Mississippi

密西西比州
  • 文章类型: Journal Article
    目的:从事农业行业的个人在工作中遇到可能导致伤害或疾病的危险。此外,参与农业行业的精神压力可能会导致工人与健康相关的负面结果。这项研究评估了2017年至2021年密西西比州农业行业员工死亡的原因。
    方法:数据由密西西比州卫生部提供。计算比例死亡率比(PMR)以确定与任何死亡原因的普通人群相比,农业行业雇员的死亡率是否升高。
    结果:农业行业员工的循环系统疾病(PMR107,95%置信区间[CI]103-110)和2019年冠状病毒病(PMR122,95%CI111-134)的死亡率在统计学上显着升高。它们还显示了由运输事故(PMR117,95%CI101-136)和暴露于无生命机械力(PMR274,95%CI183-396)引起的死亡的显着超额死亡率。
    结论:农业从业人员死亡率过高的死亡原因可以解释为与在农业行业工作相关的危害。这些发现可用于为从事农业的个人创建有针对性的未来公共卫生计划。
    OBJECTIVE: Individuals employed in the agricultural industry encounter hazards in their work that could lead to injury or illness. Furthermore, the mental stress of being involved in the agricultural industry could lead to negative health-related outcomes for workers. This study evaluates the causes of deaths among employees in Mississippi\'s agricultural industry from 2017 to 2021.
    METHODS: Data are provided by the Mississippi Department of Health. Proportionate mortality ratios (PMRs) are calculated to determine if agricultural industry employees show an elevated mortality in comparison to the general population for any cause of death.
    RESULTS: Agricultural industry employees show a statistically significant elevated mortality for circulatory disease (PMR 107, 95% confidence interval [CI] 103-110) and coronavirus disease 2019 (PMR 122, 95% CI 111-134). They also show a significant excess mortality for deaths caused by transport accidents (PMR 117, 95% CI 101-136) and exposure to inanimate mechanical forces (PMR 274, 95% CI 183-396).
    CONCLUSIONS: The causes of death for which agricultural employees show an excess mortality can be explained by the hazards associated with working in the agricultural industry. These findings can be used to create targeted future public health programs for individuals who are employed in agriculture.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    近年来,过早的“绝望的死亡”(即,由于酒精,吸毒,和自杀)在美国中年白人中受到了大众媒体的越来越多的关注,然而,关于如何解释非洲裔美国年轻人过早死亡的讨论较少。在这项研究中,我们研究了与绝望死亡相关的因素(饮酒,吸毒,吸烟)和环境因素(感知的歧视,社会经济地位,邻里条件)作为非洲裔美国人在65岁之前过早死亡的预测因素。
    杰克逊心脏研究(JHS)是一项针对杰克逊非裔美国人的纵向队列研究,密西西比州,大都市统计区。我们纳入基线年龄小于65岁的参与者(n=4000)。参与者的注册始于2000年,这些分析的数据收集到2019年。为了检查死亡率的预测因素,我们计算了多变量调整后的危险比(HR;95%CI),使用根据年龄调整的Cox比例风险模型,性别,理想的心血管健康指标,吸毒,酒精摄入量,功能状态,癌症,慢性肾病,哮喘,腰围,抑郁症,收入,教育,健康保险状况,感知到的邻里安全,和终身歧视。
    我们的队列中有230人死亡,从2001年到2019年。在调整所有协变量后,男性(HR,1.50;95%CI,1.11-2.03),使用药物的参与者(HR,1.53;95%CI,1.13-2.08),有大量饮酒事件(HR,1.71;95%CI,1.22-2.41),报告的0-1个理想心血管健康指标(HR,1.78;95%CI,1.06-3.02),患有癌症(HR,2.38;95%CI,1.41-4.01),具有较差的功能状态(HR,1.68;95%CI,1.19-2.37),或家庭年收入低于25,000美元(人力资源,1.63;95%CI,1.02-2.62)更有可能在65岁之前死亡。
    在我们庞大的非裔美国男性和女性群体中,过早死亡的临床预测因素包括不良的心血管健康和癌症,社会预测因素包括低收入,吸毒,大量饮酒,现在是一个吸烟者。临床和社会干预是必要的,以防止非洲裔美国人过早死亡。
    UNASSIGNED: In recent years, premature \"deaths of despair\" (ie, due to alcohol, drug use, and suicide) among middle-aged White Americans have received increased attention in the popular press, yet there has been less discussion on what explains premature deaths among young African Americans. In this study, we examined factors related to deaths of despair (alcohol use, drug use, smoking) and contextual factors (perceived discrimination, socioeconomic status, neighborhood conditions) as predictors of premature deaths before the age of 65 years among African Americans.
    UNASSIGNED: The Jackson Heart Study (JHS) is a longitudinal cohort study of African Americans in the Jackson, Mississippi, metropolitan statistical area. We included participants younger than 65 years at baseline (n=4000). Participant enrollment began in 2000 and data for these analyses were collected through 2019. To examine predictors of mortality, we calculated multivariable adjusted hazard ratios (HRs; 95% CI), using Cox proportional hazard models adjusted for age, sex, ideal cardiovascular health metrics, drug use, alcohol intake, functional status, cancer, chronic kidney disease, asthma, waist circumference, depression, income, education, health insurance status, perceived neighborhood safety, and exposure to lifetime discrimination.
    UNASSIGNED: There were 230 deaths in our cohort, which spanned from 2001-2019. After adjusting for all covariates, males (HR, 1.50; 95% CI, 1.11-2.03), participants who used drugs (HR, 1.53; 95% CI, 1.13-2.08), had a heavy alcohol drinking episode (HR, 1.71; 95% CI, 1.22-2.41), reported 0-1 ideal cardiovascular health metrics (HR, 1.78; 95% CI, 1.06-3.02), had cancer (HR, 2.38; 95% CI, 1.41-4.01), had poor functional status (HR, 1.68; 95% CI, 1.19-2.37), or with annual family income less than $25,000 (HR, 1.63; 95% CI, 1.02-2.62) were more likely to die before 65 years of age.
    UNASSIGNED: In our large cohort of African American men and women, clinical predictors of premature death included poor cardiovascular health and cancer, and social predictors included low income, drug use, heavy alcohol use, and being a current smoker. Clinical and social interventions are warranted to prevent premature mortality in African Americans.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:磷(P)摄入量与肥胖之间的关系是模棱两可的,两个方向的假设。
    目的:我们调查了磷摄入量与磷摄入量之间的关系,从当前数据库评估,并计算了生物可利用的P摄入量,非洲裔美国成年人的肥胖。
    方法:我们检查了原始P和生物可利用P(总,补充说,和自然),和身体质量指数(BMI)和腰围(WC)在一项横断面研究5306非洲裔美国成年人(21-84岁)从杰克逊心脏研究。共有3300名参与者进行了完整的访谈,有效的饮食数据,肾功能正常.通过FFQ评估饮食。一种新的算法用于估计P的生物利用度。BMI或WC在每个P变量上进行回归,调整总能量摄入和潜在的混杂因素。
    结果:调整协变量后,原始P(总和添加)和生物可利用P(总和添加)摄入量(表示/100mg)与BMI相关(β分别为0.11、0.67、0.31和0.71,所有P<0.0001)。无论是原始的还是生物可利用的天然P都没有显着相关,(β分别=-0.03和0.09,两者P>0.05)。当添加和自然P包含在同一模型中时,增加的P(原始和生物可利用性)摄入量与BMI(分别为0.70和0.73,两者P<0.0001)。对于WC也看到了类似的结果。摄入原始添加P倾向于与BMI更密切相关,女性(β=0.72,P<0.0001)高于男性(β=0.56,P=0.003)(P交互作用=0.06)。
    结论:我们发现,不自然,这可能是加工食品摄入量的替代指标,与较高的BMI和WC相关。当考虑到生物利用度时,这些更强,对女人来说比对男人.需要进一步调查以充分了解驱动这些关联的机制。
    BACKGROUND: The relation between phosphorus (P) intake and obesity is equivocal, with hypotheses in both directions.
    OBJECTIVE: We investigated the relationship between P intake, assessed from a current database, and calculated bioavailable P intake and obesity among African-American adults.
    METHODS: We examined associations between original and bioavailable P (total, added, and natural) and BMI and waist circumference (WC) in a cross-sectional study of 5306 African-American adults (21-84 y) from the Jackson Heart Study. A total of 3300 participants had complete interviews, valid dietary data, and normal kidney function. Diet was assessed by food frequency questionnaire. A novel algorithm was used to estimate P bioavailability. BMI or WC was regressed on each P variable, adjusting for total energy intake and potential confounders.
    RESULTS: After adjusting for covariates, original P (total and added) and bioavailable P (total and added) intakes (expressed/100 mg) were associated with BMI (β: 0.11, 0.67, 0.31, and 0.71, respectively; all P < 0.0001). Neither original nor bioavailable natural P was significantly associated (β: -0.03 and 0.09, respectively; both P > 0.05). When added and natural P were included in the same model, added P (original and bioavailable) intakes remained strongly associated with BMI (0.70 and 0.73, respectively; both P < 0.0001). Similar results were seen for WC. Intake of original added P tended to be more strongly associated with BMI, in females (β: 0.72; P < 0.0001) than in males (β: 0.56; P = 0.003) (P-interaction = 0.06).
    CONCLUSIONS: We found that greater intake of added, not natural, which may be a proxy for intake of processed foods was associated with higher BMI and WC. These were somewhat stronger when bioavailability was considered and for women than for men. Further investigation is needed to fully understand the mechanisms driving these associations.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    与其他地区相比,美国南部的COVID-19疫苗接种率较低。这项研究调查了密西西比州(MS)的COVID-19疫苗接种犹豫,以确定可能在疫苗吸收不足的地区促进MS疫苗接种策略的偏好。
    定性访谈于2021年4月至2022年1月之间完成,对MS四个联邦合格健康中心的工作人员和患者进行了访谈。采访包括以下COVID-19疫苗主题:接种疫苗的意愿,障碍和促进者,以及提供疫苗信息的方法。使用NVivo软件组织数据并使用反身主题分析进行分析。
    采访了15名诊所工作人员和49名患者。疫苗接种的障碍包括缺乏对疫苗如何起作用的知识和理解,对政府的不信任,害怕副作用,以及不接种疫苗的社会压力。疫苗接种促进者包括其广泛的可及性,保护自己和弱势群体的愿望,和以前不愉快的COVID-19疾病经历。与会者指出,疫苗信息应由卫生组织提供,尊敬的社区成员。
    结果确定了疫苗接种的障碍,比如对政府和医疗系统的不信任,以及诸如来自会众和宗教领袖的疫苗接种宣传之类的促进者。这些发现可以为未来的COVID-19疫苗接种工作提供信息,以提高MS的总体免疫率。其他地区的未来研究可以进一步评估疫苗接种障碍和促进因素的共性和差异。
    UNASSIGNED: COVID-19 vaccination rates are lower in the Southern United States compared to other regions. This study investigated COVID-19 vaccination hesitancy in Mississippi (MS) to identify preferences that may boost MS vaccination strategies in areas with poor vaccine uptake.
    UNASSIGNED: Qualitative interviews were completed between April 2021 and January 2022 with staff and patients at four Federally Qualified Health Centers in MS. Interviews included the following COVID-19 vaccine topics: willingness to be vaccinated, barriers and facilitators, and methods for providing vaccine information. Data were organized with NVivo software and analyzed using reflexive thematic analysis.
    UNASSIGNED: Fifteen clinic staff and 49 patients were interviewed. Barriers to vaccine uptake included a lack of knowledge and understanding of how the vaccine worked, distrust of the government, fear of side effects, and social pressure to stay unvaccinated. Vaccination facilitators included its widespread accessibility, a desire to protect themselves and vulnerable populations, and a previous unpleasant COVID-19 illness experience. Participants stated that vaccine information should be provided by health organizations and familiar, respected community members.
    UNASSIGNED: Results identified barriers to vaccination, such as mistrust of the government and healthcare system, and facilitators like vaccination advocacy originating from congregations and religious leaders. These findings can inform future COVID-19 vaccination efforts to increase overall immunization rates in MS. Future research in other locations could further assess commonalities and differences in the barriers and facilitators to vaccination.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:远程健康(TMH)为管理重度抑郁症(MDD)提供了一种有前途的方法。我们工作的目的是评估MDDMedicare受益人的弱势群体中TMH的使用情况及其与医疗保健利用和支出的关系。方法:这项队列研究分析了患有MDD的成年受益人的2019年密西西比州医疗保险按服务收费数据。通过在1:1倾向评分匹配之后使用TMH来匹配受试者。对TMH和非TMH队列在医疗保健利用和支出结果方面进行了比较,调整提供程序类型后匹配。结果:在7,673名确定的受益人中,551使用TMH,7122没有。预匹配,TMH队列显示双重受益人比例更高,农村居民,收入低于40,000美元的受试者,有残疾权利的受试者,和更高的Charlson合并症指数得分,与非TMH队列相比(所有p<0.001)。此外,TMH队列的门诊量较少,但是住院更多,急诊科(ED)访问,更高的医学,药房,和总支出(所有p<0.001)。匹配后,TMH与门诊就诊减少25%(p<0.001)和药房支出减少20%(p=0.01)相关。对住院没有显著影响,ED访问,医疗支出,或总支出。结论:这些结果强调了TMH在增强弱势群体可获得的医疗保健服务和医疗保险负担得起的服务方面的潜力。我们的结果为未来有关TMH的政策讨论提供了可靠的基准。未来的研究应考虑确定弱势群体使用TMH的障碍,并确保公平和高质量的患者护理。
    Background: Telemental health (TMH) offers a promising approach to managing major depressive disorder (MDD). The objective of our work was to evaluate TMH usage among a vulnerable population of MDD Medicare beneficiaries and its association with health care utilization and expenditures. Methods: This cohort study analyzed 2019 Mississippi Medicare fee-for-service data for adult beneficiaries with MDD. Subjects were matched by the use of TMH following 1:1 propensity score matching. Comparisons between TMH and non-TMH cohorts were made on health care utilization and expenditure outcomes, adjusting for provider types postmatching. Results: Among 7,673 identified beneficiaries, 551 used TMH and 7,122 did not. Prematching, TMH cohort showed greater proportions of dual beneficiaries, rural residents, subjects with income below $40,000, those with disability entitlement, and higher Charlson comorbidity index scores, compared to the non-TMH cohort (all p < 0.001). Moreover, the TMH cohort had fewer outpatient visits, but more inpatient admissions, emergency department (ED) visits, and higher medical, pharmacy, and total expenditures (all p < 0.001). Postmatching, TMH was associated with a 25% reduction in outpatient visits (p < 0.001) and a 20% reduction in pharmacy expenditures (p = 0.01), with no significant effect on inpatient admissions, ED visits, medical expenditures, or total expenditures. Conclusions: These results underscore the potential of TMH in enhancing accessible health care services for vulnerable populations and affordable services for Medicare. Our results provide a robust baseline for future policy discussions concerning TMH. Future studies should consider identifying barriers to TMH use among vulnerable populations and ensuring equitable and high-quality patient care.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    抗逆转录病毒暴露前预防(PrEP)在预防HIV方面非常有效。尽管承诺,PrEP使用率低,尤其是与男性发生性关系的年轻黑人男性(YBMSM)。密西西比州(MS)的艾滋病毒流行率是美国最高的,随着大量新的感染发生在住在杰克逊的YBMSM中,女士我们在2021年10月至2022年4月期间从MS健康诊所招募了20名符合PrEP资格的YBMSM和10名诊所工作人员。数据是通过深入访谈和简短调查远程收集的,持续了大约45-60分钟。面试内容包括PrEP知识/经验,艾滋病毒风险感知,和PrEP使用障碍和促进者。对定性数据进行编码,然后使用NVivo进行组织。使用主题分析方法,数据被评估当前使用PrEP的障碍.参与者确定了一系列障碍。障碍包括结构因素(PrEP的成本,缺乏谨慎的诊所,时间承诺,相互竞争的利益);社会因素(不知道艾滋病毒风险,污名和同性恋恐惧症,担心合作伙伴会发现PrEP的使用,不认识PrEP上的任何人);行为因素(性危险因素,否认,预防和治疗的优先级较低);和临床因素(误解的副作用,担心PrEP不起作用)。YBMSM中使用PrEP的重大障碍源于结构性,社会,行为,和临床因素。这些结果将为干预工作提供信息,以减轻障碍并改善美国南部YBMSM的PrEP吸收。
    Antiretroviral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV. Despite its promise, PrEP use is low, especially among young Black men who have sex with men (YBMSM). The prevalence of HIV in Mississippi (MS) is among the highest in the United States, with the bulk of new infections occurring amongst YBMSM living in Jackson, MS. We recruited 20 PrEP-eligible YBMSM and 10 clinic staff from MS health clinics between October 2021 and April 2022. Data were collected remotely using in-depth interviews and a brief survey, which lasted approximately 45-60 min. Interview content included PrEP knowledge/experiences, HIV risk perception, and PrEP use barriers and facilitators. Qualitative data were coded then organized using NVivo. Using thematic analysis methodology, data were assessed for current barriers to PrEP use. An array of barriers were identified by participants. Barriers included structural factors (cost of PrEP, lack of discreet clinics, time commitment, competing interests); social factors (unaware of HIV risk, stigma and homophobia, fear that partners would find out about PrEP use, not knowing anyone on PrEP); behavioral factors (sexual risk factors, denial, less priority for prevention vs treatment); and clinical factors (misunderstood side effects, fear PrEP won\'t work). Significant barriers to PrEP use among YBMSM stem from structural, social, behavioral, and clinical factors. These results will inform intervention efforts tailored to mitigate barriers and improve PrEP uptake among YBMSM in the southern United States.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:密西西比州是美国HIV感染率最高的国家之一,但PrEP摄取较低。了解PrEP的使用模式可以改善PrEP的启动和持久性。
    方法:这是杰克逊PrEP程序的混合方法评估,密西西比州。在2018年11月至2019年12月之间,参加非临床检测地点的HIV高风险客户被转介给药剂师进行当天的PrEP启动。药剂师提供了90天的PrEP处方,并在三个月内安排了随访临床预约。我们将这次访问的客户记录与杰克逊两家最大的PrEP诊所的电子健康记录联系起来,以确定与正在进行的临床护理的联系。我们确定了四种不同的PrEP使用模式,我们用于定性访谈抽样:1)填写处方并在三个月内与护理挂钩;2)填写处方并在三个月后与护理挂钩;3)填写处方并从未与护理挂钩;4)从未填写处方。在2021年,我们有目的地对这四组患者进行个人访谈,以确定PrEP启动和持续的障碍和促进因素。使用由计划行为理论提供的指南。
    结果:对121名客户进行了PrEP评估;所有客户都接受了处方。三分之一的人不到25岁,77%是黑人59%是与男性发生性关系的顺性男性。四分之一(26%)的人从未填写过PrEP处方,44%的人选择了处方,但从未与临床护理挂钩,12%的人在三个月后的某个时间点与护理相关(导致PrEP覆盖率出现差距),18%的人在3个月内接受护理。我们采访了121位客户中的26位。定性数据显示,成本,与性和艾滋病毒有关的污名,关于PrEP的错误信息,感知到的副作用是摄取和持久性的障碍。个人保持健康的愿望和PrEP诊所工作人员的支持是促进者。
    结论:大多数服用当天PrEP处方的人在前三个月内从未开始PrEP或停止PrEP。解决明显的污名和错误信息障碍并减少结构性障碍可能会增加PrEP的启动和持久性。
    Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence.
    This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior.
    There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals\' desire to stay healthy and the support of PrEP clinic staff were facilitators.
    The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    密西西比州(MS)在暴露前预防(PrEP)和COVID-19疫苗摄取方面均落后于其他州。这项研究调查了接受COVID-19疫苗和使用PrEP的意愿的相似性。在2021年4月至2022年1月期间,对15名临床工作人员和49名符合PrEP资格的患者进行了半结构化访谈。进行了自反主题分析。总的来说,51%的患者使用PrEP,67%的人接种了COVID-19疫苗。在PrEP用户中,64%的人接种了疫苗。参与者报告了类似的犹豫(疗效,副作用,并且没有感知到的风险)以及使用PrEP和COVID-19疫苗的原因(健康自主权和保护自己和他人)。服用PrEP并没有增加获得COVID-19疫苗的可能性,因此,从事一种预防行为不会导致从事其他预防行为。然而,结果表明,犹豫和使用这两种预防措施的动机的共同点。未来的预防和实施工作可以借鉴这些共同点。
    Mississippi (MS) trails behind other states in both pre-exposure prophylaxis (PrEP) and COVID-19 vaccine uptake. This study investigated similarities in willingness to receive the COVID-19 vaccine and use PrEP. Semi-structured interviews were conducted between April 2021 and January 2022 with 15 clinical staff and 49 PrEP-eligible patients living in MS. Reflexive thematic analysis was conducted. Overall, 51% of patients were on PrEP, and 67% received the COVID-19 vaccine. Among PrEP users, 64% had received the vaccine. Participants reported similar hesitations (efficacy, side effects, and no perceived risk) and reasons for use (health autonomy and protecting themselves and others) regarding PrEP and the COVID-19 vaccine. Taking PrEP did not increase the likelihood of getting the COVID-19 vaccine, thus engaging in one prevention behavior does not lead to engaging in other prevention behaviors. However, results indicated commonalities in hesitancy and motivators to utilize both preventive measures. Future prevention and implementation efforts can be informed by these commonalities.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景心血管健康(CVH)状态的变化与心血管疾病的风险有关。然而,没有研究探讨CVH与心源性猝死(SCD)风险的变化规律.我们旨在研究基线CVH和CVH随时间变化与SCD风险之间的联系。方法和结果在前瞻性队列ARIC(社区动脉粥样硬化风险)研究中进行了分析,始于1987年至1989年。ARIC从美国4个社区招募了15792名45至64岁的人(福赛斯县,北卡罗来纳州;杰克逊,密西西比州;明尼阿波利斯的郊区,明尼苏达州;和华盛顿县,马里兰)。具有0至2、3至4和5至7个理想CVH指标的受试者被归类为不良,中间,或理想的CVH,分别。考虑了在1987年至1989年和1993年至1995年之间的6年内CVH的变化。主要研究结果是医生裁定的SCD。研究人群由15026名受试者组成,其中12207人有CVH变化的数据。在平均23.0年的随访中,记录583例SCD。基线CVH指标和随时间变化的CVH指标与SCD风险之间存在很强的负相关。与CVH持续较差的受试者相比,从不良到中等/理想的人群的SCD风险较低(风险比[HR],0.67[95%CI,0.48-0.94]),中级到穷人(HR,0.73[95%CI,0.54-0.99]),从中级到理想(HR,0.49[95%CI,0.24-0.99]),理想到差/中等CVH(HR,0.23[95%CI,0.10-0.52]),或那些具有一致中级(HR,0.49[95%CI,0.36-0.66])或一致理想的CVH(HR,0.31[95%CI,0.13-0.76])。对于非SCD也观察到类似的结果。结论与持续较差的CVH相比,CVH的其他变化模式与SCD风险较低相关.这些发现强调了在SCD的原始预防中促进理想CVH的重要性。
    Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow-up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48-0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54-0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24-0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10-0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36-0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13-0.76]). Similar results were also observed for non-SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目标:性健康和生殖健康(SRH)的公平需要参与反黑人种族主义对避孕护理经验的影响,并在计划和政策设计中优先考虑黑人妇女的需求。迄今为止,这种努力是有限的。我们探索了密西西比州黑人妇女的避孕护理经验和偏好。
    方法:我们对过去2年中使用过避孕方法的成年黑人妇女进行了34次深入访谈和6次焦点小组讨论(共35名参与者)。我们在整个密西西比州的社区环境中招募,并使用以人为中心的避孕护理框架作为探索经验和偏好的指南。我们应用了4个以人为中心的避孕护理框架要素-外展和建立信任,Access,质量,和后续支持——确定和解释主题。
    结果:学校和教堂作为青少年SRH的支持来源,是外展和信任建设中最突出的主题。在没有私人保险的情况下获得任命的成本和困难被确定为准入的障碍。需要更全面的避孕咨询,包括副作用信息,以及提供者和诊所工作人员的种族主义和其他歧视的经验成为围绕质量的突出主题。最后,在随访支持方面出现了更积极的临床外展和对停药的尊重.
    结论:在这项研究中,黑人妇女中发现了高质量避孕护理的障碍和促进者以及信息,为改善获得高质量避孕护理的机会和解决历史和持续的不平等提供了干预措施的见解。
    结论:在避孕药具获取工作中以人为本和公平的时代,我们的研究结果表明,迫切需要通过教堂和学校扩大信息和支持,发展一个反种族主义者,值得信赖的医疗劳动力,改善咨询,地址预约和后续护理障碍。
    OBJECTIVE: Sexual and reproductive health (SRH) equity requires engagement with anti-Black racism\'s impact on contraceptive care experiences, and prioritization of Black women\'s needs in program and policy design. To date, such efforts have been limited. We explored contraceptive care experiences and preferences of Black women in Mississippi.
    METHODS: We conducted 34 in-depth interviews and 6 focus group discussions (with a total of 35 participants) with adult Black women who had used contraception in the last 2 years. We recruited in community settings throughout Mississippi and used the Person-Centered Contraceptive Care Framework as a guide to explore experiences and preferences. We applied the 4 Person-Centered Contraceptive Care Framework elements - Outreach and trust building, Access, Quality, and Follow-up support - to identify and interpret themes.
    RESULTS: Schools and churches as sources of support for adolescent SRH was the most salient theme within Outreach and trust building. Cost and difficulties obtaining appointments without private insurance were identified as barriers to Access. The need for more comprehensive contraceptive counseling, including side effect information, and the experience of racism and other discrimination by providers and clinic staff emerged as prominent themes around Quality. Finally, desire for more proactive clinical outreach and respect for discontinuation emerged related to Follow-up support.
    CONCLUSIONS: Barriers and facilitators to high quality contraceptive care and information identified among Black women in this study offer insights for interventions to improve access to high quality contraceptive care and address historical and ongoing inequities.
    CONCLUSIONS: In an era of increasing prioritization of person-centeredness and equity in contraceptive access efforts, our findings suggest the critical need to expand information and support through churches and schools, develop an anti-racist, trustworthy health care workforce, improve counseling, and address appointment and follow-up care barriers.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号