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1.
MMWR Morb Mortal Wkly Rep ; 72(8): 206-209, 2023 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-36821719

RESUMO

Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics.


Assuntos
Viagem Aérea , COVID-19 , Humanos , Estados Unidos/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2/genética , Aeroportos , Genômica , Centers for Disease Control and Prevention, U.S.
3.
Public Health Nutr ; 21(11): 2079-2087, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29656717

RESUMO

OBJECTIVE: The present study aimed to examine the correlates of fruit and vegetable intake (FVI) separately among parents and their adolescents. DESIGN: Cross-sectional surveys. SETTING: Online survey. SUBJECTS: Parents and adolescents completed the Family Life, Activity, Sun, Health, and Eating (FLASHE) survey through the National Cancer Institute. The survey assessed daily intake frequencies of food/beverage groups, psychosocial, parenting and sociodemographic factors. Generalized linear models were run for both parents and adolescents, for a total of six models (three each): (i) sociodemographic characteristics; (ii) psychosocial factors; (iii) parent/caregiver factors. RESULTS: Parent participants (n 1542) were predominantly 35-59 years old (86 %), female (73 %), non-Hispanic White (71 %) or non-Hispanic Black (17 %), with household income <$US 100 000 (79 %). Adolescents (n 805) were aged 12-14 years (50 %), non-Hispanic White (66 %) and non-Hispanic Black (15 %). Parents consumed 2·9 cups fruits and vegetables (F&V) daily, while adolescents consumed 2·2 cups daily. Educational attainment (higher education had greater FVI) and sex (men consumed more than women; all P<0·001) were significant FVI predictors. Parents with greater autonomous and controlled motivation, self-efficacy and preferences for fruit reported higher FVI (all P<0·001). Similarly, adolescents with greater autonomous and controlled motivation, self-efficacy and knowledge reported higher FVI (all P<0·001). Parenting factors of importance were co-deciding how many F&V teens should have, rules, having F&V in the home and cooking meals from scratch (all P<0·05). CONCLUSIONS: Findings suggest factors that impact FVI among parents and their adolescent(s), which highlight the importance of the role of parent behaviour and can inform tailored approaches for increasing FVI in various settings.


Assuntos
Dieta/estatística & dados numéricos , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Frutas , Verduras , Adolescente , Comportamento do Adolescente/psicologia , Adulto , Criança , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Motivação , Poder Familiar/psicologia , Pais/psicologia , Autoeficácia
4.
Prev Chronic Dis ; 15: E47, 2018 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-29704371

RESUMO

PURPOSE AND OBJECTIVES: The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. INTERVENTION APPROACH: We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015-2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. EVALUATION METHODS: We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. RESULTS: Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily general information rather than tailored technical assistance. IMPLICATIONS FOR PUBLIC HEALTH: Technical assistance may be used in programs and made adaptable to program needs. The inclusion and evaluation of technical assistance, especially tailored approaches, is warranted for environmental interventions, including ECE settings.


Assuntos
Creches , Fenômenos Fisiológicos da Nutrição Infantil , Intervenção Educacional Precoce , Exercício Físico , Política Nutricional , Pré-Escolar , Florida , Promoção da Saúde/métodos , Humanos , Lactente , Missouri , Avaliação Nutricional , Estado Nutricional
6.
Public Health Nutr ; 20(9): 1692-1698, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28262079

RESUMO

OBJECTIVE: The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). DESIGN: Quasi-experimental pre-post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size. SETTING: The study occurred among ECE programmes. SUBJECTS: Pre-school classrooms in nineteen ECE programmes across four US states were observed. RESULTS: EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=-0·4 and -0·6, respectively). CONCLUSIONS: The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible.


Assuntos
Dieta , Exercício Físico , Educação em Saúde , Promoção da Saúde , Avaliação Nutricional , Autorrelato , Creches , Pré-Escolar , Humanos , Política Nutricional , Estado Nutricional , Projetos Piloto , Tamanho da Amostra , Comportamento Sedentário , Estados Unidos
7.
Prev Chronic Dis ; 14: E73, 2017 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-28858606

RESUMO

The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P < .01) but did not change significantly from post-assessment to follow-up assessment. ECELC shows promise as an approach to incorporate professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Exercício Físico , Programas Nacionais de Saúde/organização & administração , Adulto , Pré-Escolar , Feminino , Promoção da Saúde , Humanos , Lactente , Recém-Nascido , Estado Nutricional , Obesidade/prevenção & controle , Estados Unidos
8.
Public Health Nutr ; 19(7): 1315-26, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26298513

RESUMO

OBJECTIVE: To assess the nutritional quality of food packages offered in the Food Distribution Program on Indian Reservations (FDPIR) using the Healthy Eating Index 2010 (HEI-2010). DESIGN: Data were collected from the list of the food products provided by the US Department of Agriculture's Food and Nutrition Handbook 501 for FDPIR. Nutritional quality was measured through a cross-sectional analysis of five randomly selected food packages offered through FDPIR. HEI-2010 component and total scores were calculated for each food package. ANOVA and t tests assessed significant differences between food packages and HEI-2010 maximum scores, respectively. SETTING: This study took place in the USA. SUBJECTS: Study units included food products offered through FDPIR. RESULTS: The mean total HEI-2010 score for the combined FDPIR food packages was significantly lower than the total HEI-2010 maximum score of 100 (66·38 (sd 11·60); P<0·01). Mean scores for total fruit (3·52 (sd 0·73); P<0·05), total vegetables (2·58 (sd 0·15); P<0·001), greens and beans (0·92 (sd 1·00); P<0·001), dairy (5·12 (sd 0·63); P<0·001), total protein foods (4·14 (sd 0·56); P<0·05) and refined grains (3·04 (sd 2·90); P<0·001) were all significantly lower than the maximum values. CONCLUSIONS: The FDPIR food package HEI-2010 score was notably higher than other federal food assistance and nutrition programmes. Study findings highlight opportunities for the FDPIR to modify its offerings to best support lifestyles towards prevention of diet-related chronic disease.


Assuntos
Dieta Saudável , Assistência Alimentar , Programas Governamentais , Indígenas Norte-Americanos , Valor Nutritivo , Estudos Transversais , Laticínios , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Fabaceae , Análise de Alimentos , Embalagem de Alimentos , Frutas , Humanos , Estilo de Vida , Verduras
9.
Public Health Nutr ; 19(5): 841-50, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26272414

RESUMO

OBJECTIVE: The purpose of the present study was to explore food preparation behaviours, attitudes, meal planning and shopping among Mexican-American mothers. DESIGN: Data were collected through four focus groups with mothers of Mexican origin/ancestry who considered themselves to be the primary food preparer. Topics included food preparation behaviours and influencers (culture, family, attitudes, barriers, meal planning and shopping). Data were analysed using a qualitative grounded theory approach. All focus groups were audio recorded, transcribed verbatim and coded for themes. SETTING: Data were collected in southern California, USA in 2013. SUBJECTS: Of the sample of twenty-one Mexican-American mothers, thirteen were born outside the USA and the mean household size was five members. RESULTS: Participants reported that food was often prepared using traditional staples and food preparation behaviours were learned from maternal family members. Participants also suggested that health was influenced by foods eaten and how they were prepared. Salient factors influencing food preparation behaviours included culture and tradition, maternal family members' food preparation behaviours, food preparation self-efficacy and attitudes towards healthy eating. Time and busy schedules were cited as barriers. CONCLUSIONS: Future interventions should consider utilizing family-based approaches and teaching culturally relevant food preparation skills, especially to youth, while reinforcing more healthful dietary practices.


Assuntos
Culinária , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos , Aculturação , Adulto , California , Comportamento de Escolha , Dieta Saudável , Características da Família , Feminino , Grupos Focais , Preferências Alimentares , Humanos , Pessoa de Meia-Idade , Mães , Meio Social , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Appetite ; 97: 37-42, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26603573

RESUMO

An estimated 78% of Hispanics in the United States (US) are overweight or obese. Household food insecurity, a condition of limited or uncertain access to adequate food, has been associated with obesity rates among Hispanic adults in the US. However, the Hispanic group is multi-ethnic and therefore associations between obesity and food insecurity may not be constant across Hispanic country of origin subgroups. This study sought to determine if the association between obesity and food insecurity among Hispanics is modified by Hispanic ancestry across low-income (≤200% of poverty level) adults living in California. Data are from the cross-sectional 2011-12 California Health Interview Survey (n = 5498). Rates of overweight or obesity (BMI ≥ 25), Calfresh receipt (California's Supplemental Nutrition Assistance Program), and acculturation were examined for differences across subgroups. Weighted multiple logistic regressions examined if household food insecurity was significantly associated with overweight or obesity and modified by country of origin after controlling for age, education, marital status, country of birth (US vs. outside of US), language spoken at home, and Calfresh receipt (P < .05). Significant differences across subgroups existed for prevalence of overweight or obesity, food security, Calfresh receipt, country of birth, and language spoken at home. Results from the adjusted logistic regression models found that food insecurity was significantly associated with overweight or obesity among Mexican-American women (ß (SE) = 0.22 (0.09), p = .014), but not Mexican-American men or Non-Mexican groups, suggesting Hispanic subgroups behave differently in their association between food insecurity and obesity. By highlighting these factors, we can promote targeted obesity prevention interventions, which may contribute to more effective behavior change and reduced chronic disease risk in this population.


Assuntos
Abastecimento de Alimentos , Hispânico ou Latino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Pobreza , Adulto , Índice de Massa Corporal , Estudos Transversais , Características da Família , Feminino , Assistência Alimentar , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Inquéritos Nutricionais , Prevalência , Fatores Socioeconômicos , Estados Unidos/epidemiologia
11.
Public Health Nutr ; 18(13): 2402-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26016406

RESUMO

OBJECTIVE: To explore the feasibility of a workplace farmstand programme through the utilization of an online ordering system to build awareness for local food systems, encourage community participation, and increase local fruit and vegetable availability. DESIGN: A 4-week pilot to explore feasibility of workplace farmstand programmes through a variety of outcome measures, including survey, mode of sale, weekly sales totals and intercept interviews. SETTING: A large private company in Sarpy County, Omaha, Nebraska, USA. SUBJECTS: Employees of the company hosting the farmstand programme. RESULTS: Pre-programme, a majority of employees indicated that quality (95·4 %), variety (94·6 %) and cost of fruits and vegetables (86·4 %) were driving factors in their fruit and vegetable selection when shopping. The availability of locally or regionally produced fruits and vegetables was highly important (78·1 %). Participants varied in their definition of local food, with nearly half (49·2 %) reporting within 80·5 km (50 miles), followed by 160·9 km (100 miles; 29·5 %) and 321·9 km (200 miles; 12·1 %). Weekly farmstand purchases (both walk-ups and online orders) ranged from twenty-eight to thirty-nine employees, with weekly sales ranging from $US 257·95 to 436·90 for the producer. The mode of purchase changed throughout the pilot, with higher use of online ordering in the beginning and higher use of walk-up purchasing at the end. CONCLUSIONS: The workplace farmstand pilot study revealed initial interest by both employees and a producer in this type of programme, helped to establish a sustained producer-employer relationship and led to additional opportunities for both the producer and employer.


Assuntos
Produtos Agrícolas , Dieta , Política Ambiental , Frutas , Política Nutricional , Cooperação do Paciente , Verduras , Adulto , Conservação dos Recursos Naturais/economia , Produtos Agrícolas/economia , Produtos Agrícolas/crescimento & desenvolvimento , Dieta/economia , Estudos de Viabilidade , Feminino , Qualidade dos Alimentos , Abastecimento de Alimentos/economia , Frutas/economia , Frutas/crescimento & desenvolvimento , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , Nebraska , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Autorrelato , Verduras/economia , Verduras/crescimento & desenvolvimento , Local de Trabalho
12.
Prev Chronic Dis ; 12: E128, 2015 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-26270742

RESUMO

We assessed the consumer food environment in rural areas by using the Nutrition Environment Measures Survey for Stores (NEMS-S) to measure the availability, price, and quality of fruits and vegetables. We randomly selected 20 grocery stores (17 rural, 3 urban) in 12 Montana counties using the 2013 US Department of Agriculture's rural-urban continuum codes. We found significant differences in NEMS-S scores for quality of fruits and vegetables; of 6 possible points, the mean quality score was 4.5; of rural stores, the least rural stores had the highest mean quality scores (6.0). Intervention strategies should aim to increase fruit and vegetable quality in rural areas.


Assuntos
Abastecimento de Alimentos/normas , Frutas/normas , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Verduras/normas , Adulto , Idoso , Análise de Variância , Doença Crônica/prevenção & controle , Comércio/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/classificação , Abastecimento de Alimentos/economia , Frutas/economia , Frutas/provisão & distribuição , Humanos , Montana , Inquéritos Nutricionais/métodos , Valor Nutritivo , Pobreza/estatística & dados numéricos , População Rural/classificação , Fatores Socioeconômicos , Estados Unidos , United States Department of Agriculture , População Urbana/classificação , Verduras/economia , Verduras/provisão & distribuição
13.
Pediatr Blood Cancer ; 61(3): 507-11, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24123899

RESUMO

BACKGROUND: Human rhinovirus (HRV), human coronavirus (hCoV), human bocavirus (hBoV), and human metapneumovirus (hMPV) infections in children with sickle cell disease have not been well studied. PROCEDURE: Nasopharyngeal wash specimens were prospectively collected from 60 children with sickle cell disease and acute respiratory illness, over a 1-year period. Samples were tested with multiplexed-PCR, using an automated system for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis. Clinical characteristics and distribution of respiratory viruses in patients with and without acute chest syndrome (ACS) were evaluated. RESULTS: A respiratory virus was detected in 47 (78%) patients. Nine (15%) patients had ACS; a respiratory virus was detected in all of them. The demographic characteristics of patients with and without ACS were similar. HRV was the most common virus, detected in 29 of 47 (62%) patients. Logistic regression showed no association between ACS and detection of HRV, hCoV, hBoV, hMPV, and other respiratory pathogens. Co-infection with at least one additional respiratory virus was seen in 14 (30%) infected patients, and was not significantly higher in patients with ACS (P = 0.10). Co-infections with more than two respiratory viruses were seen in seven patients, all in patients without ACS. Bacterial pathogens were not detected. CONCLUSION: HRV was the most common virus detected in children with sickle cell disease and acute respiratory illness, and was not associated with increased morbidity. Larger prospective studies with asymptomatic controls are needed to study the association of these emerging respiratory viruses with ACS in children with sickle cell disease.


Assuntos
Síndrome Torácica Aguda/virologia , Anemia Falciforme/virologia , Nasofaringe/virologia , Adolescente , Criança , Pré-Escolar , Coronavirus/isolamento & purificação , Feminino , Bocavirus Humano/isolamento & purificação , Humanos , Lactente , Modelos Logísticos , Masculino , Metapneumovirus/isolamento & purificação , Estudos Prospectivos , Rhinovirus/isolamento & purificação
14.
Prev Chronic Dis ; 10: E210, 2013 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-24355103

RESUMO

INTRODUCTION: Schools are uniquely positioned to influence the dietary habits of children, and farm-to-school programs can increase fruit and vegetable consumption among school-aged children. We assessed the feasibility of, interest in, and barriers to implementing farm-to-school activities in 7 school districts in Douglas County, Nebraska. METHODS: We used a preassessment and postassessment survey to obtain data from 3 stakeholder groups: school food service directors, local food producers, and food distributors. We had a full-time farm-to-school coordinator who was able to engage multiple stakeholders and oversee the development and dissemination of a toolkit. We used descriptive statistics to make comparisons. RESULTS: Seven food service directors, 5 distributors identified by the food service directors, and 57 local producers (9 completed only the preassessment survey, 16 completed only the postassessment survey, and 32 completed both) completed various components of the assessment. Interest in pursuing farm-to-school activities to incorporate more local foods in the school lunch program increased during the 2-year project; mean interest in purchasing local foods by food service directors for their districts increased from 4.4 to 4.7 (on a scale of 1 to 5). CONCLUSION: Implementing farm-to-school programming in Douglas County, Nebraska, is feasible, although food safety and distribution is a main concern among food service directors. Additional research on feasibility, infrastructure, and education is recommended.


Assuntos
Agricultura , Relações Comunidade-Instituição , Serviços de Alimentação , Abastecimento de Alimentos/métodos , Almoço , Instituições Acadêmicas , Pessoal Administrativo/psicologia , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Planejamento em Saúde Comunitária , Humanos , Nebraska , Avaliação de Programas e Projetos de Saúde
15.
AEM Educ Train ; 7(Suppl 1): S88-S90, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37383835

RESUMO

Social determinants of medical education are the most impactful aspects of recruiting, retaining, and producing the next generation of a diverse physician workforce. We can use the same framework well known to describe social determinants of health to identify social determinants that impact medical education learners and their ability to enter the workforce and succeed to completion. Efforts aimed at recruitment and retention should not exist in isolation and must be matched with those that continuously assess and evaluate the learning environment. The development of a climate where all can bring their full selves to learn, study, work, and care for patients is critically important in the creation of a learning environment where every participant can grow and thrive. If we are to address the need to diversify the workforce, we must be intentional with strategic plans, which includes addressing the social determinants that are prohibitive for some of our learners.

16.
EBioMedicine ; 98: 104875, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37983984

RESUMO

BACKGROUND: Autochthonous transmission of Zika virus (ZIKV) has been reported in 87 countries since 2015. Although most infections are mild, there is risk of Guillain-Barré syndrome and adverse pregnancy outcomes. Vaccines are urgently needed to prevent Zika, but sufficient understanding of humoral responses and tools to assess ZIKV-specific immunity are lacking. METHODS: We developed a blockade-of-binding (BOB) ELISA using A9E and G9E, two strongly neutralising ZIKV-specific monoclonal antibodies, which do not react with dengue virus. Receiver operating characteristic curve analysis assessed A9E and G9E BOB serodiagnostic performance. BOB was then applied to samples from a surveillance cohort in Risaralda, Colombia, and phase 1 ZIKV vaccine trial samples, comparing results against traditional serologic tests. FINDINGS: In the validation sample set (n = 120), A9E BOB has a sensitivity of 93.5% (95% CI: 79.3, 98.9) and specificity 97.8 (95% CI: 92.2, 99.6). G9E BOB had a sensitivity of 100% (95% CI: 89.0, 100.0) and specificity 100% (95% CI: 95.9, 100). Serum from natural infections consistently tested positive in these assays for up to one year, and reactivity tracks well with ZIKV infection status among sera from endemic areas with complicated flavivirus exposures. Interestingly, a leading ZIKV vaccine candidate elicited minimal BOB reactivity despite generating neutralising antibody responses. INTERPRETATION: In conclusion, A9E and G9E BOB assays are sensitive and specific assays for detecting antibodies elicited by recent or remote ZIKV infections. Given the additional ability of these BOB assays to detect immune responses that target different epitopes, further development of these assays is well justified for applications including flavivirus surveillance, translational vaccinology research and as potential serologic correlates of protective immunity against Zika. FUNDING: R21 AI129532 (PI: S. Becker-Dreps), CDCBAA 2017-N-18041 (PI: A. M. de Silva), Thrasher Fund (PI: M. H. Collins), K22 AI137306 (PI: M. H. Collins).


Assuntos
Dengue , Flavivirus , Vacinas de DNA , Vacinas Virais , Infecção por Zika virus , Zika virus , Feminino , Humanos , Gravidez , Anticorpos Monoclonais , Anticorpos Antivirais , Reações Cruzadas , Epitopos , Vacinação , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/prevenção & controle , Infecção por Zika virus/epidemiologia
17.
Lancet Infect Dis ; 23(2): 196-206, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36216018

RESUMO

BACKGROUND: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. METHODS: We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. FINDINGS: 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. INTERPRETATION: Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. FUNDING: US Centers for Disease Control and Prevention, International Society of Travel Medicine.


Assuntos
Exantema , Infecções por HIV , Mpox , Minorias Sexuais e de Gênero , Varíola , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Estudos Transversais , Mpox/epidemiologia
18.
J Health Psychol ; 27(4): 765-777, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33111552

RESUMO

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.


Assuntos
Gravidez , Estresse Psicológico , Feminino , Humanos , Intenção , Gravidez/psicologia , Grupos Raciais , Estados Unidos
19.
West J Emerg Med ; 24(2): 269-278, 2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36602489

RESUMO

INTRODUCTION: We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York. METHODS: A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey. RESULTS: Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators. CONCLUSION: Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.


Assuntos
COVID-19 , Medicina de Emergência , Internato e Residência , Humanos , Pandemias , Comunicação , Medicina de Emergência/educação
20.
Infect Control Hosp Epidemiol ; 43(3): 381-386, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33557990

RESUMO

Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May-June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2-10.5) and black race (OR, 8.4; 95% CI, 2.7-27.4) were associated with SARS-CoV-2 seropositivity.


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/prevenção & controle , Estudos Transversais , Atenção à Saúde , Pessoal de Saúde , Humanos , Fatores de Risco
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