strong>Objectives: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT. Results: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03–36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34–18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08–0.94). Conclusions: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.

backgroundWomen with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD. objectives This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT). methods A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies. results Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies. conclusionWhile most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.

No description available.

Background: Fire fatality rates have decreased nationally while increasing in Tennessee. Individual characteristics affect the likelihood of fatality. Identification of populations sustaining greater proportions of fire fatality within the State will better inform regional fire prevention activities. Objectives: To compare individual characteristics of fatalities occurring in residential structure fires in Appalachian and Non-Appalachian counties of Tennessee. Methods: Analyses of residential structure fire fatality in Tennessee from 2005 to 2014 were conducted using Tennessee Fire Incident Reporting System data, comparing Appalachian and Non-Appalachian county regions. Analyses were restricted to incidents occurring in noninstitutionalized residential environments. Census data was used to identify county-level demographic characteristics. Direct adjustment for age effects between regions was performed. Results: There was no difference in proportion of fatalities between Appalachian (37.28%) and Non-Appalachian (36.27%) counties. Distribution of gender was similar between regions. A greater proportion of fatalities were aged 65 and older, compared to other age groups. Age- adjusted death rates were higher for Non-Appalachian (13.63/100,000) than Appalachian (11.18/100,000) counties. Age-specific death rates for persons younger than five years was greater in Appalachia (18.06/100,000 vs. 11.94/100,000), while age-specific death rates were greater among Non-Appalachian counties for persons aged 65 and older (37.23/100,000 vs. 19.75/100,000). A greater proportion of fire fatalities occurred in mobile homes in Appalachian counties (18.4%) than Non-Appalachian counties (11.3%). Conclusion:

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Background: Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD and the only treatment available is dialysis. Objectives: The purpose of this study is to determine the association between CKD and further with Hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Methods: The study employed secondary data in a cross-sectional design. A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value <0.05 were considered significant. Odds Ratio (OR) and 95% Confidence Intervals (CI) were reported and discussed. The statistical analysis was performed using SAS version 9.4. Results: Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). Similar results have been reported if a patient had other conditions. Conclusion: Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.

Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

Background: US adolescent obesity rates have quadrupled over the past 3 decades. Research examining complex factors associatedwith obesity is limited.Objectives: The purpose of this study was to utilize a representative sample of students (grades 6 - 8) in Tennessee to determine theco-occurrence of risk behaviors with adolescent obesity prevalence and to analyze variations by strata. Methods: The 2010 youth risk behavior survey dataset was used to examine associations of obesity with variables related to sampledemographics, risk and protective behaviors, and region. Hierarchical logistic regression analyses stratified by demographics andregion were conducted to evaluate variation in obesity risk occurring on three hierarchical levels: class, school and district. Results: The sample consisted of 60715 subjects. The overall obesity rate was 22%. High prevalence of obesity existed in males, non-white race, those ever smoked and was positively correlated with age. Across three state regions, race, gender, and specific behaviors (smoking, weight misperception, disordered eating, +3 hours TV viewing, and no sports team participation) persisted as significantpredictors of adolescent obesity, although variations by region and demographics were observed. Multilevel analyses indicate that< 1%, 0 - 1.97% and4.03 - 13.06% of the variation in obesity was associated with district, school and class differences, respectively, whenstratifying the sample by demographic characteristics or region. Conclusions: Uniform school-based prevention efforts targeting adolescent obesity risk may have limited impact if they fail torespond to geographical and demographic nuances that hierarchal modeling can detect. Study results reveal that stratified hi-erarchical analytic approaches to examine adolescent obesity risk have tremendous potential to elucidate significant prevention insights.

To evaluate the association between general self-efficacy and depression/anxiety among newly HIV-diagnosed Chinese men who have sex with men (MSM) in Beijing, our study evaluated the baseline survey data of MSM taking part in a clinical trial among Chinese MSM in Beijing. The baseline survey of the trial was conducted between March 2013 and March 2014. General self-efficacy and depression/anxiety were measured using standard scales. Logistic regression and cumulative logistic regression were used to evaluate the associations between general self-efficacy and depression/anxiety. A total of 367 newly HIV-diagnosed Chinese MSM in Beijing were recruited. There were negative associations between general self-efficacy and depression/anxiety among the study population. As general self-efficacy increased by one unit, the odds of “likely” or “borderline” depression versus normal, or “likely” depression versus “borderline” depression or normal decreased by 12% [adjusted odds ratio (AOR): 0.88, 95% confidence interval (CI): 0.85–0.92] after adjusting for potential confounders. Similarly, general self-efficacy was negatively associated with anxiety (AOR: 0.89, 95% CI: 0.86–0.93). A higher level of general self-efficacy was associated with lower levels of depression and anxiety among newly HIV-diagnosed Chinese MSM. Interventions promoting overall health and wellness should address self-efficacy, depression and anxiety.

Background: Uptake of screening remains crucial in the prevention of both the incidence of colorectal cancer (CRC) and its mortality. Objectives: To estimate the prevalence of CRC screening and identify chronic conditions that predict CRC screening uptake among US adults using the 2012 National Health Interview Survey (NHIS) data. Materials and Methods: A cross-sectional analysis of the 2012 NHIS data. Chronic conditions examined were hypertension, cancer history, arthritis, ulcer, and high cholesterol level. A total of 21,511 participants were included in the analysis. Weighted univariate and multiple logistic regression analyses in SAS ver. 9.2 were used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs). Results: The overall prevalence of CRC screening was 19%. The prevalence of CRC screening in adults with cancer history, hypertension, ulcer, high cholesterol, and arthritis was significantly higher than those without the chronic conditions (26% vs.18%, 23% vs.16%, 25% vs.18%, 23% vs. 16%, and 23% vs. 17%, respectively). After adjusting for potential factors, hypertension (OR=1.18, 95%CI=1.08-1.30), ulcer (OR=1.28, 95%CI=1.10-1.48), high cholesterol (OR=1.25, 95%CI=1.14-1.39), and arthritis (OR=1.24, 95%CI=1.12-1.37) were all positively associated with CRC screening (p<0.05). Females were less likely to screen for CRC than to males (OR=0.72; 95% CI=0.65-0.80). Compared to young adults (18-44 years), screening was significantly higher in middle-aged (45-64 years) and elder adults (65+) (OR=2.60, 95%CI=2.11-3.21 and OR=2.67, 95%CI=2.13-3.33, respectively). African Americans were more likely to screen for CRC compared to their white counterparts (OR=1.61, 95% CI=1.44-1.81). Conclusions: We have found significant associations between chronic conditions and CRC screening uptake. We also found higher uptake of CRC screen in African Americans than Whites, in contrast to earlier findings.