Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Azofeifa A[original query] |
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Telemedicine trends and lessons learned during the COVID-19 pandemic-World Trade Center Health Program, 2020-2021
Azofeifa A , Liu R , Dupont H , Reissman DB . Public Health Rep 2024 333549231223143 The World Trade Center (WTC) Health Program, a limited federal health care program for eligible people exposed to the terrorist attacks on September 11, 2001, expanded telemedicine services during the COVID-19 pandemic (2020-2021). We analyzed service use trends from January 2020 through December 2021 to describe how the program implemented telemedicine services. About three-quarters (75%) of telemedicine visits were for mental health-related services. In the second quarter of 2020 (April-June), the number of telemedicine visits per 1000 members (n = 367) increased, exceeding in-person visits (n = 152) by 1.4-fold. The number of telemedicine visits per 1000 members decreased gradually during the rest of the study period but still represented 38% of total visits by the end of 2021. Changes in telemedicine visits were offset by comparable changes for in-person visits, such that the rate of total visits was essentially constant during the study period. Multivariate logistic regression models showed differences in telemedicine visit rates by member type and by demographic characteristics. Survivor members (vs responder members), those self-identified as non-Hispanic Other races (vs non-Hispanic White), those with preferred language not English (vs preferred language English), and those not living in the New York metropolitan area (vs living in the New York metropolitan area) were less likely to use telemedicine. Implementing telemedicine services in the WTC Health Program during the COVID-19 pandemic underscored the importance of extensive collaboration among partners, the capacity to rapidly develop necessary technical guidance, and the flexibility to address frequent regulatory guidance updates in a timely fashion. These lessons learned may guide similar health care providers posed with time-sensitive disruptions of in-person services. |
World Trade Center Health Program - United States, 2012-2020
Azofeifa A , Martin GR , Santiago-Colón A , Reissman DB , Howard J . MMWR Surveill Summ 2021 70 (4) 1-21 PROBLEM/CONDITION: After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area). REPORTING PERIOD COVERED: 2012-2020. DESCRIPTION OF SYSTEM: The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020. RESULTS: In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458). INTERPRETATION: Since 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions. PUBLIC HEALTH ACTION: Analysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making. |
World Trade Center Health Program, 2012-2020: Implications for clinicians and health care systems
Azofeifa A , Martin GR , Howard J . JAMA 2021 326 (12) 1147-1148 As a result of the September 11, 2001, terrorist attacks (9/11) in New York City, at the Pentagon, and near Shanksville, Pennsylvania, nearly 3000 people were killed and an estimated 400 000 individuals were exposed to toxin-containing dust, fumes from fires, and debris from damaged and collapsed buildings.1 In the decade after 9/11, medical care for first responders and other individuals was provided by local public health officials and community health programs.2 During these 10 years, funding for post-9/11 care was intermittent and uncertain. In 2010, the US Congress began consideration of permanent funding for a health care program for persons involved in rescue, response, recovery, cleanup, and related support activities following the 9/11 attacks (responders), and for persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, childcare centers, or adult day care centers in the New York City disaster area (survivors).3,4 On January 3, 2011, President Obama signed into law the James Zadroga 9/11 Health and Compensation Act of 2010, which established the World Trade Center (WTC) Health Program. The program is administered by the director of the National Institute for Occupational Safety and Health in the Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services. |
Estimating and Characterizing COVID-19 Deaths, Puerto Rico, March-July 2020.
Azofeifa A , Valencia D , Rodriguez CJ , Cruz M , Hayes D , Montañez-Báez E , Tejada-Vera B , Villafañe-Delgado JE , Cabrera JJ , Valencia-Prado M . Public Health Rep 2021 136 (3) 354-360 OBJECTIVES: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period. METHODS: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics. RESULTS: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported. CONCLUSIONS: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions. |
Driving under the influence of marijuana and illicit drugs among persons aged 16 years - United States, 2018
Azofeifa A , Rexach-Guzman BD , Hagemeyer AN , Rudd RA , Sauber-Schatz EK . MMWR Morb Mortal Wkly Rep 2019 68 (50) 1153-1157 In the United States, driving while impaired is illegal. Nonetheless, an estimated 10,511 alcohol-impaired driving deaths occurred in 2018.* The contribution of marijuana and other illicit drugs to these and other impaired driving deaths remains unknown. Data from the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (NSDUH) indicated that in the United States during 2014, 12.4% of all persons aged 16-25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana (1). The impairing effects of alcohol are well established, but less is known about the effects of illicit substances or other psychoactive drugs (e.g., marijuana, cocaine, methamphetamines, and opioids, including heroin). This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged >/=16 years, using 2018 public-use data from NSDUH. Prevalences of driving under the influence of marijuana and illicit drugs other than marijuana were assessed for persons aged >/=16 years by age group, sex, and race/ethnicity. During 2018, 12 million (4.7%) U.S. residents reported driving under the influence of marijuana in the past 12 months; 2.3 million (0.9%) reported driving under the influence of illicit drugs other than marijuana. Driving under the influence was more prevalent among males and among persons aged 16-34 years. Effective measures that deter driving under the influence of drugs are limited (2). Development, evaluation, and further implementation of strategies to prevent alcohol-impaired,(dagger) drug-impaired, and polysubstance-impaired driving, coupled with standardized testing of impaired drivers and drivers involved in fatal crashes, could advance understanding of drug- and polysubstance-impaired driving and support prevention efforts. |
Evaluating behavioral health surveillance systems
Azofeifa A , Stroup DF , Lyerla R , Largo T , Gabella BA , Smith CK , Truman BI , Brewer RD , Brener ND . Prev Chronic Dis 2018 15 E53 In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health-related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems. |
Monitoring marijuana use in the United States: Challenges in an evolving environment
Azofeifa A , Mattson ME , Grant A . JAMA 2016 316 (17) 1765-1766 In 2014, an estimated 22.2 million Americans aged 12 years or older had used marijuana in the past month.1 Under federal law, marijuana is considered an illegal Schedule I drug. However, over the last 2 decades, more than half of the states have allowed limited access to marijuana or its components, Δ9-tetrahydrocannabinol (THC) and cannabidiol, for medical reasons.2 More recently, 4 states and the District of Columbia have legalized marijuana for recreational purposes. Currently, evidence for the therapeutic benefits of marijuana are limited to treatment and improvements to certain health conditions (eg, chronic pain, spasticity, nausea).3 Recreational use of marijuana is established by patterns of individual behaviors and lifestyle choices. In either case, use of marijuana or any of its components, especially in younger populations, is associated with an increased risk of certain adverse health effects, such as problems with memory, attention, and learning, that can lead to poor school performance and reduced educational and career attainment, early-onset psychotic symptoms in those at elevated risk, addiction in some users, and altered brain development.4-7 | In September 2016, the Substance Abuse and Mental Health Services Administration and the Centers for Disease and Control and Prevention (CDC) released an issue of the CDC’s Morbidity and Mortality Weekly Report—Surveillance Summary describing historical trends in marijuana use and related indicators among the noninstitutionalized civilian population aged 12 years or older using 2002-2014 data from the National Survey on Drug Use and Health (NSDUH).8 During the last 13 years, marijuana access (ie, perceived availability) and use (ie, past-month marijuana use) have steadily increased in the United States, particularly among people aged 26 years or older, increasing from 54.9% in 2002 to 59.2% in 2014 and from 4.0% in 2002 to 6.6% in 2014, respectively. The factors associated with the national behavior patterns of marijuana use cannot be attributed solely to the heterogeneous body of state laws and policies that vary considerably with respect to year of enactment, implementation lag time, and access stipulations. However, as state laws and policies continue to evolve, these data will be useful as a baseline to monitor changes in patterns of use and associated variables. Monitoring behavioral patterns is important given the possible increased risk of adverse health consequences due to potency changes—higher concentrations of THC (the psychoactive compound)—of the cannabis plant in the United States in the last 2 decades.9 |
National estimates of marijuana use and related indicators - National Survey on Drug Use and Health, United States, 2002-2014
Azofeifa A , Mattson ME , Schauer G , McAfee T , Grant A , Lyerla R . MMWR Surveill Summ 2016 65 (11) 1-28 PROBLEM/CONDITION: In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States. PERIOD COVERED: 2002-2014. DESCRIPTION OF SYSTEM: The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession. RESULTS: In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002-2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12-17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy to obtain increased. The percentage of persons aged ≥12 reporting the mode of acquisition of marijuana was buying it and growing it increased versus getting it for free and sharing it. The percentage of persons aged ≥12 years reporting that the perceived maximum legal penalty for the possession of an ounce or less of marijuana in their state is a fine and no penalty increased versus probation, community service, possible prison sentence, and mandatory prison sentence. INTERPRETATION: Since 2002, marijuana use in the United States has increased among persons aged ≥18 years, but not among those aged 12-17 years. A decrease in the perception of great risk from smoking marijuana combined with increases in the perception of availability (i.e., fairly easy or very easy to obtain marijuana) and fewer punitive legal penalties (e.g., no penalty) for the possession of marijuana for personal use might play a role in increased use among adults. PUBLIC HEALTH ACTION: National- and state-level data can help federal, state, and local public health officials develop targeted prevention activities to reduce youth initiation of marijuana use, prevent marijuana dependence and abuse, and prevent adverse health effects. As state-level laws on medical and recreational marijuana use change, modifications might be needed to national- and state-level surveys and more timely and comprehensive surveillance systems might be necessary to provide these data. Marijuana use in younger age groups is a particular public health concern, and changing the perception of harm risk from smoking marijuana is needed. |
Dental caries and periodontal disease among U.S. pregnant women and nonpregnant women of reproductive age, National Health and Nutrition Examination Survey, 1999-2004
Azofeifa A , Yeung LF , Alverson CJ , Beltran-Aguilar E . J Public Health Dent 2016 76 (4) 320-329 OBJECTIVES: This study assessed and compared the prevalence and severity of dental caries and the prevalence of periodontal disease among pregnant and nonpregnant women of reproductive age (15-44 years) using data from the National Health and Nutrition Examination Survey, NHANES (1999-2004). METHODS: Estimates were derived from a sample of 897 pregnant women and 3,971 nonpregnant women. Chi-square and two-sample t-tests were used to assess differences between groups stratified by age, race/ethnicity, education, and poverty. Bonferroni method was applied to adjust for multiple comparisons. RESULTS: In general, there were no statistically significant differences in the prevalence estimates of dental caries and periodontal disease between pregnant women and nonpregnant women. However, results showed significant differences when stratified by sociodemographic characteristics. For example, the prevalence of untreated dental caries among women aged 15-24 years was significantly higher in pregnant women than in nonpregnant women (41 percent versus 24 percent, P = 0.001). Regardless of their pregnancy status, racial/ethnic minorities or women with less education or lower family income had higher prevalence of untreated dental caries, severity of dental caries, and periodontal disease compared to the respective reference groups of non-Hispanic whites or women with more education or higher family income. CONCLUSION: Results of this study show few clinical differences in dental caries and periodontal disease between pregnant and nonpregnant women but persistent disparities by sociodemographic characteristics. In order to reduce oral health disparities in the United States, it is important to improve access to oral health care particularly among vulnerable groups. Integrating oral health into the overall health care could benefit and improve women's oral health outcomes. |
Neural tube defects in Costa Rica, 1987-2012: origins and development of birth defect surveillance and folic acid fortification
Barboza-Argüello Mde L , Umaña-Solís LM , Azofeifa A , Valencia D , Flores AL , Rodríguez-Aguilar S , Alfaro-Calvo T , Mulinare J . Matern Child Health J 2015 19 (3) 583-90 Our aim was to provide a descriptive overview of how the birth defects surveillance and folic acid fortification programs were implemented in Costa Rica-through the establishment of the Registry Center for Congenital Anomalies (Centro de Registro de Enfermedades Congénitas-CREC), and fortification legislation mandates. We estimated the overall prevalence of neural tube defects (i.e., spina bifida, anencephaly and encephalocele) before and after fortification captured by CREC. Prevalence was calculated by dividing the total number of infants born with neural tube defects by the total number of live births in the country (1987-2012).A total of 1,170 newborns with neural tube defects were identified from 1987 to 2012 (1992-1995 data excluded); 628 were identified during the baseline pre-fortification period (1987-1991; 1996-1998); 191 during the fortification period (1999-2002); and 351 during the post-fortification time period (2003-2012). The overall prevalence of neural tube defects decreased from 9.8 per 10,000 live-births (95 % CI 9.1-10.5) for the pre-fortification period to 4.8 per 10,000 live births (95 % CI 4.3-5.3) for the post-fortification period. Results indicate a statistically significant (P < 0.05) decrease of 51 % in the prevalence of neural tube defects from the pre-fortification period to the post-fortification period. Folic acid fortification via several basic food sources has shown to be a successful public health intervention for Costa Rica. Costa Rica's experience can serve as an example for other countries seeking to develop and strengthen both their birth defects surveillance and fortification programs. |
Prevalence of elevated blood lead levels and risk factors among residents younger than 6 years, Puerto Rico-2010
Dignam T , Rivera Garcia B , De Leon M , Curtis G , Creanga AA , Azofeifa A , O'Neill M , Blanton C , Kennedy C , Rullan M , Caldwell K , Rullan J , Brown MJ . J Public Health Manag Pract 2015 22 (1) E22-35 CONTEXT: Limited data exist about blood lead levels (BLLs) and potential exposures among children living in Puerto Rico. The Puerto Rico Department of Health has no formal blood lead surveillance program. OBJECTIVES: We assessed the prevalence of elevated BLLs (≥5 micrograms of lead per deciliter of blood), evaluated household environmental lead levels, and risk factors for BLL among children younger than 6 years of age living in Puerto Rico in 2010. METHODS: We used a population-based, cross-sectional sampling strategy to enroll an island-representative sample of Puerto Rican children younger than 6 years. We estimated the island-wide weighted prevalence of elevated BLLs and conducted bivariable and multivariable linear regression analyses to ascertain risk factors for elevated BLLs. RESULTS: The analytic data set included 355 households and 439 children younger than 6 years throughout Puerto Rico. The weighted geometric mean BLL of children younger than 6 years was 1.57 mug/dL (95% confidence interval [CI], 1.27-1.88). The weighted prevalence of children younger than 6 years with BLLs of 5 mug/dL or more was 3.18% (95% CI, 0.93-5.43) and for BLLs of 10 mug/dL or more was 0.50% (95% CI, 0-1.31). Higher mean BLLs were significantly associated with data collection during the summer months, a lead-related activity or hobby of anyone in the residence, and maternal education of less than 12 years. Few environmental lead hazards were identified. CONCLUSIONS: The prevalence of elevated BLLs among Puerto Rican children younger than 6 years is comparable with the most recent (2007-2010) US national estimate (BLLs ≥5 mug/dL = 2.6% [95% CI = 1.6-4.0]). Our findings suggest that targeted screening of specific higher-risk groups of children younger than 6 years can replace island-wide or insurance-specific policies of mandatory blood lead testing in Puerto Rico. |
Assessing the prevalence of spina bifida and encephalocele in a Kenyan hospital from 2005-2010: implications for a neural tube defects surveillance system
Githuku JN , Azofeifa A , Valencia D , Ao T , Hamner H , Amwayi S , Gura Z , Omolo J , Albright L , Guo J , Arvelo W . Pan Afr Med J 2014 18 60 INTRODUCTION: Neural tube defects such as anencephaly, spina bifida, and encephalocele are congenital anomalies of the central nervous system. Data on the prevalence of neural tube defects in Kenya are limited. This study characterizes and estimates the prevalence of spina bifida and encephalocele reported in a referral hospital in Kenya from 2005-2010. METHODS: Cases were defined as a diagnosis of spina bifida or encephalocele. Prevalence was calculated as the number of cases by year and province of residence divided by the total number of live-births per province. RESULTS: From a total of 6,041 surgical records; 1,184 (93%) had reported diagnosis of spina bifida and 88 (7%) of encephalocele. Estimated prevalence of spina bifida and encephalocele from 2005-2010 was 3.3 [95% Confidence Interval (CI): 3.1-3.5] cases per 10,000 live-births. The highest prevalence of cases were reported in 2007 with 4.4 (95% CI: 3.9-5.0) cases per 10,000 live-births. Rift Valley province had the highest prevalence of spina bifida and encephalocele at 6.9 (95% CI: 6.3-7.5) cases per 10,000 live-births from 2005-2010. CONCLUSION: Prevalence of spina bifida and encephalocele is likely underestimated, as only patients seeking care at the hospital were included. Variations in regional prevalence could be due to referral patterns and healthcare access. Implementation of a neural tube defects surveillance system would provide a more thorough assessment of the burden of neural tube defects in Kenya. |
Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the United States, National Health and Nutrition Examination Survey, 1999-2004
Azofeifa A , Yeung LF , Alverson CJ , Beltran-Aguilar E . Prev Chronic Dis 2014 11 E163 INTRODUCTION: Oral diseases can be prevented or improved with regular dental visits. Our objective was to assess and compare national estimates on self-reported oral health conditions and dental visits among pregnant women and nonpregnant women of childbearing age by using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed self-reported oral health information on 897 pregnant women and 3,971 nonpregnant women of childbearing age (15-44 years) from NHANES 1999-2004. We used chi2 and 2-sample t tests to assess statistical differences between groups stratified by age, race/ethnicity, poverty, and education. We applied the Bonferroni adjustment for multiple comparisons. RESULTS: Our data show significant differences in self-reported oral health conditions and dental visits among women, regardless of pregnancy status, when stratified by selected sociodemographic characteristics. Significant differences were also found in self-reported oral health conditions and dental visits between pregnant and nonpregnant women, especially among young women, women from minority race/ethnicity groups, and women with less than high school education. CONCLUSION: We found disparities in self-reported oral health conditions and use of dental services among women regardless of pregnancy status. Results highlight the need to improve dental service use among US women of childbearing age, especially young pregnant women, those who are non-Hispanic black or Mexican American, and those with low family income or low education level. Prenatal visits could be used as an opportunity to encourage pregnant women to seek preventive dental care during pregnancy. |
Infection control assessment after an influenza outbreak in a residential care facility for children and young adults with neurologic and neurodevelopmental conditions
Azofeifa A , Yeung LF , Peacock G , Moore CA , Rodgers L , Diorio M , Page SL , Fowler B , Stone ND , Finelli L , Jhung MA . Infect Control Hosp Epidemiol 2013 34 (7) 717-22 OBJECTIVE: To assess the knowledge, attitudes, and practices of infection control among staff in a residential care facility for children and young adults with neurologic and neurodevelopmental conditions. DESIGN: Self-administered survey. SETTING: Residential care facility (facility A). PARTICIPANTS: Facility A staff ([Formula: see text]). METHODS: We distributed a survey to staff at facility A. We classified staff with direct care responsibilities as clinical (ie, physicians, nurses, and therapists) or nonclinical (ie, habilitation assistants, volunteers, and teachers) and used chi(2) tests to measure differences between staff agreement to questions. RESULTS: Of 248 surveys distributed, 200 (81%) were completed; median respondent age was 36 years; 85% were female; and 151 were direct care staff (50 clinical, 101 nonclinical). Among direct care staff respondents, 86% agreed they could identify residents with respiratory symptoms, 70% stayed home from work when ill with respiratory infection, 64% agreed that facility administration encouraged them to stay home when ill with respiratory infection, and 72% reported that ill residents with respiratory infections were separated from well residents. Clinical and nonclinical staff differed in agreement about using waterless hand gel as a substitute for handwashing (96% vs 78%; [Formula: see text]) and whether handwashing was done after touching residents (92% vs 75%; [Formula: see text]). CONCLUSIONS: Respondents' knowledge, attitudes, and practices regarding infection control could be improved, especially among nonclinical staff. Facilities caring for children and young adults with neurologic and neurodevelopmental conditions should encourage adherence to infection control best practices among all staff having direct contact with residents. |
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