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Post LA, Wu SA, Soetikno AG, Ozer EA, Liu Y, Welch SB, Hawkins C, Moss CB, Murphy RL, Mason M, Havey RJ, Lundberg AL. Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis. JMIR Public Health Surveill 2024; 10:e44398. [PMID: 38568194 DOI: 10.2196/44398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In May 2020, the World Health Organization (WHO) declared Latin America and the Caribbean (LAC) the epicenter of the COVID-19 pandemic, with over 40% of worldwide COVID-19-related deaths at the time. This high disease burden was a result of the unique circumstances in LAC. OBJECTIVE This study aimed to (1) measure whether the pandemic was expanding or contracting in LAC when the WHO declared the end of COVID-19 as a public health emergency of international concern on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history; and (3) provide, with a focus on prevention policies, a historical context for the course of the pandemic in the region. METHODS In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern (VOCs). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Additionally, we conducted a 1-sided t test for whether the regional weekly speed (rate of novel COVID-19 transmission) was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the period from August 2020 to May 2023. RESULTS The speed of pandemic spread for the region had remained below the outbreak threshold for 6 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant for the 120-day period ending on the week of May 5, 2023, the coefficients were relatively modest in magnitude (0.457 and 0.491, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any change in this clustering effect of cases on future cases. From December 2021 onward, Omicron was the predominant VOC in sequenced viral samples. The rolling t test of speed=10 became entirely insignificant from January 2023 onward. CONCLUSIONS Although COVID-19 continues to circulate in LAC, surveillance data suggest COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. However, the region experienced a high COVID-19 burden in the early stages of the pandemic, and prevention policies should be an immediate focus in future pandemics. Ahead of vaccination development, these policies can include widespread testing of individuals and an epidemiological task force with a contact-tracing system.
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Affiliation(s)
- Lori Ann Post
- Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Scott A Wu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alan G Soetikno
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Egon A Ozer
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Pathogen Genomics and Microbial Evolution, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Yingxuan Liu
- Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Claudia Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Global Communicable and Emerging Infectious Diseases, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
| | - Robert L Murphy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Maryann Mason
- Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert J Havey
- Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alexander L Lundberg
- Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Mason M, Pandya K, Lundberg A. Older adult drug overdose: an application of latent class analysis to identify prevention opportunities. Harm Reduct J 2024; 21:61. [PMID: 38481307 PMCID: PMC10936079 DOI: 10.1186/s12954-024-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Older adult overdose death rates have increased significantly in recent years. However, research for prevention of drug overdose death specific to older adults is limited. Our objective is to identify profiles based on missed intervention points (touchpoints) to inform prevention of future older adult unintentional overdose deaths. METHODS We used latent class analysis methods to identify profiles of decedents aged 55 + years in the Illinois Statewide Unintentional Drug Overdose Reporting System. This system collects data on 92.6% of all unintentional overdose deaths in Illinois and includes data from death certificates, coroner/medical examiner, toxicology, and autopsy reports. Data include decedent demographics, circumstances leading up to and surrounding the fatal overdose and details regarding the overdose. Variables in the latent class analysis model included sex, race, alcohol test result, social isolation, recent emergency department (ED) visit, chronic pain, and pain treatment. RESULTS We identified three distinct decent profiles. Class 1 (13% of decedents) included female decedents who were in pain treatment, had physical health problems, and had greater likelihood of a recent ED visit before their death. Class 2 (35% of decedents) decedents were most likely to be socially connected (live with others, employed, had social or family relationships) but less likely to have recent healthcare visits. Class 3 (52% of decedents) decedents had higher social isolation (lived alone, unemployed, unpartnered), were mostly male, had fewer known physical health conditions, and more alcohol positivity at time of death. White decedents are clustered in class 1 while Black decedents are predominant in classes 2 and 3. CONCLUSIONS These profiles link to potential touchpoint opportunities for substance use disorder screening harm reduction and treatment. Class 1 members were most likely to be reachable in healthcare settings. However, most decedents were members of Classes 2 and 3 with less engagement in the healthcare system, suggesting a need for screening and intervention in different contexts. For Class 2, intervention touchpoints might include education and screening in work or social settings such as senior centers given the higher degree of social connectivity. For Class 3, the most isolated group, touchpoints may occur in the context of harm reduction outreach and social service delivery.
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Affiliation(s)
- Maryann Mason
- Buehler Center for Health Policy and Economics, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA.
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA.
| | - Kaveet Pandya
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
| | - Alexander Lundberg
- Buehler Center for Health Policy and Economics, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
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Dastoor JD, Thomas A, Slocum JD, Regan S, Stone L, Richardson JB, Mason M, Johnson JK, Lin K, Stey A. Investigating the 2016 surge in firearm violence in Illinois, USA, through community-based organisations: a qualitative study. Inj Prev 2024:ip-2023-045075. [PMID: 38448213 DOI: 10.1136/ip-2023-045075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Illinois experienced a historic firearm violence surge in 2016 with a decline to baseline rates in 2018. This study aimed to understand this 2016 surge through the direct accounts of violence prevention community-based organisations (CBOs) in Illinois. METHODS We conducted semistructured interviews with 20 representatives from 13 CBOs from the south and west sides of greater Chicago metropolitan area. Interviews were audio recorded, coded and analysed thematically. RESULTS We identified lack of government-derived infrastructure and systemic poverty as the central themes of Illinois's 2016 firearm violence surge. Participants highlighted the Illinois Budget Impasse halted funding for violence prevention efforts, leading to 2016's violence. This occurred in the context of a strained relationship with the criminal justice system, where disengagement from police and mistrust in the justice system led victims and families to seek justice outside of the judicial system. Participants emphasised that systemic poverty and the obliteration of community support structures led to overwhelming desperation, which, in turn, increased risky behaviours perceived as necessary for survival. Participants disproportionately identified that this impacted the young people in their communities. CONCLUSIONS Lack of government-derived infrastructure and systemic poverty were the central themes of the 2016 firearm violence surge. The insights gained from the 2016 surge are applicable to understanding both current and future surges. CBOs focused on violence prevention offer insights into the context and conditions fuelling surges in the epidemic of violence.
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Affiliation(s)
- Jehannaz D Dastoor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - John D Slocum
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Joesph B Richardson
- Department of African American Studies, University of Maryland, College Park, Maryland, USA
| | - Maryann Mason
- Department of Emergency Medicine, Northwestern University, Evanston, Illinois, USA
| | - Julie K Johnson
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Anne Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Dean JR, Kaczor K, Lorenz D, Mason M, Simonton K. Characteristics of child abuse fatalities: Insights from a statewide violent death reporting system. Child Abuse Negl 2024; 149:106649. [PMID: 38295604 DOI: 10.1016/j.chiabu.2024.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Child maltreatment fatalities are a significant public health issue. Case level characteristics of abuse-related deaths can increase our understanding of maltreatment fatalities and inform region-specific prevention initiatives. OBJECTIVE Explore child abuse fatalities in the Illinois Violent Death Reporting System (IVDRS) for commonalities and distinctive features. METHODS, PARTICIPANTS AND SETTING A mixed methods study was conducted using IVDRS data from 2015 to 2018. All fatalities with a homicide or undetermined manner of death among decedents 10 years old or younger were included. Both discrete and narrative data were analyzed separately for victim, suspect, circumstance, and household characteristics. RESULTS Of the 106 deaths that met inclusion criteria, 74 % of homicide deaths (64/86) and 50 % of undetermined deaths (10/20) were due to abuse. Psychosocial characteristics most often identified in abusive deaths included family relationship problems, mental illness, and history of substance abuse. Other common characteristics included use of personal weapons or blunt instruments and death due to punishment. Including narrative data rather than discrete data alone identified 148 % more deaths with three characteristics commonly found in abusive deaths: history of abuse, shaken baby syndrome, and family history of violence. CONCLUSION This study demonstrates the capability of multi-source state-level data to enrich our understanding of child abuse fatalities. Employing the narrative review method in other states using the National Violent Death Reporting System may increase the identification of abuse fatalities. Improved recognition and characterization of abuse fatalities has the potential to help address systemic factors involved and enhance targeted prevention efforts. WHAT IS KNOWN Child abuse fatalities represent a significant and preventable public health issue in the United States. Case-specific characteristics are limited in national data sets, and their absence curtails prevention opportunities. WHAT THIS STUDY ADDS State-wide reporting systems of violent deaths offer rich and multisource data regarding child abuse fatalities including detailed victim, suspect, circumstance, and household characteristics. This data can be used to enhance our knowledge of maltreatment fatalities and may inform region-specific public health and prevention initiatives.
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Affiliation(s)
- Julie Robin Dean
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kim Kaczor
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, 485 E. Gray St. Louisville, KY 40202, USA.
| | - Maryann Mason
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kirsten Simonton
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
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Mason M, Post LA, Aggarwal R. Health care and harm reduction provider perspectives on treating older adults who use non-medical opioids: a qualitative study set in Chicago. BMC Health Serv Res 2023; 23:876. [PMID: 37598163 PMCID: PMC10439613 DOI: 10.1186/s12913-023-09843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Opioid overdose death rates are increasing for adults aged 55 and older, with especially high rates in large urban areas. In parallel, admissions to treatment programs for older adults using illicit substances are increasing as well. Despite these trends, there is a lack of information about older adults who use non-medical opioids (NMO) and even less knowledge about their health and service encounters. Conducted in Chicago, Illinois, this qualitative study explores the perspectives of health care and harm reduction service providers who work with older adults using non-medical opioids. METHODS The study used snowball sampling to locate participants with expertise in working with older adults who use non-medical opioids. In total, we conducted 26 semi-structured interviews from September 2021-August 2022. We explored questions regarding participants' perceptions of older adult opioid use patterns, comorbidities, and involvement in harm reduction outreach and opioid use disorder treatment. RESULTS Many of the providers we interviewed consider older adults who use NMO as a distinct population that employ unique use behaviors with the intent to protect them from opioid overdose. However, these same unique behaviors may potentiate their risk for overdose in today's climate. Providers report initial encounters that are not care seeking for opioid use and primarily oriented around health conditions. Older adults who use non-medical opioids are seen as complex patients due to the need to diagnostically untangle symptoms of substance use from co-morbidities and conditions associated with aging. Treatment for this population is also viewed as complicated due to the interactions between aging, comorbidities, and substance use. Providers also noted that older adults who use NMO have use behaviors that make them less visible to outreach and treatment service providers, potentially putting them at increased risk for overdose and health conditions associated with opioid use. CONCLUSIONS Findings from this study are intended to inform future research on care provision for older adults who use non-medical opioids and may be especially applicable to large urban reas with histories of opioid use dating back to earlier drug epidemics of the 1970s, 1980s, and 1990s.
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Affiliation(s)
- Maryann Mason
- Feinberg School of Medicine, Northwestern University, Chicago, 60611, USA.
- Buehler Center for Health Policy and Economics, Northwestern University, 420 E. Superior St., Rubloff Building 9th floor, Room 939, Chicago, IL, 60611, USA.
| | - Lori Ann Post
- Department of Emergency Medicine, The Buehler Center for Health Policy & Economics, Institute for Global Health, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, 9-915 Rubloff Building, 420 E. Superior St, Chicago, Il, 60611, USA
| | - Rahul Aggarwal
- Weinberg School of Arts and Sciences, Northwestern University, 1918 Sheridan Rd, Evanston, IL, 60208, USA
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Abstract
This cross-sectional study investigates the prevalence of alcohol in unintentional opioid overdose deaths in Illinois from 2017 through 2020.
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Affiliation(s)
- Aryn Z. Phillips
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park
| | - Lori A. Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Maryann Mason
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Post LA, Mason M. The Perfect Gun Policy Study in a Not So Perfect Storm. Am J Public Health 2022; 112:1707-1709. [PMID: 36302217 PMCID: PMC9670228 DOI: 10.2105/ajph.2022.307120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 09/03/2023]
Affiliation(s)
- Lori Ann Post
- The authors are with the Department of Emergency Medicine, Buehler Center for Health Policy & Economics, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Maryann Mason
- The authors are with the Department of Emergency Medicine, Buehler Center for Health Policy & Economics, Northwestern Feinberg School of Medicine, Chicago, IL
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Kwon S, Mason M, Wang-Schweig M, Morrissey J, Bartell T, Kandula NR. The Association Between Adolescent Active Commuting to School and Parent Walking Behavior: The FLASHE Study. Am J Health Promot 2022; 36:1265-1274. [PMID: 35487877 DOI: 10.1177/08901171221099271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To examine the relationship between adolescent active commuting to school (ACS; walking or biking to/from school) and parent walking activity. DESIGN Cross-sectional. SETTING US nationwide online surveys. SAMPLE 1367 parent-adolescent (12-17 years) dyads among the Family Life, Activity, Sun, Health, and Eating (FLASHE) study participants (29.4% response rate). MEASURES Online surveys asked about adolescent ACS and parent walking activity in the past week. Adolescents who reported ACS at least once in the past week were categorized as engaging in ACS. Parent walking frequency was categorized into 0-2, 3-5, and 6-7 days. ANALYSIS Logistic regression analysis was conducted to compare the probability of adolescent ACS by parent walking activity, adjusted for sociodemographic factors and adolescent-, parent-, and neighborhood-level covariates. RESULTS 28.5% of adolescents engaged in ACS at least once in the past week. Compared to 0-2 days/week of parent walking activity, ORs for adolescent ACS for 3-5 and 6-7 days/week of parent walking activity were 1.98 (95% CI=1.38-2.87) and 1.81 (1.23-2.68), respectively. In stratified analyses by parent and adolescent sex, father-son dyads presented the strongest association between adolescent ACS and parent walking 3-5 and 6-7 days/week (ORs=4.17 [1.46-11.91] and 3.95 [1.45-10.77], respectively). CONCLUSIONS Adolescents with parents who engaged in walking activity ≥3 days/week were more likely to actively commute to school. Parent walking activity may have positive intergenerational effects on adolescent ACS and physical activity.
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Affiliation(s)
- Soyang Kwon
- 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maryann Mason
- Department of Emergency Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Meme Wang-Schweig
- Division of Community Health Sciences, 50739University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Joanna Morrissey
- Department of Psychology, 14749University of Wisconsin-Green Bay, Green Bay, WI, USA
| | - Tami Bartell
- 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Namratha R Kandula
- Department of Medicine and Preventive Medicine, 12244Northwestern University, Chicago, IL, USA
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Mason M, Khazanchi R, Brewer A, Sheehan K, Liu Y, Post L. Changes in the demographic distribution of Chicago gun-homicide decedents: 2015-2021: A violent death surveillance cross-sectional study (Preprint). JMIR Public Health Surveill 2022; 9:e43723. [PMID: 37027193 PMCID: PMC10131678 DOI: 10.2196/43723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Homicide is one of the 5 leading causes of death in the United States for persons aged 1 to 44 years. In 2019, 75% of US homicides were by gun. Chicago has a gun-homicide rate 4 times the national average, and 90% of all homicides are by gun. The public health approach to violence prevention calls for a 4-step process, beginning with defining and monitoring the problem. Insight into the characteristics of gun-homicide decedents can help frame next steps, including identifying risk and protective factors, developing prevention and intervention strategies, and scaling effective responses. Although much is known about gun homicide because it is a long-standing, entrenched public health problem, it is useful to monitor trends to update ongoing prevention efforts. OBJECTIVE This study aimed to use public health surveillance data and methods to describe changes in the race/ethnicity, sex, and age of Chicago gun-homicide decedents from 2015-2021, in the context of year-to-year variation and an overall increase in the city's gun-homicide rate. METHODS We calculated the distribution of gun-related homicide deaths by 6 race/ethnicity and sex groups (non-Hispanic Black female, non-Hispanic White female, Hispanic female, non-Hispanic Black male, non-Hispanic White male, and Hispanic male), age in years, and age by age group. We used counts, percentages, and rates per 100,000 persons to describe the distribution of deaths among these demographic groups. Comparisons of means and column proportions with tests of significance set at P≤.05 were used to describe changes in the distribution of gun-homicide decedents over time by race-ethnicity-sex and age groups. The comparison of mean age by race-ethnicity-sex group is done using 1-way ANOVA with significance set at P≤.05. RESULTS The distribution of gun-homicide decedents in Chicago by race/ethnicity and sex groups had been relatively stable from 2015 to 2021 with 2 notable exceptions: a more than doubling of the proportion of gun-homicide decedents who were non-Hispanic Black female (3.6% in 2015 to 8.2% in 2021) and an increase of 3.27 years in the mean age of gun-homicide decedents. The increase in mean age coincided with a decrease in the proportion of non-Hispanic Black male gun-homicide decedents between the ages of 15-19 and 20-24 years and, conversely, an increase in the proportion of non-Hispanic Black male gun-homicide decedents aged 25-34 years<strong>.</strong>. CONCLUSIONS The annual gun-homicide rate in Chicago had been increasing since 2015 with year-to-year variation. Continued monitoring of trends in the demographic makeup of gun-homicide decedents is necessary to provide the most relevant and timely information to help shape violence prevention efforts. We detected several changes that suggest a need for increased outreach and engagement marketed toward non-Hispanic Black female and non-Hispanic Black male individuals between the ages of 25-34 years.
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Affiliation(s)
- Maryann Mason
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rushmin Khazanchi
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Audrey Brewer
- Department of Pediatrics, Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Karen Sheehan
- Department of Pediatrics, Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yingxuan Liu
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lori Post
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Bagot KS, Tomko RL, Marshall AT, Hermann J, Cummins K, Ksinan A, Kakalis M, Breslin F, Lisdahl KM, Mason M, Redhead JN, Squeglia LM, Thompson WK, Wade T, Tapert SF, Fuemmeler BF, Baker FC. Youth screen use in the ABCD® study. Dev Cogn Neurosci 2022; 57:101150. [PMID: 36084446 PMCID: PMC9465320 DOI: 10.1016/j.dcn.2022.101150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Adolescent screen usage is ubiquitous and influences development and behavior. Longitudinal screen usage data coupled with psychometrically valid constructs of problematic behaviors can provide insights into these relationships. We describe methods by which the screen usage questionnaire was developed in the Adolescent Brain Cognitive Development (ABCD) Study, demonstrate longitudinal changes in screen usage via child report and describe data harmonization baseline-year 2. We further include psychometric analyses of adapted social media and video game addiction scales completed by youth. Nearly 12,000 children ages 9-10 years at baseline and their parents were included in the analyses. The social media addiction questionnaire (SMAQ) showed similar factor structure and item loadings across sex and race/ethnicities, but that item intercepts varied across both sex and race/ethnicity. The videogame addiction questionnaire (VGAQ) demonstrated the same configural, metric and scalar invariance across racial and ethnic groups, however differed across sex. Video gaming and online social activity increased over ages 9/10-11/12 (p's < 0.001). Compared with boys, girls engaged in greater social media use (p < .001) and demonstrated higher ratings on the SMAQ (p < .001). Compared with girls, boys played more video games (p < .001) and demonstrated higher ratings on the VGAQ (p < .001). Time spent playing video games increased more steeply for boys than girls from age 9/10-11/12 years (p < .001). Black youth demonstrated significantly higher SMAQ and VGAQ scores compared to all other racial/ethnic groups. These data show the importance of considering different screen modalities beyond total screen use and point towards clear demographic differences in use patterns. With these comprehensive data, ABCD is poised to address critical questions about screen usage changes across adolescence.
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Affiliation(s)
- K S Bagot
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - R L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - A T Marshall
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Hermann
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K Cummins
- Department of Public Health, California State University, Fullerton, CA, USA
| | - A Ksinan
- RECETOX, Masaryk University, Brno, Czechia
| | - M Kakalis
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - F Breslin
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - K M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - M Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - J N Redhead
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - L M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - W K Thompson
- Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, USA
| | - T Wade
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - S F Tapert
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - B F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - F C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
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Post LA, Lundberg A, Moss CB, Brandt CA, Quan I, Han L, Mason M. Geographic Trends in Opioid Overdoses in the US From 1999 to 2020. JAMA Netw Open 2022; 5:e2223631. [PMID: 35900768 PMCID: PMC9335141 DOI: 10.1001/jamanetworkopen.2022.23631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/04/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Lori Ann Post
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Chicago, Illinois
| | - Alexander Lundberg
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Chicago, Illinois
| | - Charles B. Moss
- Department of Agricultural Economics, University of Florida, Gainesville
| | - Cynthia A. Brandt
- Center for Health Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Irene Quan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Chicago, Illinois
| | - Ling Han
- Center for Health Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Maryann Mason
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Chicago, Illinois
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Tindale A, Cantor E, Cretu I, Valli H, Bhudia S, Mason M, Lane R. Optimal timing of pacemaker implantation after cardiac surgery: should we wait 12 days? A 5-year observational study from a UK tertiary centre. Europace 2022. [DOI: 10.1093/europace/euac053.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Post-operative bradycardia is common but intrinsic rhythm often recovers. There is little consensus on the optimum time to wait between cardiac surgery and the implantation of a permanent pacemaker (PPM). Earlier device implantation may facilitate shorter length of stay. However, it may expose some patients who have no long-term pacing requirement to the risks associated with device therapy. This study aimed to understand how the number of days between cardiac surgery and PPM implantation is associated with pacing dependence and recovery of intrinsic conduction by 30 days.
Methods
We examined healthcare records of consecutive patients who underwent cardiac surgery at our centre between 01/01/2015 to 01/01/2021. The primary outcome measures were pacing dependence (PD) at 30 days and recovery of intrinsic conduction at 30 days. Recovery was defined as showing evidence of intrinsic rhythm at the 30 day check after being pacing dependent at the time of implant. Patient demographics, baseline ECG characteristics and surgical procedure were recorded. Time to pacemaker implantation and pacing indication were identified.
Pacing checks at 30 days post implant were reviewed and PD defined as no intrinsic rhythm seen over a 30 second period with base rate set at 40bpm. Univariate analysis and binary logistic regression were used to determine factors significantly associated with the primary outcome measures. Subsequent receiver-operator characteristic (ROC) analysis was used to determine the optimal timing of pacemaker implantation as defined by the Youden Index. This aims to maximise sensitivity and specificity of days to implant in predicting PD and conduction recovery at 30 days.
Results
Following 5849 operations, 103 (1.8%) patients underwent PPM implantation for a new bradycardic indication. The baseline characteristics of those paced are summarised in table 1. Numerous factors were associated with pacing dependence at 30 days on univariate analysis (table 2). However, multivariate analysis showed that only PD at implant and days to implant (DTI) were significant predictors of PD at 30 days. The only significant association with conduction recovery was DTI.
ROC analysis showed that the optimal DTI is 12 days for a variety of analyses: 1.) Predicting PD at 30 days for all patients (AUC 0.620, SE 0.056, p=0.031, 95% CI 0.511-0.730) 2.) Predicting PD in patients whose PPM indication was AV nodal dysfunction (AUC 0.706, p=0.001, Youden Index (YI) 1.34). 3.) Predicting recovery of intrinsic rhythm in patients who were pacing dependent at implant (AUC 0.80, p= 0.000, YI 1.515).
Conclusions
The number of days between surgery and pacemaker implantation is the only factor significantly associated with both pacing dependence and recovery of intrinsic conduction at 30 days. The optimum time to wait is 12 days to allow time for intrinsic conduction to recover.
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Affiliation(s)
- A Tindale
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Cantor
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Cretu
- Brunel University, London, United Kingdom of Great Britain & Northern Ireland
| | - H Valli
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Bhudia
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Mason
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Lane
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Cantor E, Butcher C, Chow JJ, Sohaib SMA, Valli H, Shun-Shin M, Shi R, Boyalla V, O’connor M, Chen Z, Haldar S, Mason M, Lane R, Francis D, Wong T. The acute haemodynamic response with endocardial biventricular pacing: comparing RV paced and LBBB patients. Europace 2022. [DOI: 10.1093/europace/euac053.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Background
A third of patients that receive cardiac resynchronisation (CRT) are non-responders. Predictors of positive response include broader QRS duration, non-ischaemic aetiology and sinus rhythm, but it is still unclear whether lead placement site determines a positive responder.
Purpose
We assessed the acute haemodynamic response of endocardial biventricular pacing in patients with intrinsic left bundle brunch block (LBBB) versus LBBB due to pre-existing right ventricular pacing (RVP).
Methods
Patients who fulfilled standard criteria for CRT implantation but had failed conventional (coronary sinus) left ventricular (LV) lead placement (primary or revision) or were deemed clinical ‘non-responders after > 6 months of conventional CRT were enrolled. The acute haemodynamic response during endocardial biventricular pacing was assessed with a roving LV lead at 9 different locations (basal and mid: septal, anterior, posterior and lateral walls and apex). Acute changes in beat-to-beat systolic blood pressure (SBP) in the left ventricle were recorded and analysed.
Results
We recruited 23 patients across 10 UK centres: 14 intrinsic LBBB and 9 dependent on RVP. Patient characteristics were comparable: age (mean 67 + 10.6 years vs. 62 + 15.4 years), ischaemic (63% vs 50%), QRS (160 + 18ms vs. 190 + 36ms, p =0.07). Of the RVP group 5/9 had septal RV leads (the remainder apically positioned).
There was no difference in the SBP improvement between the groups: change in SBP ranged from -5.25 – 19.91mmHg (median 3mmHg) in RVP patients vs -5.92 – 23.03mmHg (median 3mmHg) for intrinsic LBBB. However, the improvement in SBP was more consistent across the different segments in the patients with RVP (group A), as compared to intrinsic LBBB (group B), where the lateral wall and then non-septal walls provided the greatest haemodynamic improvement.
Figure 1: depicts SBP improvement (in mmHg) during endocardial biventricular pacing in different positions within the LV for patients with RVP (A) vs underlying intrinsic LBBB (B): 9 segment model of the LV: Ant (anterior wall), Lat (lateral wall), Post (posterior wall), Sept (septum). Outer ring represents the four basal LV locations, middle ring the mid LV locations and centre ring the apex. Scale depicts mmHg improvement in SBP.
Conclusion
When implanting an LV lead for patients who are RV pacing dependent any position within the LV provides an acute haemodynamic improvement, compared with those with intrinsic LBBB, where a targeted lateral wall approach is more important. This finding corroborates the key differences in LV activation patterns for induced versus intrinsic LBBB.
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Affiliation(s)
- E Cantor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Butcher
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - JJ Chow
- Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S M A Sohaib
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - H Valli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Shun-Shin
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Shi
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - V Boyalla
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M O’connor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Chen
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Haldar
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Mason
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Lane
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Francis
- Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - T Wong
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Dearnaley D, Hinder V, Hijab A, Horan G, Srihari N, Rich P, Houston G, Henry A, Gibbs S, Venkitaraman R, Cruickshank C, Hassan S, Mason M, Pedley I, Payne H, Brock S, Wade R, Robinson A, Din O, Lees K, Murray J, Parker C, Griffin C, Sohaib A, Hall E. OC-0105 PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Mason M, McLone S, Monuteaux MC, Sheehan K, Lee LK, Fleegler EW. Association between youth homicides and state spending: a Chicago cross-sectional case study. BMJ Open 2022; 12:e052933. [PMID: 35074815 PMCID: PMC8808420 DOI: 10.1136/bmjopen-2021-052933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To identify contributing factors associated with rapid spikes and declines in Chicago youth homicide from 2009 to 2018. SETTING City of Chicago, Illinois, US 2009-2018. PARTICIPANTS Homicide count data come from the National Violent Death Reporting System. The study included information on 2271 homicide decedents between the ages of 15 and 24 who died between 1 January 2009 and 31 December 2018. Of these decedents, 92.9% were male; 79.1% were non-Hispanic black; and 94.9% died from a firearm injury. PRIMARY AND SECONDARY OUTCOME MEASURES: (A) Temporal shifts in monthly homicide rates and (B) temporal associations between social, environmental and economic conditions/events and fluctuations in homicides. RESULTS We found statistically significant shifts in homicide rates over time: a 77% rise in monthly youth homicide rates per 100 000 persons from 2015 to 2016 (4.3 vs 7.5); dropping back to pre-2015 rates (4.3) by mid-2017. There was a temporal co-occurrence between the rapid rise in youth homicides and absence of a state budget. Conversely, we found a temporal co-occurrence of the sharp decline in homicides with the reinstatement of a state budget. Adjusting for seasonality, we found death rates were greater in the months without a budget compared with months with a budget (1.48, 95% CI 1.29 to 1.70). CONCLUSIONS Our findings suggest that state funding may be a potential protective factor against youth homicide.
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Affiliation(s)
- Maryann Mason
- Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Suzanne McLone
- Smith Child Health Research, Outreach and Advocacy Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karen Sheehan
- Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lois K Lee
- Pediatrics, Childrens Hospital Boston, Boston, Massachusetts, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Abstract
IMPORTANCE Rates of opioid overdose deaths are increasing for older adults. Less is known about these deaths compared with those of younger adults. OBJECTIVE To analyze rate variation among opioid overdose deaths in older adults by sex and by race and ethnicity over time. DESIGN, SETTING, AND PARTICIPANTS This 21-year longitudinal cross-sectional study of adults who died due to opioid overdose at 55 years or older stratified by sex and by race and ethnicity used data from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. The data include all opioid overdose deaths among this age group that occurred between January 1, 1999, and December 31, 2019 (N = 79 893). EXPOSURES Sex and racial and ethnic groups. MAIN OUTCOMES AND MEASURES Rates of opioid overdose deaths per 100 000 population by sex and by race and ethnicity for persons 55 years or older. RESULTS During the period 1999 to 2019, 79 893 US residents 55 years or older died due to an opioid overdose. Among these individuals, 79.97% were aged 55 to 64 years, and 58.98% were men. Annual numbers of deaths increased over time from 518 in 1999 to 10 292 in 2019. Annual rates of opioid overdose deaths per 100 000 persons 55 years or older increased over time and ranged from 0.90 in 1999 to 10.70 in 2019. Substantial variation by sex and by race and ethnicity was found. In 2013, rates among non-Hispanic Black men began to diverge from those of other demographic subgroups. By 2019, the opioid overdose fatality rate among non-Hispanic Black men 55 years or older was 40.03 per 100 000 population, 4 times greater than the overall opioid overdose fatality rate of 10.70 per 100 000 for persons of the same age. CONCLUSIONS AND RELEVANCE In this longitudinal cross-sectional study of US adults who died due to opioid overdose, the burden of opioid overdose deaths among older adults since 2013 was most concentrated among non-Hispanic Black men. Deaths among non-Hispanic Black men were disproportionality represented in the overall increase in the rate of opioid overdose deaths among older adults. Further research is needed to inform policy and practice.
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Affiliation(s)
- Maryann Mason
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Northwestern University, Chicago, Illinois
| | - Rebekah Soliman
- currently an undergraduate student at Northwestern University, Weinberg College of Arts and Sciences, Evanston, Illinois
| | - Howard S. Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Network Open
| | - Lori Ann Post
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Northwestern University, Chicago, Illinois
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Kim HS, Feinglass J, McCarthy DM, Lank PM, Mason M. Unintentional Opioid Overdose Death Characteristics in Illinois Before and During the COVID-19 Era, 2017 to 2020. JAMA Health Forum 2021; 2:e213699. [PMID: 35977263 PMCID: PMC8796894 DOI: 10.1001/jamahealthforum.2021.3699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/26/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Howard S. Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Network Open, Chicago, Illinois
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danielle M. McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick M. Lank
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Toxikon Consortium, Chicago, Illinois
| | - Maryann Mason
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Affiliation(s)
- Maryann Mason
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ponni Arukumar
- Cook County Medical Examiner's Office, Chicago, Illinois
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Welch SB, Kulasekere DA, Prasad PVV, Moss CB, Murphy RL, Achenbach CJ, Ison MG, Resnick D, Singh L, White J, Issa TZ, Culler K, Boctor MJ, Mason M, Oehmke JF, Faber JMM, Post LA. The Interplay Between Policy and COVID-19 Outbreaks in South Asia: Longitudinal Trend Analysis of Surveillance Data. JMIR Public Health Surveill 2021; 7:e24251. [PMID: 34081593 PMCID: PMC8213065 DOI: 10.2196/24251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/18/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia. OBJECTIVE This study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks. METHODS We extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS Traditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India's speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak. CONCLUSIONS Relaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic.
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Affiliation(s)
- Sarah B Welch
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - P V Vara Prasad
- Sustainable Intensification Innovation Lab, Department of Crop Ecophysiology, Kansas State University, Manhattan, KS, United States
| | - Charles B Moss
- Food and Resource Economics Department, University of Florida, Gainesville, FL, United States
| | - Robert Leo Murphy
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chad J Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael G Ison
- Divison of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Danielle Resnick
- International Food Policy Research Institute, Washington, DC, United States
| | - Lauren Singh
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Janine White
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kasen Culler
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael J Boctor
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maryann Mason
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Francis Oehmke
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Lori Ann Post
- Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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20
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Moris L, Gandaglia G, Vilaseca A, Van Den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, Henry A, Lam T, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouvière O, Schoots I, Van Der Poel H, Wiegel T, Willemse PP, Grummet J, Tilke D, Van Den Bergh R, Cornford P, Mottet N. Evaluation of oncological outcomes and data quality in studies assessing nerve sparing versus non-nerve sparing radical prostatectomy in non-metastatic prostate cancer: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Hazekamp C, McLone S, Yousuf S, Mason M, Sheehan K. Educational Attainment of Male Homicide Victims Aged 18 to 24 Years in Chicago: 2006 to 2015. J Interpers Violence 2021; 36:5761-5774. [PMID: 30354844 DOI: 10.1177/0886260518807216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Homicide is a preventable public health issue that has detrimental effects on both victims and witnesses and increases health care costs. From 2006 to 2015, homicide has been the second leading cause of death for youth aged 15 to 24 years in the United States. Educational attainment has been widely regarded as a protective factor against justice system involvement and violent injury. We conducted a time-trend analysis examining educational attainment levels for male victims of homicide aged 18 to 24 years in the City of Chicago, 2006 to 2015, to describe the educational attainment of youth homicide victims in Chicago. We used data from the Illinois Violent Death Reporting System and the United States Census Bureau from 2006 to 2015. Cases included male victims of homicide, 18 to 24 years of age, the injury leading to death occurred in the City of Chicago, injury leading to death occurred between 2006 and 2015, and whether or not a high school degree or equivalent had been obtained. Data were described over time using percentages and rates per 100,000 with 95% confidence intervals. Chicago male homicide victims aged 18 to 24 years were less likely to have at least a high school degree than the general population of males aged 18 to 24 years in Chicago. The homicide rate for males aged 18 to 24 years without a high school degree was significantly higher than those with a high school degree or equivalent for every time point, except 2007, and also in four of the seven Chicago Planning Regions when compared with the other three. We found there is a concentrated risk pool for undereducated male youth in Chicago.
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Affiliation(s)
- Corey Hazekamp
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Suzanne McLone
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Sana Yousuf
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Maryann Mason
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Karen Sheehan
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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22
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Brandt CA, Workman TE, Farmer MM, Akgün KM, Abel EA, Skanderson M, Bean-Mayberry B, Zeng-Treitler Q, Mason M, Bastian LA, Goulet JL, Post LA. Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study. West J Emerg Med 2021; 22:525-532. [PMID: 34125022 PMCID: PMC8203018 DOI: 10.5811/westjem.2021.4.51203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. METHODS The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. RESULTS The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). CONCLUSION Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.
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Affiliation(s)
- Cynthia A. Brandt
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - T. Elizabeth Workman
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Melissa M. Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kathleen M. Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Erica A. Abel
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut
| | | | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
- UCLA David Geffen School of Medicine, Department of Medicine, Los Angeles, California
| | - Qing Zeng-Treitler
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Maryann Mason
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Joseph L. Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lori A. Post
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
- Northwestern University, Department of Geriatric Medicine, Chicago, Illinois
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Sneed RS, Mason M, Williams JN, Sinnette C, Taber K, Mancera-Cuevas K, Curry G, Canessa P, Ramsey-Goldman R, Feldman CH. Using Critical Race Theory to Understand Trial Participation Among Black Individuals with Systemic Lupus Erythematosus: A Qualitative Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2021; 73:1387-1395. [PMID: 33973413 DOI: 10.1002/acr.24635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Black patients with systemic lupus erythematous (SLE) experience greater disease incidence and severity than White patients yet are underrepresented in SLE clinical trials. We applied Critical Race Theory to qualitatively explore the influence of racism on the underrepresentation of Black patients in SLE clinical trials and to develop a framework for future intervention. METHODS We conducted groups in Chicago and Boston with Black adults (age ≥18 years) with SLE and their caregivers. We queried participants' knowledge about clinical trials, factors that might motivate or hinder trial participation, and how race and experiences of racism might impact clinical trial participation. Focus group responses were transcribed verbatim and analyzed thematically. RESULTS We held four focus groups (N=31); 20 participants had SLE, 11 were caregivers. All participants were Black, 90% were female and the mean age was 54 years. Qualitative analyses revealed several themes that negatively impact trial participation including mistrust related to racism, concerns about assignment to placebo groups, strict study exclusion criteria, and SLE-related concerns. Factors that motivated trial participation included recommendations from physicians and reputable institutions, a desire to help the greater good, and culturally-sensitive marketing of trials. CONCLUSION Actions to improve clinical trial participation among Black individuals should focus on reframing how trial information is presented and disseminated and on reevaluating barriers that may restrict trial participation. Additionally, researchers must acknowledge and respond to the presence of racial bias in healthcare. Community-Academic Partnerships may help build trust and reduce fears of mistreatment among Black individuals with SLE.
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Affiliation(s)
- Rodlescia S Sneed
- Division of Public Health, College of Human Medicine, Michigan State University
| | - Maryann Mason
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago
| | - Jessica N Williams
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Corine Sinnette
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kreager Taber
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Karen Mancera-Cuevas
- Illinois Department of Public Health, Springfield.,Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Gina Curry
- Biological Sciences Division, Comprehensive Cancer Center, University of Chicago (UCCCC), Office of Community Engagement & Cancer Health Equity
| | | | | | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
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Post L, Mason M, Singh LN, Wleklinski NP, Moss CB, Mohammad H, Issa TZ, Akhetuamhen AI, Brandt CA, Welch SB, Oehmke JF. Impact of Firearm Surveillance on Gun Control Policy: Regression Discontinuity Analysis. JMIR Public Health Surveill 2021; 7:e26042. [PMID: 33783360 PMCID: PMC8103291 DOI: 10.2196/26042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Public mass shootings are a significant public health problem that require ongoing systematic surveillance to test and inform policies that combat gun injuries. Although there is widespread agreement that something needs to be done to stop public mass shootings, opinions on exactly which policies that entails vary, such as the prohibition of assault weapons and large-capacity magazines. OBJECTIVE The aim of this study was to determine if the Federal Assault Weapons Ban (FAWB) (1994-2004) reduced the number of public mass shootings while it was in place. METHODS We extracted public mass shooting surveillance data from the Violence Project that matched our inclusion criteria of 4 or more fatalities in a public space during a single event. We performed regression discontinuity analysis, taking advantage of the imposition of the FAWB, which included a prohibition on large-capacity magazines in addition to assault weapons. We estimated a regression model of the 5-year moving average number of public mass shootings per year for the period of 1966 to 2019 controlling for population growth and homicides in general, introduced regression discontinuities in the intercept and a time trend for years coincident with the federal legislation (ie, 1994-2004), and also allowed for a differential effect of the homicide rate during this period. We introduced a second set of trend and intercept discontinuities for post-FAWB years to capture the effects of termination of the policy. We used the regression results to predict what would have happened from 1995 to 2019 had there been no FAWB and also to project what would have happened from 2005 onward had it remained in place. RESULTS The FAWB resulted in a significant decrease in public mass shootings, number of gun deaths, and number of gun injuries. We estimate that the FAWB prevented 11 public mass shootings during the decade the ban was in place. A continuation of the FAWB would have prevented 30 public mass shootings that killed 339 people and injured an additional 1139 people. CONCLUSIONS This study demonstrates the utility of public health surveillance on gun violence. Surveillance informs policy on whether a ban on assault weapons and large-capacity magazines reduces public mass shootings. As society searches for effective policies to prevent the next mass shooting, we must consider the overwhelming evidence that bans on assault weapons and/or large-capacity magazines work.
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Affiliation(s)
- Lori Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maryann Mason
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lauren Nadya Singh
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainsville, FL, United States
| | - Hassan Mohammad
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Cynthia A Brandt
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Francis Oehmke
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Mason M, Welch SB, McLone S, Bartell T, Lank PM, Sheehan K, Post LA. A cross-sectional study of opioid involvement in non-poisoning suicide - risks and prevention opportunities. BMC Public Health 2021; 21:767. [PMID: 33882873 PMCID: PMC8060995 DOI: 10.1186/s12889-021-10792-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To examine prevalence, demographic, and incident factors associated with opioid-positivity in Illinois suicide decedents who died by causes other than poisoning. Method Cross-sectional study of Illinois’ suicide decedents occurring between January 2015 and December 2017. Data come from the National Violent Death Reporting System. We used Chi-square tests to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Incident narratives were analyzed to obtain physical and mental health histories and circumstances related to fatal injury events. Results Of 1007 non-poisoning suicide decedents screened for opioids, 16.4% were opioid-positive. White race, age 75 and over, and widowed or unknown marital status were associated with opioid-positivity. Among opioid-positive decedents, 25% had a history of substance use disorder (SUD), 61% depression, and 19% anxiety. The majority (52%) of opioid-positive decedents died by firearm, a higher percentage than opioid-negative decedents. Conclusion The opioid overdose crisis largely has not overlapped with non-poisoning suicide in this study. Overall, our analyses have not identified additional risk factors for suicide among opioid-positive suicide decedents. However, the overlap between opioid-positivity, SUD, and physical and mental health problems found among decedents in our data suggest several suicide prevention opportunities. These include medication assisted treatment for SUD which has been shown to reduce suicide, screening for opioid/benzodiazepine overlap, and limiting access to lethal means during opioid use. Improved death scene investigations for substances and use of the Prescription Drug Monitoring Program to document prescriptions are needed to further understanding of the role of substances in non-poisoning suicide.
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Affiliation(s)
- Maryann Mason
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, USA.
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, USA
| | - Suzanne McLone
- Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Tami Bartell
- Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Patrick M Lank
- Feinberg School of Medicine, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, USA
| | - Karen Sheehan
- Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA.,Feinberg School of Medicine, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, USA
| | - Lori Ann Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, USA
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Mason M, Welch SB, Arunkumar P, Post LA, Feinglass JM. Notes from the Field: Opioid Overdose Deaths Before, During, and After an 11-Week COVID-19 Stay-at-Home Order - Cook County, Illinois, January 1, 2018-October 6, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:362-363. [PMID: 33705372 PMCID: PMC7951817 DOI: 10.15585/mmwr.mm7010a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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27
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Feinglass J, Walker G, Khazanchi R, Rydland K, Tessier RA, Mason M. Community Versus Hospital Opioid-Related Overdose Deaths in Illinois. Public Health Rep 2021; 137:291-300. [PMID: 33682493 PMCID: PMC8900249 DOI: 10.1177/0033354921994901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To better understand approaches to reducing mortality from the opioid epidemic, we analyzed in-hospital versus community opioid-related overdose deaths in Illinois. METHODS We used data from the Statewide Unintentional Drug Overdose Reporting System (July 2017 through December 2018) to identify deaths that occurred in hospitals and communities (ie, homes or public spaces). We used census tract-level data for 34 Illinois counties to create bivariate mapping by overdose death rates. We used logistic regression to analyze the association of demographic and overdose characteristics with the likelihood of death in a hospital versus a community. RESULTS During the study period, 2833 opioid-related overdose deaths occurred in 24 Illinois counties, 655 (23.1%) of which occurred in the hospital; of 2178 community deaths, 1888 (86.7%) occurred in the same census tract as the decedent's recorded residence and 1285 (59.0%) occurred in the decedent's home. Non-Hispanic Black people were 1.63 (95% CI, 1.27-2.10) times more likely than non-Hispanic White people to die in a hospital. Decedents from suburban Cook County and other Chicago suburban counties were significantly more likely to die in the hospital than decedents from Chicago or other Illinois counties. Documentation of a previous overdose, history of opioid use, and having bystanders present were significantly associated with hospital deaths. Evidence of a rapid overdose, fentanyl present, or prescription opioids were significantly associated with deaths in a community. CONCLUSIONS The high number of opioid-related overdose deaths in the community illustrates the need to decriminalize illicit drug use and facilitate treatment seeking. Establishing supervised safe consumption sites may have the biggest effect in reducing the number of opioid-related overdose deaths.
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Affiliation(s)
- Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Joe Feinglass, PhD, Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, 750 N Lakeshore Dr, 10th Floor, Chicago, IL 60611, USA;
| | - Garth Walker
- Buehler Center on Health Policy and Economics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rushmin Khazanchi
- Weinberg College of Arts and Sciences Undergraduate Program, Northwestern University, Chicago, IL, USA
| | | | - Robert Andrew Tessier
- Masters in Public Health Degree Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maryann Mason
- Buehler Center on Health Policy and Economics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ho MW, Puglia F, Tighe D, Chiu GA, Ridout F, Hutchison I, Mason M, McMahon JM. BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative. Br J Oral Maxillofac Surg 2021; 59:831-836. [PMID: 34272114 DOI: 10.1016/j.bjoms.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though not all units offered the full range of service audited. Users suggest the skin and ODA audits were sufficiently clear, but improvement is required in the oncology and reconstruction questionnaire particularly. The pilot was successful in aiding the project team identify areas of weaknesses and strength in the design of the REDCap registry and implementation of the next phase of the initiative. The information and experience gained has to date enabled a successful application for section 251 approval from the HRA and progress for the next phase of national data collection.
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Affiliation(s)
- M W Ho
- Maxillofacial Surgery Department, Leeds Teaching Hospitals NHS Trust, Clarendon Way, LS2 9LU, Leeds, UK.
| | - F Puglia
- BAOMS QOMS Project Manager, NCEPOD, Ground Floor, Abbey House, 74-76 St John Street, London, EC1M 4DZ, UK.
| | - D Tighe
- Maxillofacial Unit, East Kent Hospitals University NHS Foundation Trust, Ethelbert Rd, Canterbury CT1 3NG, UK.
| | - G A Chiu
- Oral and Maxillofacial Surgery, East Lancashire Teaching Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK.
| | - F Ridout
- Saving Faces - The Facial Surgery Research Foundation, 71 Tonbridge Street, Kings Cross, London, WC1H 9DZ, UK.
| | - I Hutchison
- Saving Faces - The Facial Surgery Research Foundation, 71 Tonbridge Street, Kings Cross, London, WC1H 9DZ, UK.
| | - M Mason
- NCEPOD, Ground Floor, Abbey House, 74-76 St John Street, London, EC1M 4DZ, UK.
| | - J M McMahon
- Regional Maxillofacial Unit, The Queen Elizabeth University Hospital, 1345 Govan Road, G51 4TF, Glasgow, UK.
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Ho MW, Puglia F, Tighe D, Chiu GA, Ridout F, Hutchison I, Mason M, McMahon JM. BAOMS QOMS (Quality and Outcomes in Oral and Maxillofacial Surgery), a specialty-wide quality improvement initiative: progress since conception. Br J Oral Maxillofac Surg 2021; 59:619-622. [PMID: 33985849 DOI: 10.1016/j.bjoms.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- M W Ho
- Maxillofacial Surgery Department, Leeds Teaching Hospitals NHS Trust, Clarendon Way, LS2 9LU, Leeds, UK.
| | - F Puglia
- BAOMS QOMS Project Manager, NCEPOD, Ground Floor, Abbey House, 74-76 St John Street, London, EC1M 4DZ, UK.
| | - D Tighe
- Maxillofacial Unit, East Kent Hospitals University NHS Foundation Trust, Ethelbert Rd, Canterbury CT1 3NG, UK.
| | - G A Chiu
- Oral and Maxillofacial Surgery, East Lancashire Teaching Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK.
| | - F Ridout
- Saving Faces - The Facial Surgery Research Foundation, 71 Tonbridge Street, Kings Cross, London, WC1H 9DZ, UK.
| | - I Hutchison
- Saving Faces - The Facial Surgery Research Foundation, 71 Tonbridge Street, Kings Cross, London, WC1H 9DZ, UK.
| | - M Mason
- NCEPOD, Ground Floor, Abbey House, 74-76 St John Street, London, EC1M 4DZ, UK.
| | - J M McMahon
- Regional Maxillofacial Unit, The Queen Elizabeth University Hospital, 1345 Govan Road, G51 4TF, Glasgow, UK.
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Sutton E, Lane JA, Davis M, Walsh EI, Neal DE, Hamdy FC, Mason M, Staffurth J, Martin RM, Metcalfe C, Peters TJ, Donovan JL, Wade J. Men's experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study. Cancer Causes Control 2021; 32:261-269. [PMID: 33394204 PMCID: PMC7870600 DOI: 10.1007/s10552-020-01380-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT. Supplementary Information The online version of this article (10.1007/s10552-020-01380-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E. Sutton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - J. A. Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - M. Davis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - E. I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - D. E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - F. C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - M. Mason
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - J. Staffurth
- Department of Oncology, Cardiff University, Cardiff, UK
| | - R. M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - C. Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - T. J. Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - J. L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, Bristol, UK
| | - J. Wade
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
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Prabhakaran S, Richards CT, Kwon S, Wymore E, Song S, Eisenstein A, Brown J, Kandula NR, Mason M, Beckstrom H, Washington KV, Aggarwal NT. A Community-Engaged Stroke Preparedness Intervention in Chicago. J Am Heart Assoc 2020; 9:e016344. [PMID: 32893720 PMCID: PMC7726971 DOI: 10.1161/jaha.120.016344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We evaluated a community‐engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, −0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of −0.3% per month [95% CI, −0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, −0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, −1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, −1.1% to 1.1%]) or St Louis hospitals (difference of −0.7% per month [95% CI, −1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2–1.6) and in the South Side (OR, 1.2; 95% CI, 1.1–1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9–1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02301299.
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Affiliation(s)
| | | | - Soyang Kwon
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | - Erin Wymore
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Sarah Song
- Rush University Medical Center Chicago IL
| | | | - Jen Brown
- Northwestern University, Feinberg School of Medicine Chicago IL
| | | | - Maryann Mason
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | | | | | - Neelum T Aggarwal
- The Retirement Research Foundation Chicago IL.,Rush Alzheimer's Disease Center Chicago IL
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Merola J, Perez Chada L, Siegel M, Bagel J, Evans C, Lockshin B, Mason M, Guo N, McLean R, Greenberg J, Van Voorhees A. The National Psoriasis Foundation psoriasis treatment targets in real‐world patients: prevalence and association with patient‐reported outcomes in the Corrona Psoriasis Registry. J Eur Acad Dermatol Venereol 2020; 34:2051-2058. [DOI: 10.1111/jdv.16274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/27/2020] [Indexed: 01/12/2023]
Affiliation(s)
- J.F. Merola
- Department of Dermatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
- Department of Medicine Division of Rheumatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - L.M. Perez Chada
- Department of Dermatology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - M. Siegel
- National Psoriasis Foundation Portland OR USA
| | - J. Bagel
- Psoriasis Treatment Center of Central New Jersey East Windsor NJ USA
| | - C. Evans
- Evans Dermatology Partners Austin TX USA
| | | | | | - N. Guo
- Corrona LLC Waltham MA USA
| | | | - J.D. Greenberg
- Corrona LLC Waltham MA USA
- NYU School of Medicine New York NY USA
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Kwon S, Welch S, Mason M. Physical education environment and student physical activity levels in low-income communities. BMC Public Health 2020; 20:147. [PMID: 32005209 PMCID: PMC6995192 DOI: 10.1186/s12889-020-8278-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/27/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the association of physical education (PE) class characteristics, such as lesson context, teacher's physical activity (PA) promotion behavior, and lesson location, with student engagement in moderate- and vigorous-intensity physical activity (MVPA) during PE lessons in elementary school (ES), middle school (MS), and high school (HS). METHODS The study sample included 2106 PE classes from 40 schools located in low-income communities. The System for Observing Fitness Instruction Time (SOFIT) was used to assess lesson context, teacher's behavior, and student PA during PE lessons. Mixed models were used to examine the association between PE class characteristics and the probability of meeting the recommended level of MVPA during PE lessons (MVPA ≥50%), accounting for within-school random effects and school characteristics. RESULTS Almost all PE classes (90%) with ≥60-70% of lesson time spent in motor content and ≥ 10-20% in teacher's in-class PA promotion met the recommended level of MVPA across the school levels. More specifically, among the sub-categories of motor content, more lesson time spent in fitness was significantly associated with MVPA ≥50% in all school levels. However, more lesson time spent in game play was a significant factor only in ES (OR = 2.1; 95% CI = 1.4-3.0). Outdoor lessons were a significant factor in ES (OR = 5.3; 95% CI = 3.1-9.0) and MS (OR = 21.0; 95% CI = 6.3-69.4), but not HS (OR = 1.4; 95% CI = 0.6, 3.2). CONCLUSIONS PE lessons with higher motor content and higher teacher's in-class PA promotion are more likely to meet the recommended level of MVPA in all school levels. However, the sub-categories of motor content and lesson location could impact student MVPA differently by school levels.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children’s Hospital of Chicago Stanley Manne Children’s Research Institute, 225 E Chicago Ave. Box 157, Chicago, IL 60611 USA
| | - Sarah Welch
- Ann & Robert H. Lurie Children’s Hospital of Chicago Stanley Manne Children’s Research Institute, 225 E Chicago Ave. Box 157, Chicago, IL 60611 USA
| | - Maryann Mason
- Ann & Robert H. Lurie Children’s Hospital of Chicago Stanley Manne Children’s Research Institute, 225 E Chicago Ave. Box 157, Chicago, IL 60611 USA
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Kwon S, Honegger K, Mason M. Daily Physical Activity Among Toddlers: Hip and Wrist Accelerometer Assessments. Int J Environ Res Public Health 2019; 16:ijerph16214244. [PMID: 31683776 PMCID: PMC6862284 DOI: 10.3390/ijerph16214244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) habits seem to track over time from as young as early childhood. For children under age 3 years, wearable sensor-measured PA levels have begun to be investigated. The aims of this study were to evaluate the feasibility of using hip- vs. wrist-worn accelerometers, and to report accelerometer-derived PA metrics among toddlers. A convenience sample of 22 toddlers aged 13 to 35 months and their mothers were recruited for this study. ActiGraph wGT3X-BT accelerometers were attached to wrist bands and waist belts. The mothers were asked to affix a wrist band and a waist belt to their participating children during waking hours for four days. They also completed an acceptability survey. Of the 22 toddlers, 19 (86%) had ≥ 3 valid days of hip data, while only 14 (64%) did so for wrist data (p = 0.16). In terms of acceptability, 18 mothers (82%) responded that the 4-day hip wear was easy, while only 13 (59%) responded that the 4-day wrist wear was easy (p = 0.19). Daily light-intensity PA (LPA) was on average 161 min, and daily moderate- and vigorous-intensity PA (MVPA) was on average 47 min, as determined using published hip accelerometer cut-points. There were no significant differences in LPA or MVPA by age or by sex. In conclusion, this study suggests that hip placement of an ActiGraph accelerometer is more feasible than wrist placement among toddlers.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Kyle Honegger
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Maryann Mason
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
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Gonzalez R, Lyon L, Rabbani J, Conell C, Postlethwaite D, Spaulding M, Mason M. The association of ethnicity and Hispanic acculturation status with advance directive completion among older patients in an integrated health system. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Briker A, McLone S, Mason M, Matoba N, Sheehan K. Modifiable sleep-related risk factors in infant deaths in Cook County, Illinois. Inj Epidemiol 2019; 6:24. [PMID: 31333990 PMCID: PMC6616376 DOI: 10.1186/s40621-019-0203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Each year, approximately 3500 infants in the United States die from sleep-related deaths. The number of sleep-related infant deaths has decreased overall since the 1990s, but disparities in sleep-related deaths persist among different populations. The purpose of this study was to determine the most common risk factors and locations in Cook County, Illinois for sleep-related deaths in infants under 6 months of age. Methods We conducted a retrospective study among infants less than 6 months of age who died in Cook County, Illinois in 2015 and 2016, in which the manner of death was of undetermined intent with at least one modifiable sleeping risk factor present, as reported by the medical examiner. Data were obtained from the Illinois Violent Death Reporting System (IVDRS), a state-based, anonymous, surveillance system. County trends and circumstances of the deaths were also evaluated. Frequencies, percentages, and Chi-square analysis were used to describe and characterize these deaths. Results In Cook County in 2015 and 2016, 116 infants less than 6 months of age died where the manner of death was classified as undetermined intent. The median age of death was 2 months. Of these deaths, 63 (54.3%) of the infants were boys. African-American and Hispanic infants comprised 71 (65.7%) and 23 (21.3%) of the deaths, respectively. In 84 (72.4%) of the cases, at least one known sleeping risk factor was present and 56 (66.7%) of the infants who died with a known sleeping risk factor were co-sleeping. Notably, 33 (29.7%) of the deaths in Cook County were clustered within six zip codes. Conclusions The majority of infants who died unexpectedly in Cook County in 2015 and 2016 did so in the presence of sleeping risk factors, with co-sleeping being the most common. African-American infants, infants under 2 months of age, and several geographical areas within Chicago appear to be at increased risk. Interventions to target these preventable causes in the populations at increased risk should be instituted to prevent future deaths.
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Affiliation(s)
- Anna Briker
- 1Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Suzanne McLone
- 2Injury Prevention & Research Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Maryann Mason
- 1Feinberg School of Medicine, Northwestern University, Chicago, IL USA.,2Injury Prevention & Research Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Nana Matoba
- 1Feinberg School of Medicine, Northwestern University, Chicago, IL USA.,3Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Karen Sheehan
- 1Feinberg School of Medicine, Northwestern University, Chicago, IL USA.,2Injury Prevention & Research Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
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Patel K, Ward S, Gash K, Ferguson H, Mason M, McKay SC, Kumar B, Sudlow A, Sutton PA, Humm G, Mohan HM. Prospective cohort study of surgical trainee experience of access to gastrointestinal endoscopy training in the UK and Ireland. Int J Surg 2019; 67:113-116. [PMID: 30708061 DOI: 10.1016/j.ijsu.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Surgical trainees are reporting barriers to training in gastrointestinal (GI) endoscopy. This snapshot survey aimed to gather data on variation in access to quality GI endoscopy training for Colorectal and Upper Gastrointestinal (GI) surgical trainees across the UK and Ireland. MATERIALS AND METHODS An online 20-point survey was designed and distributed nationally to surgical trainee members of the Association of Surgeons in Training (ASiT), Dukes and The Roux Group (formerly Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland Trainees). The survey was designed in collaboration with The Roux Group for Upper GI trainees and the Dukes' Club for Colorectal trainees. RESULTS 218 responses were received, most with a Colorectal or Upper GI sub-specialty interest (colorectal 56.0%; upper GI surgery 25.7%). Only 28.6% of trainees attended a dedicated training endoscopy list at least once a week with 28.1% not attending any at all. Less than half of trainees reported having endoscopy formally timetabled on rotas (36.9%). Most trainees (88.0%) encountered difficulties in gaining endoscopy training including lack of available lists (77.2%), conflicting operative commitments (59.4%), preferential allocation of lists to gastroenterology trainees (57.9%) and resistance from endoscopy departmental leads (38.6%). Regarding JAG accreditation, 77.1% respondents felt it should be mandatory prior to CCT with 80.3% believing this would lead to better access to dedicated endoscopy training equivalent to gastroenterology trainees. 93.1% trainees felt that attaining JAG accreditation by surgical trainees was important to patient care. DISCUSSION This study demonstrates significant barriers in accessing GI endoscopy training for general surgical trainees which urgently needs to be improved. In order to meet JAG training requirements for surgical trainees, a multifaceted collaborative approach from surgical and gastroenterology training bodies, local JAG trainers and the General Surgery SAC and JCST is required. This is to ensure that endoscopy is promoted and a robust model of training is successfully designed and delivered to general surgery trainees.
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Affiliation(s)
- K Patel
- The Association of Surgeons in Training(ASiT), UK
| | | | | | | | - M Mason
- The Roux Group (Formerly AUGISt), UK
| | - S C McKay
- The Roux Group (Formerly AUGISt), UK
| | - B Kumar
- Norfolk and Norwich University Hospitals NHS Foundation Trust, UK
| | - A Sudlow
- Norfolk and Norwich University Hospitals NHS Foundation Trust, UK
| | - P A Sutton
- The Association of Surgeons in Training(ASiT), UK
| | - G Humm
- The Association of Surgeons in Training(ASiT), UK
| | - H M Mohan
- The Association of Surgeons in Training(ASiT), UK.
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Richards CT, Song SY, Kwon S, Wymore E, Kandula NR, Brown JF, Eisenstein A, Mason M, Beckstrom H, Jones P, Washington KV, Aggarwal NT, Prabhakaran S. Abstract 170: Paramedic-Suspected Stroke Increased after Implementing a Community-Engaged Stroke Preparedness Intervention in Chicago. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Emergency medical services (EMS) utilization for acute stroke is associated with improved stroke care and outcomes. We evaluated whether a community-engaged stroke preparedness intervention would increase EMS use for suspected stroke.
Methods:
The Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS) study was conducted in a South Side Chicago neighborhood with proximity to a primary stroke center. In early 2016, CEERIAS implemented a community-engaged stroke preparedness intervention delivered by trained laypersons from the target community who taught peers about the importance of calling 9-1-1 for acute stroke. Paramedic impressions of all EMS calls were obtained from the municipal EMS provider agency serving the study neighborhood. Using ArcGIS 10.5.1 and ArcGIS Pro 2.1.2 (Esri Inc., Redlands, CA), EMS run locations were geolocated, and Getis-Ord Gi* analysis was used to identify hot spots for EMS-suspected stroke. Statistical hot and cold spots are defined as areas where there is <1% chance of case clusters occurring by chance.
Results:
A total of 274,773 EMS runs were successfully geolocated in the 13.5 month pre-CEERIAS intervention period, and 267,061 in the 12.5 month post-CEERIAS intervention period. The study hospital’s neighborhood changed from a cold spot to a hot spot for EMS-suspected stroke (Figure). In the hot spot region adjacent to the study hospital, EMS use for suspected stroke increased 2.2-fold (p<0.001) post-CEERIAS compared to pre-CEERIAS. Overall EMS utilization and EMS utilization for stroke were similar pre- and post-CEERIAS elsewhere in the city.
Conclusions:
A community-engaged stroke preparedness intervention was associated with an increase in EMS use for suspected stroke in targeted neighborhoods of Chicago. Further studies should investigate the effect on stroke outcomes and dissemination strategies to broaden the impact of this intervention.
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Affiliation(s)
| | - Sarah Y Song
- Dept of Neurology, Rush Univ Med Cntr, Chicago, IL
| | - Soyang Kwon
- Dept of Pediatrics, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Erin Wymore
- Dept of Neurology, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Namratha R Kandula
- Depts of General Internal Medicine/Geriatrics and Preventive Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Jen F Brown
- Dept of Preventive Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | | | - Maryann Mason
- Depts of Pediatrics and Preventative Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | | | - Peggy Jones
- Illinois Critical Access Hosp Network, Bloomington, IL
| | | | | | - Shyam Prabhakaran
- Depts of Neurology and Med Social Sciences, Northwestern Feinberg Sch of Medicine, Chicago, IL
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Song SY, Kwon S, Wymore E, Kandula N, Brown J, Eisenstein A, Richards CT, Mason M, Beckstrom H, Jones P, Washington K, Aggarwal N, Prabhakaran S. Abstract WP240: Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS): Exploring Stroke Knowledge, Self-Efficacy, and Trust in the Healthcare System in Chicago. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
In a segregated city like Chicago with distinct neighborhood characteristics, a discrepancy between neighborhoods in stroke knowledge, self-efficacy, and trust in the medical system could impact stroke outcomes.
Methods:
As part of a study which implemented a culturally-tailored stroke preparedness intervention targeting South (S) Side Chicago communities, individuals attending community health events were recruited in S neighborhoods and North (N) Side neighborhoods pre- and one-year post-intervention to assess stroke knowledge, self-efficacy, and trust. Independent stand-alone pre- and post-sample cohorts were purposefully recruited to match demographics. Survey outcomes included knowledge (assessed via Stroke Action Test, STAT), self-efficacy (Likert scale), trust (Health Care Trust Survey), and stress (Likert). Zip codes divided subjects into S/N neighborhoods. Two-sample t-tests compared cohorts, and interactions between race/ethnicity-time and neighborhood-time were tested, with multivariable linear regression when statistically (p<0.05) significant.
Results:
We recruited 364 subjects pre-intervention (S=199, N=165) and 363 subjects post-intervention (S=198, N=165) who were well-matched in race/ethnicity, sex, and education, though the post-group was slightly younger (p=0.04). Unadjusted analysis revealed increases post-intervention in stroke knowledge (p=0.07), self-efficacy (p<0.0001), trust (p<0.0001), and stress scores (p<0.0001). After adjusting for race/ethnicity, gender, and age, the N post-group had greater gains in knowledge (N: 4.0, p=0.02 vs. S: 0.7, p=0.69), self-efficacy (N: 2.3, p<0.0001 vs. S: 0.7, p<0.0001), trust (N: 0.8, p<0.0001 vs. S: -0.1, p=0.20) and stress (N: -0.3, p<0.0001 vs. S: -0.1, p=0.04).
Conclusions:
The observed gains in stroke knowledge, self-efficacy, trust, and stress, greater in the North Side of Chicago, could signal overall improved public health messaging around stroke recognition and treatment, but could also point to socioeconomic factors that may have disproportionately benefited North Side residents. Further focused research to understand neighborhood factors which influence stroke awareness and action is necessary.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peggy Jones
- Illinois Critical Access Hosp Network, Bloomington, IL
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Prabhakaran S, Kwon S, Wymore E, Song SY, Brown J, Mason M, Kandula N, Jones P, Eisenstein A, Beckstrom H, Richards CT, Washington KV, Aggarwal NT. Abstract TMP73: The Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS) Study: Primary Results. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tmp73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Early hospital arrival after stroke increases access to proven treatments and improves outcomes. We hypothesized that a community-engaged stroke preparedness intervention to overcome barriers to early activation of 9-1-1 would increase early hospital arrival and emergency medical services (EMS) use after stroke in high-risk neighborhoods in Chicago.
Methods:
We partnered with stakeholders in a South Side Chicago community with a high stroke incidence and in close proximity to a primary stroke center to develop a community stroke preparedness intervention. The intervention was delivered by “stroke promoters”, trained lay persons from the target neighborhood who utilized in-person discussions to overcome barriers and obtain stroke preparedness pledges as measured by “Pacts to Act FAST”. We applied an interrupted time-series analysis at the target hospital to study the effects of the intervention on EMS utilization and hospital arrival within 3 hours of symptom onset among patients with confirmed ischemic stroke. We compared these results to 6 North Side Chicago stroke centers and 17 St. Louis stroke centers as concurrent controls.
Results:
During a 12-month period, 242 stroke promoters distributed >110,000 educational materials, participated in 167 community events, and registered 39,975 Pacts to Act FAST, reaching 19.4% of residents in the target South Side neighborhoods. Early arrival increased (0.5%/month post-intervention; p=0.124 for slope change) at the target hospital but was not different compared to North Side hospitals (p=0.560) or St. Louis hospitals (p=0.072). The effect on early arrival was significant among patients <66 years old (0.8%/month increase; p=0.036), men (1.2%/month increase; p=0.026), and African-Americans (0.9%/month increase; p=0.037). No effect was observed on EMS use.
Conclusions:
Using a community-engaged approach to deliver a stroke preparedness intervention in Chicago, we observed a modest increase in early hospital arrival after confirmed stroke, which was more pronounced in younger, male, and African-Americans patients. Future efforts should consider improving message penetration and sustainability using novel personal approaches such as social media.
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Affiliation(s)
| | - Soyang Kwon
- Lurie Children's Hosp of Chicago, Chicago, IL
| | | | | | | | | | | | - Peggy Jones
- Illinois Critical Access Hosps Network, Normal, IL
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Bagot KS, Matthews SA, Mason M, Squeglia LM, Fowler J, Gray K, Herting M, May A, Colrain I, Godino J, Tapert S, Brown S, Patrick K. Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci 2018; 32:121-129. [PMID: 29636283 PMCID: PMC6447367 DOI: 10.1016/j.dcn.2018.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 01/06/2023] Open
Abstract
Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.
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Affiliation(s)
- K S Bagot
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S A Matthews
- Penn State University, 507 Oswald Tower, University Park, PA, 16802, USA.
| | - M Mason
- University of Tennessee, Henson Hall, 213 Knoxville, Knoxville, TN, 37996-3332, USA.
| | - Lindsay M Squeglia
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - J Fowler
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - M Herting
- University of Southern California, 2011 N Soto St., Los Angeles, CA, 90032, USA.
| | - A May
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - I Colrain
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - J Godino
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Tapert
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Brown
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Patrick
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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Balyasnikova S, Haboubi N, Wale A, Santiago I, Morgan M, Cunningham D, Mason M, Berho M, Brown G. Session 2: Extramural vascular invasion and extranodal deposits: should they be treated the same? Colorectal Dis 2018; 20 Suppl 1:43-48. [PMID: 29878681 DOI: 10.1111/codi.14078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Professor Nagtegaal has already highlighted that lymph nodes are probably not responsible for the development of liver metastases. If they are not, then is there another mechanism? Professor Haboubi addresses the question of extranodal deposits - their frequency and their importance in the development of metastatic disease. The experts review the evidence and discuss whether this information will alter treatment decisions and staging systems in the future.
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Affiliation(s)
| | - N Haboubi
- Surgical Pathology, Salford University, Manchester, UK
| | - A Wale
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I Santiago
- The Champalimaud Foundation, Lisbon, Portugal
| | - M Morgan
- University Hospital of Wales, Cardiff, UK
| | - D Cunningham
- Clinical Research and Development, NIHR Biomedical Research Centre, The Royal Marsden NHS Foundation Trust, London, UK
| | - M Mason
- Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - M Berho
- Pathology and Laboratory Medicine, Cleveland Clinic, Weston, FL, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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Quimby EG, McLone SG, Mason M, Sheehan K. Cross sectional analysis of Chicago vs suburban Cook County suicide deaths among 10-24-year-olds in the Illinois violent death reporting system. Inj Epidemiol 2018; 5:20. [PMID: 29637420 PMCID: PMC5893507 DOI: 10.1186/s40621-018-0142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In 2014, suicide was the second leading cause of death among 10- to 24-year-olds in the US. Studies note disparities in youth suicide based on sex, race/ethnicity, and urban vs rural settings. This study investigates demographics, mental health indicators, and other circumstances surrounding youth/young adult deaths by suicide, comparing Chicago and suburban Cook County from 2005 to 2010. Methods Using the Illinois Violent Death Reporting System (IVDRS), we employed a cross-sectional design to provide descriptive analysis of decedents in three age groups (10–14, 15–19, and 20–24 years) in two geographic areas: urban (city of Chicago) and suburban (suburban Cook County) between January 1, 2005 and December 31, 2010. We used chi-square testing to test for significant differences in each age group by demographics, mental health indicators, and suicide markers in each area. Results Between 2005 and 2010, the IVDRS reported 299 deaths by suicide among 10–24-year-olds, 52% in Chicago, and 48% in suburban Cook County. Of these deaths, 5.7%, 33.4% and 60.9% were ages 10–14, 15–19, and 20–24 years, respectively. Non-Hispanic (NH) whites comprised 50.7% of the totals, NH Blacks 26.5%, Hispanics 16.8%, and Asians 5.7%. In Chicago, males were 84% of suicides and 62.7% in suburban Cook County among 15–19-year-olds (p < 0.05). White race was significantly different in 10–14-year-olds: 0% in Chicago, 54% in suburban Cook County (p < 0.05). Racial and ethnic differences in suicides among 15–19-year-olds in Chicago vs suburban Cook County were: NH White 22.4% vs 74.5% (p < 0.001), NH Black 46.9% vs 13.7% (p < 0.05), Hispanic 24.5% vs 7.8% (p < 0.05). There were also differences for 20–24-year-olds with NH White 43% vs 65.4% and NH Black 32% vs 13.6% (p < 0.05 for both). For mechanism of death, in 15–19-year-olds, there were differences between city and suburban in firearm deaths (42.9% vs 20%, p < 0.05) and in poisoning (0 vs 14%, p < 0.05). Conclusions Our analyses detected significant location-related differences in the characteristics of decedents within the Chicago region indicating that local data are needed to inform suicide prevention efforts so that those at most risk can be prioritized for services. IVDRS is a potent tool in identifying these variations.
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Affiliation(s)
- Ernika G Quimby
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Suzanne G McLone
- Injury Prevention and Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maryann Mason
- Injury Prevention and Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karen Sheehan
- Injury Prevention and Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Jenkins V, Payne H, Mason M, May S, Matthews L, Catt S. EXTREQOL Identifies Ongoing Challenges in Maximising Quality of Survival in Men with Metastatic Castrate-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:331-333. [PMID: 29459101 DOI: 10.1016/j.clon.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK.
| | - H Payne
- Department of Oncology, University College Hospital London, London, UK
| | - M Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Velindre Hospital, Cardiff, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - S Catt
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Eisenstein AR, Song S, Mason M, Kandula NR, Richards C, Aggarwal NT, Prabhakaran SK. A Community-Partnered Approach to Inform a Culturally Relevant Health Promotion Intervention for Stroke. Health Educ Behav 2018; 45:697-705. [DOI: 10.1177/1090198117752787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The purpose of this study was to generate information from multiethnic, high-risk communities to inform the creation of culturally relevant health promotion intervention for increasing early hospital arrival after stroke. Methods. The study employed a qualitative design, using focus groups with African American, Caucasian, and Hispanic adults in two Chicago community areas. The study relied heavily on stakeholder input in creating the focus group guide, recruiting participants, and interpreting the analysis. Results. Six focus groups gained information from 51 participants, including insights and perspective on participants’ stroke experience and knowledge as well as on facilitators and barriers to calling 9-1-1. Qualitative analysis uncovered themes relating to risk factors, symptoms, knowledge of stroke mechanisms, experience of acute stroke, help seeking, stroke education, recovery, treatment, and emotions. Communities were closely aligned in their knowledge of stroke, but had differing ideas around stroke education and dissemination of education. Discussion. This study identified nuances in real-world barriers to receiving acute stroke services in minority and disadvantaged communities in Chicago neighborhoods. Our findings indicated significant amount of variation by race/ethnicity and, in particular, a lack of similarities based on race/ethnic groups in different communities. These findings underscore the importance of working with communities to fully understand the community-level dynamics that occur.
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Affiliation(s)
- Amy R. Eisenstein
- CJE SeniorLife, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Song
- Rush University Medical Center, Chicago, IL, USA
| | - Maryann Mason
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Eisenstein A, Song SY, Kandula N, Richards CT, Mason M, Kwon S, Brown J, Beckstrom H, Jones P, Washington K, Wymore E, Corado C, Aggarwal NT, Prabhakaran S. Abstract TP167: Race-ethnic Differences in Barriers To 9-1-1 Use for Acute Stroke in Chicago. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Racial/ethnic minority and lower income communities are disproportionately affected by stroke. Earlier recognition and treatment after stroke onset improves outcomes. The goal of this study was to understand the barriers to and facilitators of stroke recognition and subsequent action in multi-ethnic, high-risk communities in Chicago to inform a culturally relevant intervention for increasing early hospital arrival after stroke.
Methods:
This qualitative research study, funded by PCORI, engaged community members and stakeholders in development of a focus group guide about stroke recognition and action, participant recruitment, and analysis and interpretation of results. Six (4 in English, 2 in Spanish) focus groups (51 participants) were conducted with African-American (n=26), Caucasian (n=12), and Hispanic adults (n=13) in two communities. Analysis of focus group transcripts was done by 4 team members using constant comparative methods in which initial thematic codes were derived from the focus group guide. Initial codes were applied, results compared, and codes revised until agreement was reached among coders.
Results:
Themes relating to risk factors, symptoms, knowledge of stroke mechanisms, experience of acute stroke, help seeking, stroke education, recovery, and treatment were identified. Though there was a general understanding of stroke treatments such as “tPA” among all participants, Hispanics frequently discussed folk treatments including "smoothies" and "linseed oil." Specific barriers to calling 9-1-1 included fears about immigration status and fatalism among Hispanics and financial costs and fear/embarrassment of being wrong among African-Americans. Suggestions for stroke education and dissemination included offering resources for low-cost care and treatment among Hispanics and emphasizing neighborhood-level prevalence of stroke among African-Americans.
Conclusions:
This study identified differences in knowledge of treatments and attitudes and specific barriers to acute stroke care in minority and lower income communities in Chicago. These findings underscore the importance of engaging communities to tailor interventions and messages to racial/ethnic barriers and needs.
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Affiliation(s)
| | | | | | | | | | - Soyang Kwon
- Lurie Children’s Hosp of Chicago, Chicago, IL
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Aggarwal NT, Song S, Kwon S, Wymore E, Kandula N, Brown J, Eisenstein A, Richards C, Mason M, Beckstrom H, Jones P, Washington K, Prabhakaran S. Abstract TP288: Development and Preliminary Results of a Community Partnered Stroke Preparedness Intervention in Chicago. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Delayed recognition and hospital arrival after acute stroke leads to worse outcomes. Given multi-level barriers to calling 9-1-1 for stroke, we sought to develop a community-partnered stroke preparedness intervention in Chicago’s underserved communities (where EMS use is low, despite high stroke incidence and mortality) tailored to neighborhood and cultural needs and barriers.
Methods:
As part of the CEERIAS study, we recruited local laypersons to serve as community promoters for a training program that sought to instruct them on delivering targeted messages to their communities. Each half-day training session was facilitated by CEERIAS study investigators, and consisted of a mix of didactic material on stroke statistics relevant to South Side communities, hospital-based tours of the “stroke patient journey,” role playing and tailored strategies for community messaging based on aim 1 focus group findings, and distribution of stroke education materials, “Pact to Act FAST” pledge cards, and website (www.ceerias.com) instructions.
Results:
We conducted 21 training sessions for 242 community promoters (81 African-American [AA] males, 133 AA females, 4 Hispanic males, 5 Hispanic females, 3 Caucasian males, 16 Caucasian females) between October 2015 and May 2016. Since training, these community promoters have distributed >110,000 educational materials including FAST cards and magnets and participated in 167 community events. A total of 38,221 Pact to Act FAST pledges have been registered (Figure), 80.3% of which registered in South Side Chicago zip codes (Figure).
Conclusions:
A community-partnered stroke preparedness campaign was effective in increasing stroke awareness in underserved minority communities, as noted by the high volume of Pact to Act FAST pledges. Data on 9-1-1 calls for stroke and early arrival after stroke at neighborhood hospitals will be analyzed to assess effect of the intervention.
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Affiliation(s)
- Neelum T Aggarwal
- Rush Alzheimer’s Disease Ctr and Dept. of Neurological Sciences and, Rush Univ Med Cntr, Chicago, IL
| | - Sarah Song
- Dept. of Neurological Sciences and, Rush Univ Med Cntr, Chicago, IL
| | - Soyang Kwon
- Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Erin Wymore
- Neurological Sciences, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Namratha Kandula
- Internal Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Jen Brown
- Preventive Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | - Amy Eisenstein
- Med Social Sciences, Council for Jewish Elderly, Chicago, IL
| | | | - Maryann Mason
- Preventive Medicine, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | | | | | | | - Shyam Prabhakaran
- Dept. of Neurological Sciences and, Northwestern Feinberg Sch of Medicine, Chicago, IL
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Song SY, Kwon S, Wymore E, Kandula N, Brown J, Eisenstein A, Richards CT, Mason M, Beckstrom H, Jones P, Washington K, Aggarwal NT, Prabhakaran S. Abstract WP175: Neighborhood Differences in Stroke Knowledge, Self-efficacy, and Barriers to Calling 9-1-1 in Chicago. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Differences in self-efficacy, stroke knowledge, and symptom recognition during acute stroke may affect calling 9-1-1, time to hospital arrival, and stroke outcomes. In a segregated city like Chicago, with significant disparities in stroke outcomes, comparing differences between geographic neighborhoods could reveal important areas for focused interventions.
Methods:
The ongoing Community Engagement in Early Recognition and Immediate Action in Stroke (CEEERIAS) study is a community- and patient-partnered intervention to improve early hospital arrival for stroke patients in Chicago. As part of study analysis, we conducted surveys of a sample of Chicago residents to assess stroke knowledge, self-efficacy, and barriers to calling 9-1-1. Subjects, recruited at community events, were separated into North Side (N) and South Side (S) groups by subject zip code. Surveys included the validated Stroke Action Test (STAT) for knowledge, self-efficacy scales for willingness to call 9-1-1 for stroke, and the Health Care Trust Survey for trust.
Results:
A total of 364 subjects participated (199 in N group and 165 in S group; 55% female [S: 63.6% vs. N: 48.3%]). The N group was more educated while the S group had greater interest in participating in the CEERIAS study, more health problems, and more recent hospital visits. Though stroke knowledge using the STAT was similar, the N group felt more confident recognizing a stroke (p<0.0001). The S group was less likely to believe that immediate hospital care improved post-stroke survival and more likely to believe doctors treated that black patients differently than whites, that hospitals covered up mistakes, and that hospitals experimented on people without consent. The S group was more likely to not call 9-1-1 for fear of financial costs, compared to the N group (23.5% vs. 4.5%, p<0.001).
Conclusion:
Though both neighborhoods had similar levels of stroke knowledge, the subjects living on the South Side had higher mistrust of hospitals and were less likely to call 9-1-1 due to financial costs. Understanding neighborhood-level perceptions of healthcare and barriers allows for development and implementation of targeted, nuanced community-partnered interventions to reduce disparities in stroke outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peggy Jones
- IL Critical Access Hosp Network, Bloomington, IL
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Mason M, Valero-Sanchez I, Archer J, Smith IE. P215 Continuous positive airway pressure (cpap) versus auto-cpap (apap) for the initial treatment of obstructive sleep apnoea syndrome: clinical efficacy and cost. Sleep Breath 2017. [DOI: 10.1136/thoraxjnl-2017-210983.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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