RESUMEN
There is concern that in-person schooling during the coronavirus disease 2019 (COVID-19) pandemic will facilitate disease transmission. Through asymptomatic surveillance and contact tracing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we found low rates of asymptomatic SARS-CoV-2 infection and little in-school transmission of COVID-19 when physical distancing and masking strategies were enforced despite a high community prevalence of COVID-19.
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Infecciones Asintomáticas/epidemiología , COVID-19/transmisión , Instituciones Académicas/organización & administración , Adolescente , COVID-19/diagnóstico , COVID-19/epidemiología , Prueba de COVID-19 , Niño , Preescolar , Trazado de Contacto/métodos , Femenino , Humanos , Masculino , Pandemias , Prevalencia , Estudios Prospectivos , SARS-CoV-2 , Instituciones Académicas/estadística & datos numéricos , Tennessee/epidemiologíaRESUMEN
This article summarizes the facts and rulings of a relatively recent and representative federal appellate court decision concerning a parent's civil rights lawsuit in response to a school nurse's visual examination of a child's "private parts." The discussion of the court's rulings extends to a sampling of related case law and, as in a previous NASN School Nurse Zirkel article, the difference between legal and professional boundaries.
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Examen Físico , Servicios de Enfermería Escolar/legislación & jurisprudencia , Niño , Femenino , Humanos , Responsabilidad Legal , TennesseeAsunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/aislamiento & purificación , Acinetobacter baumannii/patogenicidad , Adulto , Anciano , Antibacterianos/farmacología , Bacteriemia/epidemiología , Bacteriemia/microbiología , Ciprofloxacina/farmacología , Ciprofloxacina/uso terapéutico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Quimioterapia Combinada/métodos , Femenino , Humanos , Masculino , Meropenem/farmacología , Meropenem/uso terapéutico , Persona de Mediana Edad , Combinación Piperacilina y Tazobactam , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tennessee/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. STUDY DESIGN: Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. RESULTS: From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. CONCLUSIONS: Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders.
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Infecciones Comunitarias Adquiridas/epidemiología , Hospitalización , Neumonía/epidemiología , Adolescente , Estudios de Casos y Controles , Parálisis Cerebral/epidemiología , Niño , Preescolar , Aberraciones Cromosómicas , Discapacidades del Desarrollo/epidemiología , Síndrome de Down/epidemiología , Epilepsia/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Admisión del Paciente/estadística & datos numéricos , Médula Espinal/anomalías , Tennessee/epidemiología , Utah/epidemiologíaRESUMEN
OBJECTIVE: To assess the relationship between secondhand smoke (SHS) exposure and disease severity among children hospitalized with community-acquired pneumonia (CAP). STUDY DESIGN: Children hospitalized with clinical and radiographic CAP were enrolled between January 1, 2010, and June 30, 2012 at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community study. Household SHS exposure was defined based on the number of smokers in the child's home. Outcomes included hospital length of stay, intensive care unit admission, and mechanical ventilation. Proportional hazards and logistic regression models were used to assess associations between SHS exposure and outcomes. All models were adjusted for age, sex, race/ethnicity, household education level, government insurance, comorbidities, enrollment site, year, and season. RESULTS: Of the 2219 children included in the study, SHS exposure was reported in 785 (35.4%), including 325 (14.8%) with ≥2 smokers in the home. Compared with nonexposed children, the children exposed to ≥2 smokers had longer length of stay (median, 70.4 hours vs 64.4 hours; adjusted hazard ratio, 0.85; 95% CI, 0.75-0.97) and were more likely to receive intensive care (25.2% vs 20.9%; aOR, 1.44; 95% CI, 1.05-1.96), but not mechanical ventilation. Outcomes in children exposed to only 1 household smoker were similar to those in nonexposed children. CONCLUSION: Children hospitalized with CAP from households with ≥2 smokers had a longer length of stay and were more likely to require intensive care compared with children from households with no smokers, suggesting that they experienced greater pneumonia severity.
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Infecciones Comunitarias Adquiridas/diagnóstico , Neumonía/diagnóstico , Contaminación por Humo de Tabaco/efectos adversos , Niño , Preescolar , Infecciones Comunitarias Adquiridas/fisiopatología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Hospitalización , Humanos , Lactante , Tiempo de Internación , Masculino , Neumonía/fisiopatología , Modelos de Riesgos Proporcionales , Análisis de Regresión , Respiración Artificial , Tennessee , UtahRESUMEN
OBJECTIVE: To describe the characteristics of benign and malignant mediastinal masses, which may predict their etiology and facilitate the safe and timely management of patients, especially those residing in histoplasmosis-endemic regions. STUDY DESIGN: We conducted a retrospective review of the health records of 131 patients aged <19 years who were referred to 2 tertiary care children's hospitals between 2005 and 2010 for evaluation of mediastinal masses. RESULTS: Most patients (79%) had benign masses, including 98 with confirmed or suspected histoplasmosis. Overall, compared with patients with malignant masses, patients with benign masses were younger and more likely to be African American, to complain of cough, and to have pulmonary nodules by chest computed tomography. In addition, patients with malignant disease were more likely to complain of malaise and to have neck swelling, abnormal extrathoracic lymphadenopathy, lymphopenia, anterior mediastinal involvement, and/or pleural effusion. Positive histoplasmosis serologic tests were specific but insensitive for a benign etiology. No single clinical, laboratory, or radiologic feature was sufficiently sensitive and specific for distinguishing between benign and malignant masses; however, the presence of lymphopenia, anterior mediastinal involvement, or enlarged cervical lymph nodes on computed tomography had a sensitivity of 93%, specificity of 95%, positive predictive value of 86%, and negative predictive value of 97% for cancer. Sixty-four patients (49%) underwent invasive testing, including 37 (36%) of those with benign masses. CONCLUSION: Patients in this series who had involvement of the anterior mediastinum, lymphopenia, or enlarged cervical lymph nodes had a high likelihood of cancer. Expectant management of patients lacking these characteristics may be safe and reduce unnecessary invasive testing.
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Enfermedades Endémicas , Histoplasmosis/diagnóstico , Histoplasmosis/epidemiología , Neoplasias del Mediastino/diagnóstico , Adolescente , Áreas de Influencia de Salud , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Neoplasias del Mediastino/terapia , Estudios Retrospectivos , Sensibilidad y Especificidad , Tennessee/epidemiologíaRESUMEN
OBJECTIVE: To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language. STUDY DESIGN: We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening components and tested the association between parent primary language and tuberculin skin test (TST) placement and documentation of results. RESULTS: During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were identified as at high risk for LTBI. Of these, 514 (62%) did not have documented TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or documentation of results, but non-Hispanic Black children were more likely to not have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P=.03) when adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement. CONCLUSION: Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST results among high-risk children, the latter of which was associated with race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.
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Tuberculosis Latente/diagnóstico , Tamizaje Masivo/métodos , Atención Primaria de Salud/métodos , Adolescente , Niño , Preescolar , Registros Electrónicos de Salud , Femenino , Humanos , Lactante , Masculino , Análisis Multivariante , Estudios Retrospectivos , Tennessee , Prueba de TuberculinaRESUMEN
In the United States (USA), the age of those newly diagnosed with HIV is changing, particularly among men who have sex with men (MSM). A retrospective analysis included HIV-infected adults from seven sites in the Caribbean, Central and South America network (CCASAnet) and the Vanderbilt Comprehensive Care Clinic (VCCC-Nashville, Tennessee, USA). We estimated the proportion of patients <25 years at HIV diagnosis by calendar year among the general population and MSM. 19,466 (CCASAnet) and 3,746 (VCCC) patients were included. The proportion <25 years at diagnosis in VCCC increased over time for both the general population and MSM (p < 0.001). Only in the Chilean site for the general population and the Brazilian site for MSM were similar trends seen. Subjects <25 years of age at diagnosis were less likely to be immunocompromised at enrollment at both the VCCC and CCASAnet. Recent trends in the USA of greater numbers of newly diagnosed young patients were not consistently observed in Latin America and the Caribbean. Prevention efforts tailored to young adults should be increased.
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Factores de Edad , Infecciones por VIH/diagnóstico , Homosexualidad Masculina/estadística & datos numéricos , Vigilancia de la Población/métodos , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Región del Caribe/epidemiología , América Central/epidemiología , Femenino , Infecciones por VIH/epidemiología , Homosexualidad Masculina/psicología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , América del Sur/epidemiología , Tennessee/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
STUDY OBJECTIVES: Inflammation may represent a common physiological pathway linking both short and long sleep duration to mortality. We evaluated inflammatory markers as mediators of the relationship between sleep duration and mortality in community-dwelling older adults. DESIGN: Prospective cohort with longitudinal follow-up for mortality outcomes. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Participants in the Health, Aging and Body Composition (Health ABC) Study (mean age 73.6 ± 2.9 years at baseline) were sampled and recruited from Medicare listings. MEASUREMENTS AND RESULTS: Baseline measures of subjective sleep duration, markers of inflammation (serum interleukin-6, tumor necrosis factor-α, and C-reactive protein) and health status were evaluated as predictors of all-cause mortality (average follow-up = 8.2 ± 2.3 years). Sleep duration was related to mortality, and age-, sex-, and race-adjusted hazard ratios (HR) were highest for those with the shortest (< 6 h HR: 1.30, CI: 1.05-1.61) and longest (> 8 h HR: 1.49, CI: 1.15-1.93) sleep durations. Adjustment for inflammatory markers and health status attenuated the HR for short (< 6 h) sleepers (HR = 1.06, 95% CI = 0.83-1.34). Age-, sex-, and race-adjusted HRs for the > 8-h sleeper group were less strongly attenuated by adjustment for inflammatory markers than by other health factors associated with poor sleep with adjusted HR = 1.23, 95% CI = 0.93-1.63. Inflammatory markers remained significantly associated with mortality. CONCLUSION: Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.
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Envejecimiento/sangre , Envejecimiento/fisiología , Biomarcadores/sangre , Composición Corporal , Estado de Salud , Inflamación/sangre , Mortalidad , Sueño/fisiología , Anciano , Proteína C-Reactiva/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Interleucina-6/sangre , Estilo de Vida , Estudios Longitudinales , Masculino , Pennsylvania , Estudios Prospectivos , Grupos Raciales , Características de la Residencia , Trastornos del Inicio y del Mantenimiento del Sueño , Análisis de Supervivencia , Tennessee , Factores de Tiempo , Factor de Necrosis Tumoral alfa/sangreRESUMEN
BACKGROUND & AIMS: The gastric cancer-causing pathogen Helicobacter pylori up-regulates spermine oxidase (SMOX) in gastric epithelial cells, causing oxidative stress-induced apoptosis and DNA damage. A subpopulation of SMOX(high) cells are resistant to apoptosis, despite their high levels of DNA damage. Because epidermal growth factor receptor (EGFR) activation can regulate apoptosis, we determined its role in SMOX-mediated effects. METHODS: SMOX, apoptosis, and DNA damage were measured in gastric epithelial cells from H. pylori-infected Egfr(wa5) mice (which have attenuated EGFR activity), Egfr wild-type mice, or in infected cells incubated with EGFR inhibitors or deficient in EGFR. A phosphoproteomic analysis was performed. Two independent tissue microarrays containing each stage of disease, from gastritis to carcinoma, and gastric biopsy specimens from Colombian and Honduran cohorts were analyzed by immunohistochemistry. RESULTS: SMOX expression and DNA damage were decreased, and apoptosis increased in H. pylori-infected Egfr(wa5) mice. H. pylori-infected cells with deletion or inhibition of EGFR had reduced levels of SMOX, DNA damage, and DNA damage(high) apoptosis(low) cells. Phosphoproteomic analysis showed increased EGFR and erythroblastic leukemia-associated viral oncogene B (ERBB)2 signaling. Immunoblot analysis showed the presence of a phosphorylated (p)EGFR-ERBB2 heterodimer and pERBB2; knockdown of ErbB2 facilitated apoptosis of DNA damage(high) apoptosis(low) cells. SMOX was increased in all stages of gastric disease, peaking in tissues with intestinal metaplasia, whereas pEGFR, pEGFR-ERBB2, and pERBB2 were increased predominantly in tissues showing gastritis or atrophic gastritis. Principal component analysis separated gastritis tissues from patients with cancer vs those without cancer. pEGFR, pEGFR-ERBB2, pERBB2, and SMOX were increased in gastric samples from patients whose disease progressed to intestinal metaplasia or dysplasia, compared with patients whose disease did not progress. CONCLUSIONS: In an analysis of gastric tissues from mice and patients, we identified a molecular signature (based on levels of pEGFR, pERBB2, and SMOX) for the initiation of gastric carcinogenesis.
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Daño del ADN , Células Epiteliales/enzimología , Receptores ErbB/metabolismo , Mucosa Gástrica/enzimología , Infecciones por Helicobacter/enzimología , Helicobacter pylori/metabolismo , Receptor ErbB-2/metabolismo , Animales , Apoptosis , Línea Celular , Supervivencia Celular , Transformación Celular Neoplásica/metabolismo , Transformación Celular Neoplásica/patología , Técnicas de Cocultivo , Colombia , Progresión de la Enfermedad , Activación Enzimática , Células Epiteliales/microbiología , Células Epiteliales/patología , Receptores ErbB/deficiencia , Receptores ErbB/genética , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastritis/enzimología , Gastritis/microbiología , Gastritis/patología , Infecciones por Helicobacter/genética , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/patogenicidad , Honduras , Humanos , Metaplasia , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Oxidorreductasas actuantes sobre Donantes de Grupo CH-NH/metabolismo , Fosforilación , Lesiones Precancerosas/enzimología , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Análisis de Componente Principal , Multimerización de Proteína , Receptor ErbB-2/genética , Transducción de Señal , Neoplasias Gástricas/enzimología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Tennessee , Poliamino OxidasaRESUMEN
Among 2012 Docstyle survey respondents, 80% identified doxycycline as the appropriate treatment for Rocky Mountain spotted fever in patients ≥ 8 years old, but only 35% correctly chose doxycycline in patients <8 years old. These findings raise concerns about the higher pediatric case-fatality rate of Rocky Mountain spotted fever observed nationally. Targeted education efforts are needed.
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Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Fiebre Maculosa de las Montañas Rocosas/tratamiento farmacológico , Autoinforme , Adulto , Anciano , Antibacterianos/efectos adversos , Niño , Doxiciclina/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fiebre Maculosa de las Montañas Rocosas/mortalidad , Tasa de Supervivencia/tendencias , Tennessee/epidemiologíaRESUMEN
OBJECTIVE: To examine healthcare resource utilization for acute respiratory illness in Latino infants compared with other racial/ethnic groups. STUDY DESIGN: We studied 674 term-born, previously healthy infants brought in for an unscheduled healthcare visit for an acute respiratory illness. The predictor variable was infant race/ethnicity, and the primary outcome was healthcare resource utilization, adjusted for age and disease severity. RESULTS: The cohort was 14% Latino, 52% white, 22% African American, and 12% other race/ethnicity. More than one-third (37%) of the mothers of Latino infants were Spanish-speaking. The bronchiolitis severity score was higher (indicating more severe disease) in white infants (median, 6.0; IQR, 3.0-9.0 on a scale of 0-12) compared with Latino (median, 3.0; IQR, 1.0-6.0) and African American (median, 3.5; IQR, 1.0-6.0) infants (P < .001 for the comparison of all groups). Disease severity was similar in Latino and African American infants (P = .96). Latino infants were the most likely to receive antibiotics (58%, compared with 47% of whites and 34% of African Americans; P = .005) and to have body fluid cultures drawn. Latino infants also were more likely than African American infants to undergo chest radiography and respiratory virus rapid antigen testing (P ≤ .01). Latino infants from Spanish-speaking families had a higher rate of respiratory syncytial virus testing compared with those from English-speaking families (76% vs 51%; P = .016). CONCLUSION: Providers caring for Latino infants with acute respiratory illness ordered more antibiotics and diagnostic testing for this group, particularly compared with African Americans, even though the 2 groups had similar disease severity and socioeconomic disparities. Language barrier may be a possible explanation for these differences.
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Servicios de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Infecciones por Virus Sincitial Respiratorio/terapia , Infecciones del Sistema Respiratorio/etnología , Infecciones del Sistema Respiratorio/terapia , Enfermedad Aguda , Etnicidad , Femenino , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Lactante , Lenguaje , Masculino , Infecciones del Sistema Respiratorio/virología , Clase Social , Tennessee , Estados UnidosRESUMEN
BACKGROUND AND OBJECTIVE: The association of large arterial rigidity and kidney function decline in longitudinal analyses is not well established. This study evaluated the association of aortic pulse wave velocity (aPWV) and pulse pressure (PP) with rapid kidney function decline and incident CKD in the Health, Aging and Body Composition study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Participants were 2129 older adults with a baseline measurement of aPWV, PP, and cystatin C and at least one additional measurement of cystatin C, either at year 3 or year 10. Outcomes were rapid kidney function decline (estimated GFRcysC loss of >3 ml/min per 1.73 m(2) per year) and incident CKD (eGFRcysC < 60 ml/min per 1.73 m(2) in participants with baseline estimated GFR > 60 ml/min per 1.73 m(2)). Multivariate regression models were used to evaluate association of aPWV and PP with each outcome. RESULTS: Mean (SD) baseline estimated GFRcysC was 79±29 ml/min per 1.73 m(2). Median follow-up duration was 8.9 years. In multivariable analyses, aPWV was not associated with rapid decline (odds ratio [OR], 95% confidence interval [CI] 1.16, 0.89-1.52) but was associated with incident CKD (incident rate ratio [IRR], 95% CI, 1.39, 1.09-1.77) and PP was associated with both rapid decline (OR, 95% CI 1.10, 1.04-1.16) and incident CKD (IRR, 95% CI, 1.06, 1.01-1.11). CONCLUSIONS: Large arterial stiffness assessed by aPWV and pulsatility assessed by PP were associated with incident CKD among older adults. Pulsatility assessed by PP was associated with rapid kidney function decline and incident CKD. Future research should determine whether interventions targeting arterial rigidity will prevent CKD development and progression.
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Enfermedades Renales/epidemiología , Enfermedades Renales/fisiopatología , Riñón/fisiopatología , Rigidez Vascular , Anciano , Presión Arterial , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Cistatina C/sangre , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Incidencia , Enfermedades Renales/sangre , Enfermedades Renales/diagnóstico , Modelos Lineales , Modelos Logísticos , Masculino , Análisis Multivariante , Oportunidad Relativa , Pennsylvania/epidemiología , Pronóstico , Estudios Prospectivos , Análisis de la Onda del Pulso , Medición de Riesgo , Factores de Riesgo , Tennessee/epidemiología , Factores de TiempoRESUMEN
PURPOSE: To investigate differences in pre-pregnancy BMI status in patients with spontaneous preterm birth (PTB) compared with term birth and assess the role of ethnicity as a risk modifier in BMI-associated PTB. METHODS: A case-control study involving self-reported African American and Caucasian women delivering singletons in Nashville, TN, USA, 2003-2009. Maternal pre-pregnancy BMI was recorded in 447 PTB-cases (African American = 145, Caucasian = 302) and 1315 term-birth controls (African American = 522; Caucasian = 793). Crude and adjusted odds ratio (OR and AOR) for PTB were calculated using normal BMI (18.5-24.9 kg/m(2)) as reference. Age, education, marital status, income, smoking, parity, previous PTB and pregnancy weight gain were included as covariates in logistic regression. RESULTS: No significant differences were noted in the OR for PTB among different BMI categories when women of different ethnicity were combined. Odds of PTB were greater in obese than in normal weight Caucasian women, even after adjusting for confounders (AOR = 1.84, 95%CI [1.15, 2.95]). Obese African American women had a decreased crude OR for PTB, although this was not significant after adjusting for confounders (AOR = 0.72, 95%CI [0.38, 1.40]). The odds for early PTB (<32 weeks) were decreased in obese compared with normal weight African American women (OR = 0.23, 95%CI [0.08, 0.70]), whereas they were increased in obese compared with normal weight Caucasian women (OR = 2.30, 95%CI [1.32, 4.00]). CONCLUSION: The risk for PTB in women with different pre-pregnancy BMI categories differs according to ethnicity.
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Índice de Masa Corporal , Nacimiento Prematuro/etnología , Nacimiento Prematuro/epidemiología , Negro o Afroamericano , Estudios de Casos y Controles , Femenino , Humanos , Oportunidad Relativa , Embarazo , Factores de Riesgo , Factores Socioeconómicos , Tennessee/epidemiología , Población BlancaAsunto(s)
Emigrantes e Inmigrantes/legislación & jurisprudencia , Derechos del Paciente/legislación & jurisprudencia , Diálisis Renal , Asignación de Recursos/ética , Justicia Social , Anemia/etiología , Anemia/terapia , Transfusión Sanguínea , Determinación de la Elegibilidad/ética , Determinación de la Elegibilidad/legislación & jurisprudencia , Urgencias Médicas , Humanos , Testigos de Jehová , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , México/etnología , Rol del Médico , Justicia Social/ética , Justicia Social/legislación & jurisprudencia , Justicia Social/psicología , TennesseeRESUMEN
Migration is a gendered process which may differentially alter conceptual models of illness as variation and change within specific sub-domains reflect unique experiences and interactions. Forty Mexican migrants completed a questionnaire consisting of 30 true/false questions regarding the symptoms, causes, and treatments of 19 illnesses (570 total questions). Results were analyzed using the Cultural Consensus Model and residual agreement analyses to measure patterns of inter-informant agreement. While men and women share overall agreement, they differ significantly in conceptions of treatment. In general, men over-extend the efficacy of treatment options while women restrict the abilities of folk healers and emphasize dietary changes in treating many illnesses. Variations reflect different social roles and interactions as migration patterns and living conditions reinforce gendered roles in medical decision-making. Women have greater experience with illnesses and interactions with biomedical services, which causes them to approximate biomedical providers' model of treatment.
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Formación de Concepto , Enfermedad , Conocimientos, Actitudes y Práctica en Salud , Migrantes , Adulto , Enfermedad/etiología , Femenino , Humanos , Masculino , México/etnología , Modelos Teóricos , Factores Sexuales , Encuestas y Cuestionarios , TennesseeRESUMEN
UNLABELLED: Bioactive compounds from natural plant sources are becoming increasingly important to the food industry. Ilex paraguariensis is used in the preparation of a widely popular tea beverage (Yerba Mate) in the countries of Uruguay, Paraguay, Argentina, and Brazil. In this study, extracts of 4 brands of commercial tea, derived from the holly plant species, Ilex paraguariensis, were evaluated for their ability to inhibit or inactivate bacterial foodborne pathogens. The ultimate goal was to evaluate potential use of the extracts in commercial applications. Dialyzed aqueous extracts were screened for antimicrobial activity against Escherichia coli O157:H7 and Staphylococcus aureus. S. aureus was found to be the more sensitive to extracts than E. coli O157:H7. Minimum bactericidal concentrations (MBCs) were determined to be approximately 150 to 800 µg/mL and 25 to 50 µg/mL against E. coli O157:H7 and S. aureus, respectively. A Uruguayan brand had reduced activity against E. coli O157:H7 compared to the Argentinean brands tested. It was concluded that Yerba Mate could be used as a potential antimicrobial in foods and beverages against these pathogenic bacteria. PRACTICAL APPLICATION: Soluble extracts from Yerba Mate are natural antimicrobials that can be incorporated into food products to achieve longer shelf life.
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Antibacterianos/farmacología , Escherichia coli O157/efectos de los fármacos , Ilex paraguariensis/química , Extractos Vegetales/farmacología , Hojas de la Planta/química , Staphylococcus aureus/efectos de los fármacos , Antibacterianos/aislamiento & purificación , Antiinfecciosos/aislamiento & purificación , Antiinfecciosos/farmacología , Argentina , Bebidas/análisis , Recuento de Colonia Microbiana , Diálisis , Escherichia coli O157/crecimiento & desarrollo , Conservantes de Alimentos/aislamiento & purificación , Conservantes de Alimentos/farmacología , Enfermedades Transmitidas por los Alimentos/prevención & control , Pruebas de Sensibilidad Microbiana , Viabilidad Microbiana/efectos de los fármacos , Extractos Vegetales/aislamiento & purificación , Solubilidad , Staphylococcus aureus/crecimiento & desarrollo , Tennessee , UruguayRESUMEN
BACKGROUND: In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate this outbreak. METHODS: A case was defined as either culture-confirmed MDR TB with a drug-susceptibility pattern closely resembling that of the index case, or a clinical diagnosis of active TB disease and corroborated contact with a person with culture-confirmed MDR TB. Medical records were reviewed, and patients and their contacts were interviewed. RESULTS: Five secondary TB cases were associated with the index case. Of 369 contacts of the index case, 189 (51%) were evaluated. Of those, 97 (51%) had positive tuberculin skin test (TST) results, 79 (81%) began therapy for latent TB infection (LTBI), and 38 (48%) completed LTBI therapy. CONCLUSION: Despite consistent follow up by public health officials, a low proportion of patients diagnosed with LTBI completed therapy. Clinicians and public health practitioners who serve immigrant communities should be vigilant for MDR TB.