrical indications in cases of very preterm neonates is associated with a decreased risk for death in the delivery room or within 24 hours of delivery but is not associated with an improvement in the overall morbidity or mortality.


Assuntos
Ruptura Prematura de Membranas Fetais , Lactente Extremamente Prematuro , Doenças do Prematuro/mortalidade , Trabalho de Parto Prematuro , Adulto , Cesárea , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Missouri , Paridade , Gravidez , Estudos Retrospectivos
15.
J Public Health Manag Pract ; 28(2): E446-E455, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34475370

RESUMO

CONTEXT: St Louis City has been demolishing vacant buildings at an increasing rate. Demolition can cause lead dust spread, and childhood lead exposure can have negative effects on cognition, growth, and development. Previous studies show an association between exposure to multiple demolitions and elevated blood lead levels (EBLLs) in children, but St Louis City does not monitor the effects of demolitions on children's blood lead levels. OBJECTIVES: The purpose of this study was to measure the association between exposure to demolitions and EBLLs in children younger than 6 years in St Louis City from 2017 to 2020. DESIGN/SETTING/PARTICIPANTS: We analyzed blood lead testing data for children 0 to 72 months of age (n = 22 192) and proximity to demolitions. Exposure was the presence of demolitions within 400 ft of a child's address in the 33 days before their first lead test. MAIN OUTCOME MEASURE: We used logistic regression to test the association between proximity to demolition and EBLLs (≥5 µg/dL). RESULTS: The percentage of children living in proximity to 1 or more demolitions was slightly higher among those with EBLLs (n = 21; 1.3%) than among those without EBLLs (n = 250; 1.2%). However, after adjusting for age, sex, year home was built, season, neighborhood socioeconomic percentile, and neighborhood racial composition, the odds of EBLLs were not significantly different for children exposed to 1 or more demolitions (OR = 0.82; 95% CI, 0.5-1.25) compared with exposed to zero demolitions. CONCLUSIONS: Although this study found no association between exposure to demolitions and EBLLs, results should be interpreted with caution, given numerous limitations. Given the consequences of childhood lead exposure, it is recommended that St Louis City conduct a similar analysis on demolitions conducted after 2020 using systematically collected demolition dates. Targeted testing or soil and air monitoring could also be informative.


Assuntos
Intoxicação por Chumbo , Chumbo , Criança , Exposição Ambiental/efeitos adversos , Humanos , Lactente , Chumbo/análise , Intoxicação por Chumbo/epidemiologia , Modelos Logísticos , Missouri , Características de Residência
16.
Am J Emerg Med ; 51: 1-5, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34637995

RESUMO

BACKGROUND: Many patients with Coronavirus disease-2019 (Covid-19) present with radiological evidence of pneumonia. Because it is difficult to determine co-existence of bacterial pneumonia, many of these patients are initially treated with antibiotics. We compared the rates of bacterial infections and mortality in Covid-19 patients with pulmonary infiltrates versus patients diagnosed with 'pneumonia' the year previously. METHODS: We conducted a medical record review of patients admitted with Covid-19 and a pulmonary infiltrate and compared them with patients diagnosed with pneumonia admitted in the prior year before the pandemic. Data abstracted included baseline demographics, comorbidities, signs and symptoms, laboratory and microbiological results, and imaging findings. Outcomes were bacterial infections and mortality. Patients presenting with and without Covid-19 were compared using univariable and multivariable analyses. RESULTS: There were 1398 and 1001 patients admitted through the emergency department (ED) with and without Covid-19 respectively. Compared with non-Covid-19 patients, those with Covid-19 were younger (61±18 vs. 65±25 years, P < 0.001) and had a lower Charlson Comorbidity Index (0.7 vs. 1.2, P < 0.001). Bacterial infections were present in fewer Covid-19 than non-Covid-19 patients (8% vs. 13%, P < 0.001), and most infections in Covid-19 were nosocomial as opposed to community acquired in non-Covid-19 patients. CXR was more often read as abnormal and with bilateral infiltrates in patients with Covid-19 (82% vs. 70%, P < 0.001 and 81% vs. 48%, P < 0.001, respectively). Mortality was higher in patients with Covid-19 vs. those without (15% vs. 9%, P < 0.001). Multivariable predictors (OR [95%CI]) of mortality were age (1.04 [1.03-1.05]/year), tachypnea (1.55 [1.12-2.14]), hypoxemia (2.98 [2.04-4.34]), and bacterial infection (2.80 [1.95-4.02]). Compared with non-Covid-19 patients with pneumonia, patients with Covid-19 were more likely to die (2.68 [1.97-3.63]). CONCLUSIONS: The rate of bacterial infections is lower in Covid-19 patients with pulmonary infiltrates compared with patients diagnosed with pneumonia prior to the pandemic and most are nosocomial. Mortality was higher in Covid-19 than non-Covid-19 patients even after adjusting for age, tachypnea, hypoxemia, and bacterial infection.


Assuntos
Infecções Bacterianas/epidemiologia , COVID-19/mortalidade , Coinfecção/epidemiologia , Pneumonia/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Infecção Hospitalar/epidemiologia , Feminino , Hospitalização , Humanos , Hipóxia/epidemiologia , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taquipneia/epidemiologia
17.
J Emerg Nurs ; 48(1): 94-101.e1, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34656362

RESUMO

OBJECTIVE: The purpose of this project was to describe patterns in over-the-counter medication prescribing for nonacute patients with Medicaid in a pediatric emergency department. Differences were also tested in visit time and charges between patients with and without over-the-counter medication prescriptions. METHODS: Retrospective chart review of children with Missouri Medicaid presenting to a single site between January 1, 2018 and December 31, 2018 was conducted. Low-acuity patients with common diagnoses were included. Over-the-counter medications prescribed, the cost of prescriptions, the time spent in the emergency department, provider care time, patient age, and the month of visit were extracted. Data were analyzed with descriptive statistics and t tests. RESULTS: Approximately 37% of children were prescribed over-the-counter medications, most commonly antipyretics. When comparing visits in which an over-the-counter medication was prescribed to visits without an over-the-counter medication prescription, we found no significant difference in the associated charges, total time in the department, and provider care time. CONCLUSION: Over-the-counter medications were prescribed for more than one-third of children cared for in the pediatric emergency department for low-acuity presentations. These visits may represent a substantial area for Medicaid access barriers, system redesign, and cost savings.


Assuntos
Serviço Hospitalar de Emergência , Medicaid , Criança , Humanos , Missouri , Estudos Retrospectivos , Estados Unidos
18.
Nurs Res ; 71(1): 12-20, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34469415

RESUMO

BACKGROUND: Transition to adult healthcare is a critical time for adolescents and young adults (AYAs) with sickle cell disease, and preparation for transition is important to reducing morbidity and mortality risks associated with transition. OBJECTIVE: We explored the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition. METHODS: This cross-sectional, correlational study was conducted with 50 family caregivers-AYAs dyads receiving care from a large comprehensive sickle cell clinic between October 2019 and February 2020. Participants completed the Decision-Making Involvement Scale, the Sickle Cell Self-Efficacy Scale, and the Readiness to Transition Questionnaire. Multiple linear regression was used to assess the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition to adult healthcare. RESULTS: Whereas higher levels of expressive behaviors, such as sharing opinions and ideas in decision-making, were associated with higher levels of AYA healthcare responsibility, those behaviors were inversely associated with feelings of overall transition readiness. Self-efficacy was positively associated with overall transition readiness but inversely related to AYA healthcare responsibility. Parent involvement was negatively associated with AYA healthcare responsibility and overall transition readiness. DISCUSSION: While increasing AYAs' decision-making involvement may improve AYAs' healthcare responsibility, it may not reduce barriers of feeling unprepared for the transition to adult healthcare. Facilitating active AYA involvement in decision-making regarding disease management, increasing self-efficacy, and safely reducing parent involvement may positively influence their confidence and capacity for self-management.


Assuntos
Anemia Falciforme/psicologia , Tomada de Decisões , Transferência de Pacientes/normas , Autoeficácia , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Estudos Transversais , Gerenciamento Clínico , Feminino , Humanos , Masculino , Missouri , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
20.
J Nurs Care Qual ; 37(1): 21-27, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34751164

RESUMO

BACKGROUND: US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. PROBLEM: For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. APPROACH: It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. CONCLUSIONS: Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.


Assuntos
Prática Avançada de Enfermagem , Enfermeiras e Enfermeiros , Humanos , Missouri , Casas de Saúde , Admissão e Escalonamento de Pessoal , Serviço Social
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