153 research outputs found

    THE DEVELOPMENT OF A COMMUNITY INFORMED CUMULATIVE STRESSORS AND RESILIENCY INDEX (CSRI) TO EXAMINE ENVIRONMENTAL HEALTH DISPARITIES AND DISEASE RISK IN SOUTH CAROLINA

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    Communities with environmental justice (EJ) issues usually have disparities in exposure to chemical and non-chemical stressors and health status compared to other communities without underlying EJ issues. Improving cumulative risk assessment (CRA) screening tools and models can provide the necessary information needed to reduce health disparities and create more resilient communities. To address these gaps in EJ science, this dissertation has three specific aims: 1) Identify perceptions of environmental and resilience factors that may influence health among African-Americans in North Charleston, South Carolina (SC) (Study 1), 2) Develop a Cumulative Stressors and Resiliency Index (CSRI) used to rank risk in SC (Study 2), and 3) Examine associations between CSRI scores and risk of asthma hospitalizations/emergency department (ED) visits in SC (Study 3). Community stakeholders (N=18) participated in key-informant interviews and completed a 26-item paper survey in study one. Interviews were transcribed and coded, while mode, frequencies, and percentages were calculated for each indicator based on its ability to influence health. Statistical tests performed in study two included a Principal Component Analysis (PCA), one-way analysis of variance (ANOVA), and linear regression performed in SAS Enterprise Guide 7.1. Choropleth maps were also developed in ArcMap 10.5. We concluded by calculating descriptive statistics by Environmental Affairs (EA) region, Spearman’s rank-order correlation, one-way ANOVA, and negative binomial regression analyses in study three. Many of the indicators (61%) were rated as extremely high priority items and included environmental hazards, sociodemographic attributes, and factors that may influence resiliency. CSRI scores ranged from 7.4 – 64.0 with a mean score of 29.1. Statistically significant differences in CSRI scores were evident by EA region (p <0.0001) and a one-unit increase in the percentage of non-white populations per census tract projected to increase CSRI scores by roughly 6.1%. The CSRI was not able to predict risk of asthma hospitalizations/ED visits as hypothesized. Overall, we demonstrated that identifying and addressing chemical and non-chemical stressors and resiliency gaps in areas impacted by environmental injustice may lead to overall improvements in community resilience. We anticipate this work will be used as a blueprint to build more resilient and equitable communities in SC

    Contabilidad de gestión presupuestaria: Análisis del costo en la adopción de decisiones en metas de venta en la empresa Cediasa, periodo 2013 a travez de su estructura de costo utilizando el método de costos

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    En el presente trabajo de investigación se analizó alternativas de decisión en relación a metas en ventas que la empresa CEDIASA debe realizar, para aumentar su utilidades, utilizando el método Costo - Beneficio, con la información de su estructura de costo del año 2013 así como el desarrollo de un caso práctico donde se puedan establecer el beneficio que espera la empresa. El método utilizado para esta investigación fue bibliográfico, se investigo en diversos libros y manuales de costos, así como se indago información en internet. Cabe mencionar que las alternativas de decisiones en el área de venta son de suma importancia ya que este cumple con la función de resguardar los activos líquidos de la entidad. Lo que nos plantea el informe de los tipos de decisiones que toman las empresas pueden ser: Decisiones programadas, decisiones no programadas, toma estratégicas de decisiones, toma de decisiones para el control administrativo, toma de decisiones para el control operativo. El análisis de la estructura de costo de la empresa CEDIASA, a través del método costo – beneficio, permite plantear alternativas de ventas donde la empresa puede generar utilidades de acuerdo a sus objetivos y metas en relación a sus ventas y determinar así su punto de equilibrio donde pueda cubrir tanto costos totales y su beneficio deseado brindado, una garantía razonable en la eficiencia y eficacia de las operaciones y confiabilidad de la información

    Gangrena de Fournier

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    El actual trabajo de titulación presentó una revisión de literatura y análisis de caso clínico correspondiente a la gangrena de Fournier. Se compendia información vigente de contenido epidemiológico, etiopatogénico, de diagnóstico y tratamiento de dicha entidad, permitiendo así entrelazar dicho contenido con el caso clínico analizado. Se toma en consideración el caso de un paciente de 39 años de edad sin antecedentes de importancia quien inicialmente acude a casa de salud por presentar dolor abdominal y edema testicular de 13 días de evolución previo a su ingreso. Al momento de su hospitalización, paciente es valorado, se realizan exámenes complementarios y de imagen, y es catalogado como choque séptico de partes blandas, gangrena de Fournier vs fasceitis necrotizante, disfunción orgánica múltiple (coagulación, metabólico, hepático), trombocitopenia e hiponatremia. Se realizó limpieza quirúrgica por varias ocasiones, además de inicio de transferencia para Hospital de tercer nivel pero no se tuvo respuesta acertada, por lo que se instauró antibiótico terapia dirigida, agresiva y de amplio espectro, corticoide, sedoanalgesia, fluido terapia y ventilación mecánica previamente, obteniendo resultados favorables, concluyendo que a pesar de que el paciente se encontraba en un Hospital de segundo nivel y no se contaba con los requerimientos necesarios para el control apropiado del desarrollo de la enfermedad, los médicos en conjunto supieron brindar de forma oportuna el tratamiento adecuado para obtener la evolución favorable y exitosa del paciente.The current degree work presented a review of the literature and clinical case analysis corresponding to Fournier's gangrene. Current information on epidemiological, etiopathogenic, diagnostic and treatment content of said entity was summarized, thus allowing interlacing of said content with the clinical case analyzed. The case of a 39 - year - old patient with no history of importance who initially goes to a health house for presenting abdominal pain and testicular edema of 13 days before admission is considered. At the time of hospitalization, the patient is assessed, complementary and imaging tests are performed, and it is classified as septic soft tissue shock, Fournier gangrene vs necrotizing fasciitis, multiple organ diffusion (coagulation, metabolic, hepatic), thrombocytopenia and hyponatremia. Surgical cleaning was performed several times, in addition to the start of transfer to the third level Hospital but there was nosuccessful response, so antibiotics were directed, aggressive and broad - spectrum therapy, corticosteroid, sedoanalgesia, fluid therapy and mechanical ventilation previously, obtaining favorable results, concluding that although the patient was in a second level Hospital and did not have the requirements for the appropriate control of the development of the disease, the doctors as a whole knew how to provide the treatment in a timely manner suitable to obtain the favorable and successful evolution of the patient

    Spatial disparity in the distribution of superfund sites in South Carolina: an ecological study

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    BACKGROUND: According to the US Environmental Protection Agency (EPA), Superfund is a federal government program implemented to clean up uncontrolled hazardous waste sites. Twenty-six sites in South Carolina (SC) have been included on the National Priorities List (NPL), which has serious human health and environmental implications. The purpose of this study was to assess spatial disparities in the distribution of Superfund sites in SC. METHODS: The 2000 US census tract and block level data were used to generate population characteristics, which included race/ethnicity, socioeconomic status (SES), education, home ownership, and home built before 1950. Geographic Information Systems (GIS) were used to map Superfund facilities and develop choropleth maps based on the aforementioned sociodemographic variables. Spatial methods, including mean and median distance analysis, buffer analysis, and spatial approximation were employed to characterize burden disparities. Regression analysis was performed to assess the relationship between the number of Superfund facilities and population characteristics. RESULTS: Spatial coincidence results showed that of the 29.5% of Blacks living in SC, 55.9% live in Superfund host census tracts. Among all populations in SC living below poverty (14.2%), 57.2% were located in Superfund host census tracts. Buffer analyses results (0.5mi, 1.0mi, 5.0mi, 0.5km, 1.0km, and 5.0km) showed a higher percentage of Whites compared to Blacks hosting a Superfund facility. Conversely, a slightly higher percentage of Blacks hosted (30.2%) a Superfund facility than those not hosting (28.8%) while their White counterparts had more equivalent values (66.7% and 67.8%, respectively). Regression analyses in the reduced model (Adj. R(2) = 0.038) only explained a small percentage of the variance. In addition, the mean distance for percent of Blacks in the 90th percentile for Superfund facilities was 0.48mi. CONCLUSION: Burden disparities exist in the distribution of Superfund facilities in SC at the block and census tract levels across varying levels of demographic composition for race/ethnicity and SES

    Understanding the Challenges of Reducing Cancer in Appalachia: Addressing a Place-Based Health Disparity Population

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    The Appalachian region of the United States has long been recognized for its poor economic and social indicators. Only during the past decade have multi-state data become more accessible to describe the regions’ poor health status and resulting outcomes. A recent community-based participatory study engaged rural Appalachians to describe “what makes Appalachia different?” from other geographic areas and cultural groups in the United States and identify those characteristics that influence the region’s health. This article summarizes the community interpretation of these findings

    Being overburdened and medically underserved: assessment of this double disparity for populations in the state of Maryland

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    Environmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this “double disparity” for the first time in Maryland. We assessed spatial disparities in the distribution of TRI facilities in Maryland across varying levels of sociodemographic composition using 2010 US Census Health Professional Shortage Area (HPSA) data. Univariate and multivariate regression in addition to geographic information systems (GIS) were used to examine relationships between sociodemographic measures and location of TRI facilities. Buffer analysis was also used to assess spatial disparities. Four buffer categories included: 1) census tracts hosting one or more TRI facilities; 2) tracts located more than 0 and up to 0.5 km from the closest TRI facility; 3) tracts located more than 0.5 km and up to 1 km from a TRI facility; and 4) tracts located more than 1 km and up to 5 km from a TRI facility. We found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities. A significant increase in income was observed with an increase in distance between a census tract and the closest TRI facility. In general, percent non-white was higher in HPSA tracts that host at least one TRI facility than in non-HPSA tracts that host at least one TRI facility. Additionally, percent poverty, unemployment, less than high school education, and homes built pre-1950 were higher in HPSA tracts hosting TRI facilities than in non-HPSA tracts hosting TRI facilities. We found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland. We also found that both low-income groups and persons without a high school education are both overburdened and medically underserved. The results of this study provide insight into how state agencies can better address the double disparity of disproportionate environmental hazards and limited access to health care resources facing vulnerable communities in Maryland.https://doi.org/10.1186/1476-069X-13-2
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