To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE ( p < .0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.
Background: While the majority of COVID-19 patients fully recover from the infection and become asymptomatic, a significant proportion of COVID-19 survivors experience a broad spectrum of symptoms lasting weeks to months post-infection, a phenomenon termed "post-acute sequelae of COVID-19 (PASC)". The aim of this study is to determine whether inflammatory proteins are dysregulated and can serve as potential biomarkers for systemic inflammation in COVID-19 survivors. Methods: We determined the levels of inflammatory proteins in plasma from 22 COVID-19 long haulers (COV-LH), 22 COVID-19 asymptomatic survivors (COV-AS), and 22 healthy subjects (HS) using an Olink proteomics assay and assessed the results by a beads-based multiplex immunoassay. Results: Compared to HS, we found that COVID-19 survivors still exhibited systemic inflammation, as evidenced by significant changes in the levels of multiple inflammatory proteins in plasma from both COV-LH and COV-AS. CXCL10 was the only protein that significantly upregulated in COV-LH compared with COV-AS and HS. Conclusions: Our results indicate that several inflammatory proteins remain aberrantly dysregulated in COVID-19 survivors and CXCL10 might serve as a potential biomarker to typify COV-LH. Further characterization of these signature inflammatory molecules might improve the understanding of the long-term impacts of COVID-19 and provide new targets for the diagnosis and treatment of COVID-19 survivors with PASC. This article is protected by copyright. All rights reserved.
Purpose Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. Methods The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. Results Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). Conclusion Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
This study aimed to explore the use of chemical and physical enhancement strategies for the intradermal delivery of cromolyn sodium (CS) for treatment of atopic dermatitis. CS gels were formulated to individually contain 2.5 and 9% salcaprozate sodium (SNAC) as a potential chemical enhancer. The effect of microneedles, alone and in combination with SNAC, was investigated via in vitro permeation studies. Skin impedance and FTIR evaluation of SNAC-treated stratum corneum (SC) was done and compared to the control. The amount of drug delivered in the dermis after 24 h by the 2.5% and 9% SNAC gels was 23.29 ± 1.89 µg/cm2 and 35.87 ± 2.23 µg/cm2, respectively, which were significantly higher than the control (p < 0.05) but were not remarkably different from each other (p > 0.05). Microneedles enhanced permeation in both the control and 2.5% SNAC groups (p < 0.05); however, no synergistic enhancement was observed when microneedle and SNAC treatments were combined (p > 0.05). Over 24 h of treating the SC with 2.5% SNAC, FTIR evaluation showed stretches on the CH2 asymmetric and symmetric stretching vibrations observed at 2920.23 cm-1 and 2850.79 cm-1 respectively in untreated SC, which shifted to higher wavenumbers and indicated some lipid fluidizing effect. However, no significant drop in skin impedance was seen with SNAC as compared to the control (p > 0.05). SNAC was concluded to have skin permeation enhancement effect on CS, while microneedles effectively enhanced CS permeation even in the absence of SNAC.
Severe traumatic arterial injuries are rarely seen in pediatric patients. Management decisions are often guided by anecdotal experience due to a lack of well documented evidence-based guidelines. This paper demonstrates success with multidisciplinary management and close, structured follow-up in a 5 year old boy with traumatic brachial artery dissection and extensive soft tissue loss.
This chapter introduces Trauma-Informed Pedagogies: A Guide for Responding to Crisis and Inequality in Higher Education, which is an equity-centered, evidence-based guide to trauma-informed teaching and learning in higher education. First, the chapter contextualizes the book in understanding that trauma is not just in past but also in the present and discusses the prevalence and impact of trauma on college students and educators. Next, the chapter explores what it means to respond to trauma, crisis, and inequality using a trauma-informed approach. The chapter then describes the origins and aims of the book and the book’s contents.
Vocal fatigue has remained an elusive construct—despite its significant impact on communication, vocation, and quality of life. Current frameworks define vocal fatigue in the context of vocal demands and vocal demand-responses. However, the impact of factors like individuals’ baseline vocal fitness and perception of the demand are not well understood. What is also not well understood are the effects of specific vocal demand ingredients on an individual's vocal demand responses. Furthermore, current outcome measures utilized to capture vocal fatigue lack sensitivity and underlying mechanisms are poorly understood. These gaps have led to inconclusive next steps in how to best define, assess, monitor, and manage vocal fatigue. A conceptual framework is needed to study and better understand vocal fatigue constructs. Such a framework should consider the individual's baseline physiology, psychology, key vocal demand ingredients, and biophysiological mechanisms underlying demand responses. The objective of this paper is to help the reader better understand the complex and heterogeneous nature of vocal fatigue and its impact on reliable assessment and monitoring. Future studies will require better elucidation of vocal demand ingredients, will need more sensitive vocal demand response measures, and will need to take in to account an individual's baseline physiology and psychological factors.
Naloxone, an FDA-approved opioid inhibitor, used to reverse opioid overdose complications has up till date faced challenges associated with its delivery. Limitations include the use of invasive delivery forms and the need for frequent redosing due to its short half-life. The goal of the current study was to design a transdermal rapidly dissolving polymeric microneedle (MN) patch with delivery and pharmacokinetic properties comparable to that seen with the commercially available NAL products, eliminating their delivery limitations. Patches of varying dimensions (500 µm; 100 array,800 µm; 100array, and 600 µm; 225 array) were fabricated to evaluate the effect of increasing MN length, and density (no. of needles/unit area) on drug release. Drug dose in each of these patches was 17.89 ± 0.23 mg, 17.2 ± 0.77 mg, and 17.8 ± 1.01 mg, respectively. Furthermore, the insertion efficiency of each of the MN patches was 94 ± 4.8%, 90.6 ± 1.69%, and 96 ± 1.29%, respectively. Compared to passive permeation, a reduced lag time of about 5–15 min was observed with a significant drug flux of 15.09 ± 7.68 g𝜇/cm2/h seen in the first 1 h (p < 0.05) with the array of 100 needles (500 µm long). Over 24 h, a four and ten-fold increase in permeation was seen with the longer length and larger density MN patch, respectively, when compared to the 500 µm (100 array) patch. Model simulations and analyses revealed the significance of needle base diameter and needle count in improving systemic pharmacokinetics of NAL.
Objective: This study explored the characteristics and health care utilization of adults released from state prisons and enrolled in Medicaid in Indiana, which has policies to facilitate timely enrollment. Methods: Medicaid claims and Department of Corrections data were used to examine demographic and incarceration characteristics and health care utilization patterns of adults (N=15,929) released from state prisons and enrolled in Medicaid within 120 days of release, between 2015 and 2018. Results: More than 80% of participants had at least one health encounter within 120 days of initiating coverage, and nearly 50% used the emergency department. Those enrolled in Medicaid within 30 days of release were more likely to have behavioral health needs and to utilize subacute behavioral health care than those who enrolled later. Conclusions: Understanding these patterns of health care utilization is essential to operationalizing procedures and interventions to support the health care needs of adults involved in the criminal legal system.
This review discusses the inhibition of macromolecular structure formation as a novel and under-investigated drug target. The disruption of cell wall structures by penicillin-binding protein interactions is one potential target. Inhibition of DNA polymerase III assembly by novel drugs is a second target that should be investigated. RNA polymerase protein structural interactions are a third potential target. Finally, disruption of ribosomal subunit biogenesis represents a fourth important target that can be further investigated. Methods to examine these possibilities are discussed.
Background Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State. Methods The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%. Results The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35–5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28–3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23–2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11–2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13–2.53). Conclusions The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system.
Objective: College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence. Participants: Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020. Methods: We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators. Results: Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use. Conclusions: ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings.
Purpose Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. Method Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5–18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. Results Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). Conclusions These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.
There are only sporadic cases of tetanus in children in the United States. We describe an unimmunized child with generalized tetanus who required nearly a month of mechanical ventilation with analgesia, sedation, and neuromuscular blockade. Dantrolene showed benefit in spasm control and patient comfort when used in combination with other drugs.
Objectives: Compliance with coronavirus disease 2019 (COVID-19) guidelines, including the use of masks and social distancing and vaccinations, has been poor. Our study examined what factors may identify those who will be more or less compliant, especially in regard to those with identified higher risk. Methods: A telephone survey of 200 adult patients from two practices, one general internal medicine and the other rheumatology, was performed in May and June 2021. Questions included age, sex, perception of immunocompetence, smoking history, mask and social distancing compliance, COVID-19 symptoms and/or test-proven infection, and immunization status for COVID-19. Those agreeing to participate also underwent chart review for body mass index, physician-assessed immunocompetence, and diabetes mellitus. Results: No clinical factors approached statistical significance for the prediction of compliance or noncompliance. Compliance with mask and social distancing highly correlated with vaccination and avoidance of infection, however. Conclusions: Attempts to improve compliance cannot be focused on any of the particular groups examined in this study.
Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South. Methods: To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders. Results: Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV. Conclusions: This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.
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