scholarly journals 763. Risk Factors for Homeless Status and Mortality Among Homeless TB Cases in Texas, 2010–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S274-S274 ◽  
Author(s):  
Saroochi Agarwal ◽  
Duc T Nguyen ◽  
Edward A Graviss
Keyword(s):  
United States ◽  
Risk Factors ◽  
Care Facility ◽  
Information Management System ◽  
The United States ◽  
Case Definition ◽  
Foreign Born ◽  
Excessive Alcohol Consumption ◽  
Term Care ◽  
Radiographic Findings

Abstract Background A disproportionate amount of tuberculosis (TB) cases and mortality occur among people experiencing homelessness in the United States. Our objective was to identify risk factors for mortality among reported homeless TB cases in Texas, a state with an increased TB prevalence in the United States. Methods Using data from the Centers for Disease Control and Prevention TB Genotyping Information Management System (TB GIMS), we evaluated the demographic, laboratory and clinical characteristics of people identified as being homeless in the year preceding TB diagnosis in Texas from January 1, 2010 to December 31, 2017. TB cases with missing or unknown homeless status were removed from the analysis. Multivariate logistic regression was used to analyze and evaluate risk factors associated with homeless status and mortality among homeless TB cases. Results Of the 10,103 newly diagnosed TB cases over the 8-year period, 543 (5.4%) were reported as being homeless in the year preceding TB diagnosis. In 412 homeless TB patients with a reported outcome as “died” or “completed,” 57 (13.8%) died during treatment and 355 (86.2%) completed therapy. Age >45, male, black ethnicity, foreign-born, urban living, excessive alcohol consumption, IDU, long-term care facility resident, diabetes, previous TB, and pulmonary TB were associated with homeless TB cases. Being homeless and having TB increased the risk of mortality compared with having TB alone (OR 2.26, P < 0.01). Age >45 years, positive HIV status, cavitary and miliary radiographic findings, no or unknown culture conversion and TB case confirmation by a positive culture/NAA/smear compared with clinical case definition/provider diagnosis were independent risk factors for mortality among homeless TB cases in Texas. Conclusion Being homeless increased the risk of TB mortality by nearly 130% compared with being housed prior to TB diagnosis. Our findings indicate that homelessness may be being diagnosed and treated in more advanced TB diseased homeless individuals who probably have poorer health due to the stresses of poverty, comorbidities, and lack of access to healthcare, leading to higher mortality. Additionally, testing and treatment for HIV among those reporting homelessness may reduce mortality among this high-risk group. Disclosures All authors: No reported disclosures.

scholarly journals PREVALENCE AND RISK FACTORS FOR ADRD AMONG ARAB AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S543-S543
Author(s):  
Florence Dallo
Keyword(s):  
United States ◽  
Risk Factors ◽  
National Health Interview Survey ◽  
The United States ◽  
Arab Americans ◽  
Foreign Born ◽  
P Values ◽  
Future Studies ◽  
Interview Survey ◽  
Age And Sex

Abstract In the United States (U.S.), Alzheimer’s Disease and Related Dementias (ADRD) afflict over 4.7 million individuals ages 65 or older. Arab Americans are a subgroup of whites in which ADRD is not well understood. This study estimates prevalence and risk factors for ADRD among Arab Americans ages 45 or older. Data for 2000-2017 from the National Health Interview Survey (NHIS) using the region of birth question was used (N=222,219). The age- and sex-adjusted prevalence of ADRD was 10.3% for foreign-born Arab Americans compared to approximately 7.5% for US-born non-Hispanic whites (NHW), blacks and Asians. The prevalence of ADRD was 8.6% for Hispanics (all p-values <.0001). When controlling for age and sex, Arab Americans were 1.4 times (OR=1.02,1.93) more likely to have ADRD compared to US-born NHW. Future studies should capture other generations of Arab Americans to better understand the trend of ADRD among this understudied, often invisible population.

scholarly journals Geospatial analysis, web-based mapping and determinants of prostate cancer incidence in Georgia counties: evidence from the 2012-2016 SEER data

2020 ◽  
Author(s):  
Justice Moses Kwaku Aheto ◽  
Ovie A. Utuama ◽  
Getachew A. Dagne
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Risk Factors ◽  
Relative Risk ◽  
Cancer Incidence ◽  
Spatial Model ◽  
The United States ◽  
Foreign Born ◽  
Web Based ◽  
Prostate Cancer Incidence

Abstract Background: Prostate cancer (CaP) cases are high in the United States. According to the American Cancer Society, there are an estimated number of 174,650 CaP new cases in 2019. The estimated number of deaths from CaP in 2019 is 31,620, making CaP the second leading cause of cancer deaths among American men with lung cancer been the first. Our goal is to estimate and map prostate cancer relative risk, with the ultimate goal of identifying counties at higher risk where interventions and further research can be targeted.Method: The 2012-2016 Surveillance, Epidemiology, and End Results (SEER) Program data was used in this study. Analyses were conducted on 159 Georgia counties. The outcome variable is incident prostate cancer. We employed a Bayesian geospatial model to investigate both measured and unmeasured spatial risk factors for prostate cancer. We visualised the risk of prostate cancer by mapping the predicted relative risk and exceedance probabilities. We finally developed interactive web-based maps to guide optimal policy formulation and intervention strategies.Results: Number of persons above age 65 years and below poverty, higher median family income, number of foreign born and unemployed were risk factors independently associated with prostate cancer risk in the non-spatial model. Except number of foreign born, all these risk factors were also significant in the spatial model with the same direction of effects. Substantial geographical variations in prostate cancer incidence were found in the study. The predicted mean relative risk was 1.20 with a range of 0.53 to 2.92. Individuals residing in Towns, Clay, Union, Putnam, Quitman, and Greene counties were at increased risk of prostate cancer incidence while those residing in Chattahoochee were at the lowest risk of prostate cancer incidence.Conclusion: Our results can be used as an effective tool in the identification of counties that require targeted interventions and further research by program managers and policy makers as part of an overall strategy in reducing the prostate cancer burden in Georgia State and the United States as a whole.

scholarly journals 2462. Public Health Response to Contain the First Outbreak of New Delhi Metallo-β-Lactamase-Producing Klebsiella pneumoniae in Minnesota

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S852-S852
Author(s):  
Brittany VonBank ◽  
Sean O’Malley ◽  
Paula Snippes Vagnone ◽  
Mary Ellen Bennett ◽  
Tammy Hale ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Infection Control ◽  
Care Facility ◽  
The United States ◽  
New Delhi ◽  
Surveillance Culture ◽  
Public Health Response ◽  
Term Care ◽  
Health Response

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi-metallo-β-lactamase (NDM) carbapenemase are uncommon in the United States but are a serious threat for untreatable antibiotic-resistant infections. In Minnesota (MN), NDM-CRE is typically associated with receipt of healthcare abroad. We describe the public health response to contain the first outbreak of NDM-CRE in MN. Methods CRE is reportable, with isolate submission to the MN Department of Health (MDH) for MALDI-TOF identification, phenotypic carbapenemase production testing, and PCR for carbapenemase genes. On December 24, 2018, MDH identified a case of NDM-K. pneumoniae in a long-term care facility (LTCF) without travel. MDH initiated an investigation. We defined a case as having NDM-K. pneumoniae matching the outbreak PFGE pattern from a clinical or surveillance culture. Cases were identified through surveillance, point prevalence survey (PPS) rectal swab colonization testing, and PFGE at MDH. MDH collected a healthcare exposure history for all cases. A containment response occurred in any facility where a case received healthcare in the 30 days prior. Results Nine cases of clonal NDM-K. pneumoniae with specimen collection dates between December 24, 2018 and March 26, 2019 were identified; 8 were residents of LTCF A and 1 was a roommate in LTCF B of a former LTCF A resident. PPS testing of 260 healthcare contacts occurred in 6 facilities, including LTCF A, LTCF B, and 4 acute care hospitals (ACH) that accepted LTCF A transfers; 7/9 cases were identified through PPS and 2/9 cases were identified through CRE surveillance. One case from LTCF A was identified in an ACH, but PPS did not identify transmission in ACHs. MDH conducted on-site infection control assessments in 2 LTCFs, identified numerous infection control (IC) lapses at LTCF A, and provided telephone IC consultation to 4 ACHs. Conclusion Surveillance and PPS uncovered an outbreak of NDM CRE in 2 LTCFs. Patient transfers led to a regional public health response lasting several months that included IC consultation and additional PPS. Intervention to coordinate containment responses among interconnected healthcare facilities is critical to containing the spread of novel resistance mechanisms in the United States. Disclosures All authors: No reported disclosures.

Old People Talk about Suicide: A Discussion about Suicide in a Long-Term Care Facility for Frail and Elderly People

1989 ◽  
Vol 19 (3) ◽  
pp. 237-251 ◽  
Author(s):  
Sidney R. Saul ◽  
Shura Saul
Keyword(s):  
United States ◽  
Elderly People ◽  
Long Term Care ◽  
Group Discussion ◽  
Care Facility ◽  
The United States ◽  
Old People ◽  
Term Care ◽  
Long Term Care Facility

In the institution, talk of suicide, like talk of death, is often suppressed. This article presents some sociohistorical concepts about suicide as a framework for considering contemporary attitudes among elderly people in the United States. In this illuminating verbatim report of a group therapy session in a long-term care institution, the residents openly discuss their feelings about the suicide of a fellow resident. Their range of feelings, positive and negative, is revealed. Also illustrated is the importance of providing an emotional outlet such as this group discussion for the intense feelings generated by suicide. Implications for training and practice are suggested, as well as some unresolved human dilemmas.

scholarly journals Risk Factors for Indeterminate Outcome on Interferon Gamma Release Assay in Non-US-Born Persons Screened for Latent Tuberculosis Infection

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Jody C Sharninghausen ◽  
Adrienne E Shapiro ◽  
David M Koelle ◽  
H Nina Kim
Keyword(s):  
United States ◽  
Risk Factors ◽  
Interferon Gamma ◽  
Multivariable Analysis ◽  
Latent Tuberculosis ◽  
The United States ◽  
Interferon Gamma Release Assay ◽  
Foreign Born ◽  
Asian Race ◽  
Release Assay

Abstract Background Non-US-born individuals account for the majority of active tuberculosis (TB) in the United States. Interferon gamma release assay (IGRA) is the preferred diagnostic test for latent TB but can produce an indeterminate result. We investigated the prevalence and predictors of an indeterminate IGRA (IND-IGRA) in a diverse cohort of non-US-born individuals and evaluated outcomes after IND-IGRA. Methods We identified patient age ≥18 years who had an outpatient IGRA between 2010 and 2017 in our health system and whose primary language was not English. We used univariate and multivariable logistic regression to examine the association of IND-IGRA with a variety of clinical factors. Results Of 3128 outpatients with ≥1 IGRA done, 33% were Asian, 30% Hispanic, and 29% black; 44% were men, and the median age was 50 years. An initial IND-IGRA occurred in 118 (3.8%; 95% confidence interval [CI], 3.1%–4.5%); notably, Asian race (55%) and rheumatologic conditions (25%) were prevalent in this group. In multivariable analysis, Asian race was independently associated with IND-IGRA (adjusted odds ratio [aOR], 2.9; 95% CI, 1.9–4.3), in addition to the presence of anemia and hypoalbuminemia (aOR for interaction, 4.3; 95% CI, 1.3–14.3). Only 55% of patients with an initial IND-IGRA underwent repeat testing; of those who did, 66% had a determinate result. Conclusions Asian race and anemia/hypoalbuminemia were independent risk factors for an indeterminate IGRA outcome in foreign-born patients screened in the United States. Our study underscores the importance of following through on indeterminate results in these key subgroups.

scholarly journals Geospatial analysis, web-based mapping and determinants of prostate cancer incidence in Georgia counties: evidence from the 2012–2016 SEER data

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justice Moses K. Aheto ◽  
Ovie A. Utuama ◽  
Getachew A. Dagne
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Risk Factors ◽  
Relative Risk ◽  
Cancer Incidence ◽  
Spatial Model ◽  
The United States ◽  
Foreign Born ◽  
Web Based ◽  
Prostate Cancer Incidence

Abstract Background Prostate cancer (CaP) cases are high in the United States. According to the American Cancer Society, there are an estimated number of 174,650 CaP new cases in 2019. The estimated number of deaths from CaP in 2019 is 31,620, making CaP the second leading cause of cancer deaths among American men with lung cancer been the first. Our goal is to estimate and map prostate cancer relative risk, with the ultimate goal of identifying counties at higher risk where interventions and further research can be targeted. Methods The 2012–2016 Surveillance, Epidemiology, and End Results (SEER) Program data was used in this study. Analyses were conducted on 159 Georgia counties. The outcome variable is incident prostate cancer. We employed a Bayesian geospatial model to investigate both measured and unmeasured spatial risk factors for prostate cancer. We visualised the risk of prostate cancer by mapping the predicted relative risk and exceedance probabilities. We finally developed interactive web-based maps to guide optimal policy formulation and intervention strategies. Results Number of persons above age 65 years and below poverty, higher median family income, number of foreign born and unemployed were risk factors independently associated with prostate cancer risk in the non-spatial model. Except for the number of foreign born, all these risk factors were also significant in the spatial model with the same direction of effects. Substantial geographical variations in prostate cancer incidence were found in the study. The predicted mean relative risk was 1.20 with a range of 0.53 to 2.92. Individuals residing in Towns, Clay, Union, Putnam, Quitman, and Greene counties were at increased risk of prostate cancer incidence while those residing in Chattahoochee were at the lowest risk of prostate cancer incidence. Conclusion Our results can be used as an effective tool in the identification of counties that require targeted interventions and further research by program managers and policy makers as part of an overall strategy in reducing the prostate cancer burden in Georgia State and the United States as a whole.

scholarly journals Characteristics of US-Licensed Foreign-Educated Physical Therapists

2016 ◽  
Vol 96 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Mark W. Cornwall ◽  
Mary T. Keehn ◽  
Mark Lane
Keyword(s):  
United States ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Skilled Nursing Facility ◽  
Care Facility ◽  
The United States ◽  
The Philippines ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Term Care

Background Foreign-educated physical therapists are often viewed as one possible solution to the current shortage of physical therapists, yet there is very little research regarding these individuals. Objective The purpose of this study was to describe those physical therapists who are licensed in the United States but who were educated in another country. This description includes their country of education, their employment patterns, and the reasons they decided to emigrate and work as a physical therapist in the United States. Design A cross-sectional survey was conducted. Methods An electronic survey was sent to all physical therapists currently licensed in the United States who had been educated in another country. Those who had been licensed within the last 5 years are reported. Results The results of the survey indicated that the typical foreign-educated physical therapist is female, aged 32.2 years, and was born and trained in either the Philippines or India. A majority of foreign-educated physical therapists obtained their first license in New York, Michigan, Illinois, Texas, or Florida. The most common reasons cited as to why a particular jurisdiction was chosen for initial employment were “recruiter recommendation,” “family, spouse, partner, or friends,” “ease of the licensure process,” and “ability to secure a visa sponsor.” A majority of foreign-educated physical therapists in this study initially worked in a skilled nursing facility, a long-term care or extended care facility, or a home health setting. Limitations Only those foreign-educated physical therapists licensed within the last 5 years are reported. Conclusions This study is the first to report on foreign-educated physical therapists in the United States. The findings of this study will provide important and useful information to others dealing with physical therapy professional and workforce issues.

scholarly journals Geospatial Analysis, Web-Based Mapping and Determinants of Prostate Cancer Incidence in Georgia Counties: Evidence from the 2012-2016 SEER Data.

2020 ◽  
Author(s):  
Justice Moses Kwaku Aheto ◽  
Ovie A. Utuama ◽  
Getachew A. Dagne
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Risk Factors ◽  
Relative Risk ◽  
Cancer Incidence ◽  
Spatial Model ◽  
The United States ◽  
Foreign Born ◽  
Web Based ◽  
Prostate Cancer Incidence

Abstract Background: Prostate cancer (CaP) cases are high in the United States. According to the American Cancer Society, there are an estimated number of 174,650 CaP new cases in 2019. The estimated number of deaths from CaP in 2019 is 31,620, making CaP the second leading cause of cancer deaths among American men with lung cancer been the first. Our goal is to estimate and map prostate cancer relative risk, with the ultimate goal of identifying counties at higher risk where interventions and further research can be targeted. Methods: The 2012-2016 Surveillance, Epidemiology, and End Results (SEER) Program data was used in this study. Analyses were conducted on 159 Georgia counties. The outcome variable is incident prostate cancer. We employed a Bayesian geospatial model to investigate both measured and unmeasured spatial risk factors for prostate cancer. We visualised the risk of prostate cancer by mapping the predicted relative risk and exceedance probabilities. We finally developed interactive web-based maps to guide optimal policy formulation and intervention strategies. Results: Number of persons above age 65 years and below poverty, higher median family income, number of foreign born and unemployed were risk factors independently associated with prostate cancer risk in the non-spatial model. Except for the number of foreign born, all these risk factors were also significant in the spatial model with the same direction of effects. Substantial geographical variations in prostate cancer incidence were found in the study. The predicted mean relative risk was 1.20 with a range of 0.53 to 2.92. Individuals residing in Towns, Clay, Union, Putnam, Quitman, and Greene counties were at increased risk of prostate cancer incidence while those residing in Chattahoochee were at the lowest risk of prostate cancer incidence.Conclusion: Our results can be used as an effective tool in the identification of counties that require targeted interventions and further research by program managers and policy makers as part of an overall strategy in reducing the prostate cancer burden in Georgia State and the United States as a whole.

scholarly journals Relationship of Preeclampsia With Maternal Place of Birth and Duration of Residence Among Non-Hispanic Black Women in the United States

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Ellen Boakye ◽  
Garima Sharma ◽  
S. Michelle Ogunwole ◽  
Sammy Zakaria ◽  
Arthur J. Vaught ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
The United States ◽  
Cardiovascular Disease Risk Factors ◽  
Foreign Born ◽  
Healthy Immigrant Effect ◽  
Cross Sectional

Background: Preeclampsia is one of the leading causes of maternal mortality in the United States. It disproportionately affects non-Hispanic Black (NHB) women, but little is known about how preeclampsia and other cardiovascular disease risk factors vary among different subpopulations of NHB women in the United States. We investigated the prevalence of preeclampsia by nativity (US born versus foreign born) and duration of US residence among NHB women. Methods: We analyzed cross-sectional data from the Boston Birth Cohort (1998–2016), with a focus on NHB women. We performed multivariable logistic regression to investigate associations between preeclampsia, nativity, and duration of US residence after controlling for potential confounders. Results: Of 2697 NHB women, 40.5% were foreign born. Relative to them, US-born NHB women were younger, in higher percentage current smokers, had higher prevalence of obesity (body mass index ≥30 kg/m 2 ) and maternal stress, but lower educational level. The age-adjusted prevalence of preeclampsia was 12.4% and 9.1% among US-born and foreign-born women, respectively. When further categorized by duration of US residence, the prevalence of all studied cardiovascular disease risk factors except for diabetes was lower among foreign-born NHB women with <10 versus ≥10 years of US residence. Additionally, the odds of preeclampsia in foreign-born NHB women with duration of US residence <10 years was 37% lower than in US-born NHB women. In contrast, the odds of preeclampsia in foreign-born NHB women with duration of US residence ≥10 years was not significantly different from that of US-born NHB women after adjusting for potential confounders. Conclusions: The prevalence of preeclampsia and other cardiovascular disease risk factors is lower in foreign-born than in US-born NHB women. The healthy immigrant effect, which typically results in health advantages for foreign-born women, appears to wane with longer duration of US residence (≥10 years). Further research is needed to better understand these associations.

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