No description available.

No description available.

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.

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

No description available.

Falls are the number one mechanism of injury for The Trauma Center and Johnson City Medical Center (JCMC TC). JCMC TC is one of two level one trauma centers in the region and one of only six in the state. The main method for trauma prevention is outcome specific education and awareness. Injury prevention education is a critically needed area in the field of trauma and emergency care. Falls are the number one cause of injury in populations age >65. Socioeconomic status, age, gender, and race are all mitigating factors in the likelihood of greater length of stays, death in hospital, and death within one year of discharge for those who fall in a home setting. According to the CDC, people over the age of 75 are four to five times more likely than people under 75 to be admitted to a long-term care facility for more than a year. What is the relationship between patient characteristics and fall related outcomes in a level one trauma center? We looked at associations between patient demographics and associated outcomes for those admitted to the trauma center secondary to a ground level fall (GLF) in the home. Dataset: De-identified National Trauma Databank information was compiled by the JCMC Registrar for the past 8 years for the metrics: Injury Severity Score (ISS), length of stay, 48hr readmission, and disposition (home, nursing home, skilled nursing facility (SNF)).Demographic information, along with mechanism of fall, was collected for each patient. Patient age, gender, and date of injury was all used for statistical analysis and trend recognition. Statistical Analysis: Bivariate analyses included independent samples t-tests and Oneway ANOVA to find differences between groups. Results: T-test results show women are significantly more likely than men to be admit for a ground level fall (p<.001) and those with a higher ISS are more likely to have an extended stay in an inpatient setting (p<.001). One-Way ANOVA analysis of collected data shows an annual increase from 2006-2013 of trauma admissions for ground level falls (p<.01). Eight year analysis showed a two-fold increase in these admissions. Over 30% of patients admitted with a GLF are discharged to a SNF leading to higher societal costs due to Medicare reimbursement rates. Diagnosis related groups codes (DRG) dictate Medicare reimbursement rate of $14,091 per patient with an average facility cost of $14,196 per patient with no readmissions (Unplanned readmission within 180 days occurred at a rate of 8.3%). Conclusion: Fall education programs are necessary and needed in rural level one trauma centers to educate citizens on causes and methods of preventing falls in their homes. A decrease in these falls would lead to an increase in productive years of life and a reduction in strain on the hospital system.

Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and is a serious public health threat worldwide. Timely and effective control of the pandemic is highly dependent on preventive approaches. Perception of risk is a major determinant of health behavior. The current study explores the association between actual risk and perceived risk for one’s self, family/friends and friends, and community. A questionnaire was administered to participants in Central Appalachia (n = 102). The actual risk was based on the number of chronic conditions of the following conditions: hypertension, heart disease, cancer, diabetes, and chronic obstructive pulmonary disease. Participants were also queried about their perception of risk for COVID-19. Generalized Linear Models were used to independently evaluate the likelihood of perceived risk for one’s: self, family/friends, and community, based on actual risk. Actual risk for COVID-19 was significantly associated with higher likelihood of higher perception of risk for one’s self (b = 0.24; p = 0.04), but not with one’s family/friends (b = 0.05; p = 0.68), or one’s community (b = 0.14; p = 0.16). No health insurance was negatively associated with perception of risk for self (b = −0.59; p = 0.04) and family/friends (b = −0.92; p < 0.001). Male gender (b = −0.47; p = 0.01) was also negatively associated with perception of risk for family/friends. In conclusion, individuals’ actual risk for COVID-19 is associated with their own perception of risk. This indicates that one’s perception of risk for COVID-19 is greater for their own health compared to their family/friends or the community. Therefore, monitoring and following up with chronic disease patients and addressing their lack of awareness of risk to others is needed to prevent and curtail the spread of COVID-19.

Background: Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda. Methods: Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework. Results: Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities. Conclusions: Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients’ interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities.

Purpose: To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking. Methods: Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth’s and mother’s social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates. Results: In the adjusted first cigarette use models, neither youth’s nor mother’s social class discrimination was a significant predictor among Black youth, but mother’s discrimination was associated with increased risk [HR = 1.53 (1.18–1.99)] among White youth. In the adjusted ND models, mother’s discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13–0.63)], but neither youth’s nor mother’s discrimination predicted transition to ND among White youth. Conclusions: The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother’s discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.

This study investigated whether core beliefs about the world being safe and predictable (i.e. world assumptions) mediated the association between discrimination and internalizing and substance use problems among individuals from marginalized groups. Path analyses tested mediating effects of four types of world assumptions on the association between discrimination (race-, gender-, and sexual orientation-based) and anxiety, depression, alcohol and cannabis problems in college students (N = 1,181, agemean = 19.50, SD = 1.67). Limited support for mediation by world assumptions was found: among Asian students, race-based discrimination indirectly impacted anxiety symptoms through low perceived controllability of events. Direct effects across groups and discrimination types were also found.