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Cohen SA, Brown MJ, Xu F, Nash CC, Greaney ML. Geographic differences in the magnitude of black-white disparities in having obesity. Obes Sci Pract 2023; 9:516-528. [PMID: 37810524 PMCID: PMC10551120 DOI: 10.1002/osp4.679] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a "rural mortality penalty" where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas. Objective Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity. Methods Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents' county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division. Results Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas. Conclusion Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.
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Affiliation(s)
- Steven A. Cohen
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Monique J. Brown
- Department of Epidemiology and BiostatisticsArnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Furong Xu
- School of EducationAlan Shawn Feinstein College of Education and Professional StudiesUniversity of Rhode IslandChafee Social Science CenterKingstonRhode IslandUSA
| | - Caitlin C. Nash
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Mary L. Greaney
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
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Bourque SL, Williams VN, Scott J, Hwang SS. The Role of Distance from Home to Hospital on Parental Experience in the NICU: A Qualitative Study. Children (Basel) 2023; 10:1576. [PMID: 37761537 PMCID: PMC10529472 DOI: 10.3390/children10091576] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
Prolonged admission to the neonatal intensive care unit presents challenges for families, especially those displaced far from home. Understanding specific barriers to parental engagement in the NICU is key to addressing these challenges with hospital-based interventions. The objective of this qualitative study was to explore the impact of distance from home to hospital on the engagement of parents of very preterm infants (VPT) in the neonatal intensive care unit (NICU). We used a grounded theory approach and conducted 13 qualitative interviews with parents of VPT who were admitted ≥14 days and resided ≥50 miles away using a semi-structured interview guide informed by the socio-ecological framework. We used constant comparative method with double coders for theme emergence. Our results highlight a multitude of facilitators and barriers to engagement. Facilitators included: (1) individual-delivery preparedness and social support; (2) environmental-medical team relationships; and (3) societal-access to perinatal care. Barriers included: (1) individual-transfer stressors, medical needs, mental health, and dependents; (2) environmental-NICU space, communication, and lack of technology; and (3) societal-lack of paid leave. NICU parents with geographic separation from home experienced a multitude of barriers to engagement, many of which could be addressed by hospital-based interventions.
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Affiliation(s)
- Stephanie L. Bourque
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
| | - Venice N. Williams
- Department of Pediatrics, Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jessica Scott
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
| | - Sunah S. Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
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Bilani N, Itani M, Soweid L, Iska S, Bertasi T, Bertasi R, Yaghi M, Mohanna M, Dominguez B, Saravia D, Alley E, Nahleh Z, Arteta-Bulos R. Geographic Origin may Affect Outcomes for Hispanic Patients with Non-Small Cell Lung Cancer in the United States. Clin Lung Cancer 2023; 24:e219-e225. [PMID: 37271715 DOI: 10.1016/j.cllc.2023.04.011] [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: 01/03/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Social determinants of health thoroughly explored in the literature include insurance status, race, and ethnicity. There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogeneous population. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with non-small cell lung cancer (NSCLC) in the Unites states, by geographic region of origin. MATERIALS AND METHODS We identified a cohort of Hispanic patients in the Unites states with NSCLC for which region of origin was documented within the 2004 to 2016 National Cancer Database (NCDB) registry. This included patients from Cuba, Puerto Rico, Mexico, South and Central America, and the Dominican Republic. We performed multivariate logistic regression modeling to determine whether origin was a significant predictor of cancer staging at diagnosis, adjusting for age, sex, histology, grade, insurance status, and facility type. Race was not included due to a nonsignificant association with stage at diagnosis at the bivariate level in this cohort. Subsequently, we used Kaplan-Meier modeling to identify whether overall survival (OS) of Hispanic patients differed by origin. RESULTS A total of 12,557 Hispanic patients with NSCLC were included in this analysis. The breakdown by origin was as follows: n = 2071 (16.5%) Cuban, n = 2360 (18.8%) Puerto Rican, n = 4950 (39.4%) Mexican, n = 2329 (18.5%) from South or Central America, and n = 847 (6.7%) from the Dominican Republic. After controlling for age, sex, histology, grade, insurance status and treating facility type, we found that geographic origin was a significant predictor of advanced stage at diagnosis (P = .015). Compared to Cubans, patients of Puerto Rican origin were less likely to present with advanced disease (68.4% vs. 71.9%; OR: 0.82; 95%CI: 0.69-0.98; P = .026). We also identified a significant (log-rank P-value<.001) difference in OS by geographic origin, even at early-stages of diagnosis. Dominican patients with NSCLC exhibited the highest 5-year OS rate (63.3%), followed by patients from South/Central America (59.7%), Puerto Rico (52.3%), Mexico (45.9%), and Cuba (43.8%). CONCLUSION This study showed that for Hispanic individuals living in the Unites states, region/country of origin is significantly associated with outcomes, even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.
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Affiliation(s)
- Nadeem Bilani
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY.
| | - Mira Itani
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | | | - Sindu Iska
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Tais Bertasi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY
| | - Raphael Bertasi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY
| | - Marita Yaghi
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Mohamed Mohanna
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Barbara Dominguez
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Diana Saravia
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Evan Alley
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Zeina Nahleh
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Rafael Arteta-Bulos
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
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4
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Gonçalves C, Duarte L, Alves JJC. Differences Between Right and Left Colon Cancer in Beira Interior. Cureus 2023; 15:e37500. [PMID: 37187661 PMCID: PMC10181845 DOI: 10.7759/cureus.37500] [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] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Colorectal cancer (CRC) is the second most common cancer in Portugal and worldwide, with a high mortality rate, especially in more advanced stages. In recent decades, there has been a growing interest in the distinction between right colorectal carcinoma (RCC) and left colorectal carcinoma (LCC) due to the different presentation, treatment, and prognosis. Studies show that RCC and LCC have different clinical and biological characteristics, being considered two distinct entities. Material and methods This cross-sectional, descriptive, and comparative retrospective study included data collection at the three hospitals of Beira Interior - Centro Hospitalar Cova de Beira, Hospital Amato Lusitano, and Hospital Sousa Martins - over a 6-year period. Results The proportion of RCC cases was higher. The proportion of women was higher in the RCC group compared to the LCC (46.2%, 121/262 vs. 39%, 76/195). Anemia was statistically higher in the RCC group (p <0.01). On the other hand, intestinal occlusion tends to appear in patients with LCC (p <0.001). The most frequent surgery was elective. The proportion of emergency surgery was higher in the LCC group (LCC vs RCC: 27.2% vs 18.3%; p = 0.03). Discussion and conclusion In both the RCC and LCC groups, the male sex is the most frequently observed in Beira Interior and in Portugal, opposite from the world population, in which the female sex predominates in patients with RCC. The RCC presents alterations in bowel habits more often (p> 0.05). On the other hand, anemia is more common in RCC and intestinal occlusion in LCC, following the current literature. Conducting targeted studies and optimizing the screening and treatment processes are key to reducing mortality associated with CRC.
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Affiliation(s)
- Catarina Gonçalves
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Liliana Duarte
- Esophagogastric Surgery, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | - João José C Alves
- General Surgery, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
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5
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Corrigan J, Tsai WH, Ip-Buting A, Ng C, Ogah I, Peller P, Sharpe H, Laratta C, Pendharkar SR. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med 2021; 18:1013-1020. [PMID: 34823649 DOI: 10.5664/jcsm.9776] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated OSA differs by rural versus urban residential address. METHODS In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated OSA that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included: the proportion of patients who were adherent to CPAP; change in Epworth Sleepiness Scale (ESS) score; change in EuroQOL-5D score; and Visit-Specific Satisfaction Instrument score. All outcomes were measured three months after CPAP initiation. RESULTS We enrolled 242 patients (100 rural) with mean (SD) age 51 (13) years and respiratory event index 24 (18) events/hour. Mean (95% CI) CPAP use was 3.19 (2.8,3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at three months, mean CPAP use was 4.89 (4.51,5.28) hours/night and was not different between rural and urban patients. Improvement in ESS and patient satisfaction were similar between groups, but EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence in multivariable regression analysis. CONCLUSIONS Rural versus urban residence was not associated with differences in CPAP adherence when guided by specialist-interpreted diagnostic sleep testing.
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Affiliation(s)
- Jennifer Corrigan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- Ward of the 21st Century Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Imhokhai Ogah
- Department of Medicine, Queen's University, Kingston, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Cheryl Laratta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Banerjee R, Loren AW. Driving distances and loss to follow-up after hematopoietic cell transplantation. EJHaem 2021; 2:272-275. [PMID: 35845266 PMCID: PMC9175729 DOI: 10.1002/jha2.179] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 06/15/2023]
Abstract
In a recent multicenter analysis, long geographic distances predicted loss to follow-up (LTF) among allogeneic hematopoietic cell transplantation (HCT) survivors. We hypothesized that lower frequencies of patient interactions (including in-person appointments and telemedicine encounters) would predict LTF rather than long driving distances. However, in our retrospective single-center analysis of 263 HCT survivors, the only predictors of LTF were residence in the furthest driving-distance quartile and Medicaid insurance (but not annualized frequencies of patient interactions). Our findings suggest that telemedicine may not necessarily "rescue" long-distance HCT survivors from LTF. Other solutions, for example patient-specific partnerships with local providers, may be helpful.
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology/OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Alison W. Loren
- Division of Hematology/OncologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Magallón-Botaya R, Oliván-Blázquez B, Ramírez-Cervantes KL, Méndez-López-de-la-Manzanara F, Aguilar-Palacio I, Casajuana-Closas M, Andrés-Esteban E. Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care. Int J Environ Res Public Health 2021; 18:ijerph18073842. [PMID: 33917578 PMCID: PMC8038835 DOI: 10.3390/ijerph18073842] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/16/2022]
Abstract
Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.
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Affiliation(s)
- Rosa Magallón-Botaya
- GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain; (R.M.-B.); (F.M.-L.-d.-l.-M.); (I.A.-P.)
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (RedIAPP), 08007 Barcelona, Spain;
| | - Bárbara Oliván-Blázquez
- GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain; (R.M.-B.); (F.M.-L.-d.-l.-M.); (I.A.-P.)
- Research Network on Preventive Activities and Health Promotion (RedIAPP), 08007 Barcelona, Spain;
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence:
| | - Karen Lizzette Ramírez-Cervantes
- Department of Applied Economics, Rey Juan Carlos University, 28300 Madrid, Spain; (K.L.R.-C.); (E.A.-E.)
- Bleeding Patient Research Group, Idi-Paz Research Institute, 28029 Madrid, Spain
- Prevention Department, Spanish Association against Cancer, 28040 Madrid, Spain
| | | | - Isabel Aguilar-Palacio
- GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain; (R.M.-B.); (F.M.-L.-d.-l.-M.); (I.A.-P.)
- Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain
- GRISSA Research Group, 50009 Zaragoza, Spain
| | - Marc Casajuana-Closas
- Research Network on Preventive Activities and Health Promotion (RedIAPP), 08007 Barcelona, Spain;
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Eva Andrés-Esteban
- Department of Applied Economics, Rey Juan Carlos University, 28300 Madrid, Spain; (K.L.R.-C.); (E.A.-E.)
- Bleeding Patient Research Group, Idi-Paz Research Institute, 28029 Madrid, Spain
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Abu-Hammad O, Alnazzawi A, Borzangy SS, Abu-Hammad A, Fayad M, Saadaledin S, Abu-Hammad S, Dar-Odeh N. Factors Influencing Global Variations in COVID-19 Cases and Fatalities; A Review. Healthcare (Basel) 2020; 8:E216. [PMID: 32708986 PMCID: PMC7551068 DOI: 10.3390/healthcare8030216] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 06/20/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/24/2022] Open
Abstract
Since the first cases of the novel corona virus disease (COVID-19) were diagnosed in China, outcomes associated with this infection in terms of total numbers of cases and deaths have varied widely between countries. While some countries had minimal rates of infections and deaths, other countries were hit hard by the pandemic. Countries with highest numbers of cases continued to change over time, but at the time of submission of this article they are: USA, Brazil, Russia, UK, India, Spain, Italy, Peru and Chile. This is in contrary to many countries in the Middle East, Far East, and Africa, which had lower cases or deaths/cases rates. This raised many questions pertaining to this variation. This overview explores the potential factors that contribute to spread, transmission and outcomes of the COVID-19 infection. It also uses an evidence-based approach in reviewing the available most recent literature that tackled the various factors that modify the populations' response to COVID-19, namely, factors pertaining to population characteristics, environmental and geographic factors.
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Affiliation(s)
- Osama Abu-Hammad
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
- School of Dentistry, University of Jordan, Amman 11942, Jordan
| | - Ahmad Alnazzawi
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Sary S Borzangy
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | | | - Mostafa Fayad
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
- Faculty of Dental Medicine, Al-Azhar University for Boys, Cairo 11751, Egypt
| | - Selma Saadaledin
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | | | - Najla Dar-Odeh
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
- School of Dentistry, University of Jordan, Amman 11942, Jordan
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Silver MR, Racette BA, Dube U, Faust IM, Nielsen SS. Well Water and Parkinson's Disease in Medicare Beneficiaries: A Nationwide Case-Control Study. J Parkinsons Dis 2020; 10:693-705. [PMID: 32083591 PMCID: PMC7342021 DOI: 10.3233/jpd-191793] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Well water frequently is considered a risk factor for Parkinson's disease (PD), but few studies were designed appropriately to test whether geographic factors affect PD risk. OBJECTIVE To determine the risk of PD in relation to residential use of private well water. METHODS In a nationwide, population-based case-control study, we identified all incident PD cases (N = 89,790) and all comparable controls (N = 21,549,400) age 66-90 who solely relied on Medicare coverage in the U.S. in 2009. We estimated the probability of use of private well water using zip code of residence at diagnosis/reference and U.S. Census data on household water source. We modeled this exposure linearly in logistic regression to calculate the odds ratio (OR) and 95% confidence interval (CI) of PD risk in relation to well water use. We adjusted for age, sex and race/ethnicity, and verified that smoking and use of medical care did not confound results. We repeated analyses with a 2-year exposure lag and separately within each U.S. state. RESULTS Use of well water was inversely associated with PD risk (OR = 0.87, 95% CI 0.85-0.89). We confirmed this association in a Cox survival analysis in which we followed controls for 5 years, death or PD diagnosis. There was little evidence that well water use increased risk of PD in any individual state. CONCLUSIONS Although it remains possible that exposures in well water in more narrow geographic regions increase PD risk, in general these results suggest that exposures more common in urban/suburban areas might also be relevant.
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Affiliation(s)
- Maya R. Silver
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brad A. Racette
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Umber Dube
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Irene M. Faust
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan Searles Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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10
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Feng X, Wang Y, Tang L, Li D. Polyphenols of Leaf, Litter and Soil of Pinus bungeana across China and Their Responses to Ecological Factors. Chem Biodivers 2019; 16:e1900205. [PMID: 31294527 DOI: 10.1002/cbdv.201900205] [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: 04/15/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
The importance of phenolic compounds for responding to various environmental conditions has been widely emphasized. However, the role of interactions between polyphenols and ecological factors, especially C, N, and P stoichiometry was little studied. Here, 15 sites across five provinces of Pinus bungeana in temperate regions of China were studied. The results showed that the higher values of total phenolic contents (TPC) of leaf and litter were distributed among the north distribution area of P. bungeana, lower values were in the south, whereas soil TPC were contrary to leaf and litter TPC. The stepwise regression, path analysis and decision index of path analysis for leaf TPC and ecological factors showed that altitude had the most direct impact on leaf TPC. Moreover, the principal determinants of leaf, litter and soil TPC were soil C/P ratios, longitude, and soil N/P ratios, respectively. In addition, the leaf, litter and soil TPC of P. bungeana were limited by soil C/N ratios, mean annual temperature, and soil P, respectively. Overall, our study provided evidence that ecological factors affected strongly the leaf, litter and soil TPC of P. bungeana.
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Affiliation(s)
- Xueping Feng
- College of Forestry, Northwest A & F University, Yangling, 712100, P. R. China
| | - Yongtao Wang
- College of Forestry, Northwest A & F University, Yangling, 712100, P. R. China
| | - Lili Tang
- College of Forestry, Northwest A & F University, Yangling, 712100, P. R. China
| | - Dengwu Li
- College of Forestry, Northwest A & F University, Yangling, 712100, P. R. China
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SHAH PARTHD, TROGDON JUSTING, GOLDEN SHELLEYD, GOLIN CAROLE, MARCINIAK MACARYWECK, BREWER NOELT. Impact of Pharmacists on Access to Vaccine Providers: A Geospatial Analysis. Milbank Q 2018; 96:568-592. [PMID: 30203603 PMCID: PMC6131320 DOI: 10.1111/1468-0009.12342] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 11/29/2022] Open
Abstract
Policy Points: Policymakers in the United States should consider expanding pharmacy practice laws to allow pharmacists to vaccinate adolescents as a way to improve geographic access to adolescent vaccines, particularly for human papillomavirus (HPV) vaccine, which has low uptake. Our state-level analysis showed that pharmacists are more geographically dispersed than primary care physicians in the US state of Texas. Including pharmacists among available adolescent vaccine providers would improve the geographic distribution of vaccine providers, especially in areas with an inadequate number of primary care physicians. CONTEXT The largest disparities in human papillomavirus (HPV) vaccination in the United States are due to geography. One potential way of addressing these disparities is by improving geographic access to HPV vaccination. Two federal panels have recommended including community pharmacists as HPV vaccine providers as a strategy to improve opportunities for HPV vaccination for adolescents. We sought to evaluate whether community pharmacists can improve the number of vaccine providers in areas with primary care physician shortages in the US state of Texas. METHODS We gathered publicly available physician and pharmacist 2016 workforce data from the Texas Medical Board and Board of Pharmacy. We conducted geospatial analysis of census tracts to analyze the distribution of physicians and pharmacists and how pharmacists change vaccine provider coverage across the state. FINDINGS Census tracts with high numbers of physicians per capita tended to be located near one another, in 5 of 5 analyses of Moran's I (median = .04). In contrast, pharmacist rates were not spatially dependent on census tract in any of our analyses. If pharmacists were added to primary care physicians as vaccine providers, 35% of urban census tracts that previously had inadequate coverage would be adequately covered, while 18% of inadequately covered rural census tracts would become adequately covered. Overall, when pharmacists were included with primary care physicians as vaccine providers, vaccine providers per capita increased in 2,413 of the 4,508 urban census tracts (54%), while the rate increased in 223 of 746 rural census tracts (30%). CONCLUSIONS Pharmacists are more geographically dispersed across census tracts than primary care physicians. As a result, adding pharmacists to the workforce would increase the availability of vaccine providers in areas with inadequate primary care provider coverage.
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Affiliation(s)
- PARTH D. SHAH
- The Cecil G. Sheps Center for Health Services Research
- UNC Gillings School of Global Public Health
| | - JUSTIN G. TROGDON
- UNC Gillings School of Global Public Health
- UNC Lineberger Comprehensive Cancer Center
| | - SHELLEY D. GOLDEN
- UNC Gillings School of Global Public Health
- UNC Lineberger Comprehensive Cancer Center
| | - CAROL E. GOLIN
- The Cecil G. Sheps Center for Health Services Research
- UNC Gillings School of Global Public Health
| | | | - NOEL T. BREWER
- UNC Gillings School of Global Public Health
- UNC Lineberger Comprehensive Cancer Center
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Zhang X, Zhou L, Liu Y. Modeling Land Use Changes and their Impacts on Non-Point Source Pollution in a Southeast China Coastal Watershed. Int J Environ Res Public Health 2018; 15:ijerph15081593. [PMID: 30060454 PMCID: PMC6121497 DOI: 10.3390/ijerph15081593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022]
Abstract
Changes in landscape patterns in a river basin play a crucial role in the change on load of non-point source pollution. The spatial distribution of various land use types affects the transmission of non-point source pollutants on the basis of source-sink theory in landscape ecology. Jiulong River basin in southeast of China was selected as the study area in this paper. Aiming to analyze the correlation between changing landscape patterns and load of non-point source pollution in this area, traditional landscape metrics and the improved location-weighted landscape contrast index based on the minimum hydrological response unit (HRULCI) were applied in this study, in combination with remote sensing and geographic information system (GIS) technique. The results of the landscape metrics showed the enhanced fragmentation extent and the decreasing polymerization degree of the overall landscape in the watershed. High values of HRULCI were concentrated in cultivated land, while low HRULCI values mostly appeared in forestland, indicating that cultivated land substantially enhanced non-point source pollution, while forestland inhibited the pollution process.
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Affiliation(s)
- Xin Zhang
- State Key Laboratory of Remote Sensing Science, Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Beijing 100101, China.
| | - Lin Zhou
- College of Remote Sensing Information Engineering, Wuhan University, Wuhan 430079, Hubei, China.
| | - Yuqi Liu
- State Key Laboratory of Remote Sensing Science, Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Beijing 100101, China.
- University of Chinese Academy of Sciences, Beijing 100049, China.
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Yesilot N, Putaala J, Bahar SZ, Tatlısumak T. Ethnic and Geographical Differences in Ischaemic Stroke Among Young Adults. Curr Vasc Pharmacol 2018; 15:416-429. [PMID: 28155625 DOI: 10.2174/1570161115666170202161719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/15/2016] [Revised: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischaemic stroke in young adults encompasses approximately 5 - 15% of all ischaemic strokes, depending on the selected upper age limit. The key features of the disease, including incidence, risk factors, underlying causes, mortality, outcomes, as well as long-term risks of recurrent events are different from those for elderly patients. There is also evidence indicating that these characteristics may differ ethnically and geographically. It is clinically important to recognize such differences not only for correct diagnosis and treatment, but also for introducing accurate preventive measures. Ethnic differences may stem from several factors, including genetic influence, and necessitate different approaches, such as personalized diagnostic work-up based on patient characteristics. CONCLUSION In this review, we summarize and discuss the existing data on the geographic and ethnic differential characteristics of young adult ischaemic stroke.
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Affiliation(s)
- Nilufer Yesilot
- Istanbul Tıp Fakultesi, Nöroloji AD, Capa, Fatih, Istanbul. Turkey
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki. Finland
| | - Sara Zarko Bahar
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul. Turkey
| | - Turgut Tatlısumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki. Finland
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Peng RB, Lee H, Ke ZT, Saunders MR. Racial disparities in kidney transplant waitlist appearance in Chicago: Is it race or place? Clin Transplant 2018; 32:e13195. [PMID: 29430739 DOI: 10.1111/ctr.13195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prior work has demonstrated how neighborhood poverty and racial composition impact racial disparities in access to the deceased donor kidney transplant waitlist, both nationally and regionally. We examined the association between neighborhood characteristics and racial disparities in time to transplant waitlist in Chicago, a diverse city with continued neighborhood segregation. METHODS Using data from the United States Renal Data System (USRDS) and the US Census, we investigated time from dialysis initiation to kidney transplant waitlisting for African American and white patients in Chicago using cause-specific proportional hazards analyses, adjusting for individual sociodemographic and clinical characteristics, as well as neighborhood poverty and racial composition. RESULTS In Chicago, African Americans are significantly less likely than whites to appear on the renal transplant waitlist (HR 0.73, P < .05). Compared to whites in nonpoor neighborhoods, African Americans in poor neighborhoods are significantly less likely to appear on the transplant waitlist (HR 0.61, P < .05). Over 69% of African Americans with ESRD live in these neighborhoods. CONCLUSIONS Consistent with national data, African Americans in Chicago have a lower likelihood of waitlisting than whites. This disparity is explained in part by neighborhood poverty, which impacts the majority of African American ESRD patients in Chicago.
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Affiliation(s)
- Robert B Peng
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Haena Lee
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Zheng T Ke
- Department of Statistics, University of Chicago, Chicago, IL, USA
| | - Milda R Saunders
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
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15
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Zulkapli NA, Abdullah JM. Malaysian Journal of Medical Sciences' Performance Status in 2016. Malays J Med Sci 2018; 24:1-4. [PMID: 29379381 DOI: 10.21315/mjms2017.24.6.1] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022] Open
Abstract
This editorial aims to report on the performance of the Malaysian Journal of Medical Sciences (MJMS) in the year 2016. The performance report is based on an analysis of the auto-generated data compiled from the ScholarOne Manuscripts™. It will specifically focus on the pattern of manuscript submission, geographical distribution of contributors, manuscript submission by month and the acceptance-rejection rate of post-review manuscripts. It will also discuss the effects of the decision to raise the article acceptance standards. The MJMS would also like to share the news of its receipt of the 2016 Current Research in Malaysia (CREAM) award. This honour was bestowed upon us by the Ministry of Higher Education (MOHE) of Malaysia, on November 1, 2016.
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Affiliation(s)
- Nour Azimah Zulkapli
- Production Editor, Malaysian Journal of Medical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia
| | - Jafri Malin Abdullah
- Chief Editor, Malaysian Journal of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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16
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Jayawardene WP, Lohrmann DK, Dickinson S, Torabi MR. Population-Level Measures to Predict Obesity Burden in Public Schools: Looking Upstream for Midstream Actions. Am J Health Promot 2016; 32:708-717. [PMID: 27708069 DOI: 10.1177/0890117116670305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
PURPOSE To estimate school-level obesity burden, as reflected in prevalence of obesity, based on the characteristics of students' socioeconomic and geographic environments. DESIGN Secondary analysis of cross-sectional data. SETTING Public schools (N = 504) from 43 of 67 counties in Pennsylvania. PARTICIPANTS Kindergarten through grade 12 students (N = 255 949). MEASURES School-level obesity prevalence for the year 2014 was calculated from state-mandated student body mass index (BMI) measurements. Eighteen aggregate variables, characterizing schools and counties, were retrieved from federal data sources. ANALYSIS Three classification variables-excess weight (BMI ≥ 85th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI > 35% or 120% of 95th percentile)-each with 3 groups of schools (low-, average-, and high-prevalence) were created for discriminant function analysis, based on state mean and standard deviation of school distribution. Analysis tested each classification model to reveal school- and county-level dimensions on which school groups differed from each other. RESULTS Discriminant functions for obesity, which contained school enrollment, percentage of students receiving free/reduced-price lunch, percentage of black/Hispanic students, school location (suburban/other), percentage of county adults with postsecondary education, and percentage of county adults with obesity, yielded 67.86% correct classification (highest accuracy), compared to 34.23% schools classified by chance alone. CONCLUSION In the absence of mandated student BMI screenings, the model developed in this study can be used to identify schools most likely to have high obesity burden and, thereafter, determine dissemination of enhanced resources for the implementation of proven prevention policies and programs.
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Affiliation(s)
- Wasantha P Jayawardene
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - David K Lohrmann
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - Stephanie Dickinson
- 2 Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - Mohammad R Torabi
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
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Saunders MR, Lee H, Alexander GC, Tak HJ, Thistlethwaite JR, Ross LF. Racial disparities in reaching the renal transplant waitlist: is geography as important as race? Clin Transplant 2015; 29:531-8. [PMID: 25818547 DOI: 10.1111/ctr.12547] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the United States, African Americans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied. METHODS The US Renal Data System (USRDS) was linked with US census data to examine time from dialysis initiation to waitlisting for whites (n = 188,410) and African Americans (n = 144,335) using Cox proportional hazards across 11 UNOS regions, adjusting for potentially confounding individual, neighborhood, and state characteristics. RESULTS Likelihood of waitlisting varies significantly by UNOS region, overall and by race. Additionally, African Americans face significantly lower likelihood of waitlisting compared to whites in all but two regions (1 and 6). Overall, 39% of African Americans with ESRD reside in Regions 3 and 4--regions with a large racial disparity and where African Americans comprise a large proportion of the ESRD population. In these regions, the African American-white disparity is an important contributor to their overall regional disparity. CONCLUSIONS Race remains an important factor in time to transplant waitlist in the United States. Race contributes to overall regional disparities; however, the importance of race varies by UNOS region.
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Affiliation(s)
- Milda R Saunders
- Department of Medicine, Section of Hospital Medicine, University of Chicago Medical Center, Chicago, IL, USA.,MacLean Center for Clinical Medical Ethics, University of Chicago Medical Center, Chicago, IL, USA
| | - Haena Lee
- Department of Medicine, Section of Hospital Medicine, University of Chicago Medical Center, Chicago, IL, USA.,Department of Sociology, University of Chicago, Chicago, IL, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Hyo Jung Tak
- Department of Health Management and Policy, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
| | - J Richard Thistlethwaite
- Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Lainie Friedman Ross
- MacLean Center for Clinical Medical Ethics, University of Chicago Medical Center, Chicago, IL, USA.,Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.,Department of Pediatrics, University of Chicago Hospitals, Chicago, IL, USA
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Abstract
OBJECTIVE The purpose of this article is to evaluate American Board of Pediatrics Certifying Examination performance based on city population, hypothesizing that larger cities are associated with higher exam performance. METHODS Pediatric residency programs were retrospectively evaluated from 2010 to 2012. The associated city populations were found using census data. Simple linear regression was performed for continuous variables, and χ(2) tests were performed for categorical variables, using α = .05. RESULTS For 188 programs, the median pass rate was 79.5% (interquartile range = 69% to 90%). Regression showed that city size explains program size (P < .001). Examinees from larger cities had a higher pass rates than examinees from smaller cities, and examinees who are in cities that share residency programs had a higher pass rate than examinees from solo city programs (both P < .05). CONCLUSIONS City size is associated with examinee performance on the American Board of Pediatrics Certifying Examination. City size should be a consideration of future residency applicants.
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McNally RJQ, James PW, Ducker S, Norman PD, James OFW. No rise in incidence but geographical heterogeneity in the occurrence of primary biliary cirrhosis in North East England. Am J Epidemiol 2014; 179:492-8. [PMID: 24401563 PMCID: PMC3908630 DOI: 10.1093/aje/kwt308] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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] [Indexed: 12/29/2022] Open
Abstract
In this study, we examined temporal changes in the incidence of primary biliary cirrhosis (PBC) and investigated associations between PBC incidence and sociodemographic factors and spatial clustering. We included 982 patients aged ≥40 years from North East England with incident PBC diagnosed during 1987–2003. Age-standardized incidence rates with 95% confidence intervals were calculated. Negative binomial regression was used to analyze incidence and socioeconomic deprivation. Clustering analysis was performed using point process methods, testing the null hypothesis that disease risk does not vary spatially and that PBC cases occur independently. The age-standardized incidence rate was 53.50 per million persons per year (95% confidence interval: 48.65, 58.35) in 1987–1994 and 45.09 per million persons per year (95% confidence interval: 41.10, 49.07) in 1995–2003. Risk of PBC increased in areas with higher levels of socioeconomic deprivation (P = 0.035). More specifically, risk increased in areas with higher levels of overcrowded homes (P = 0.040), higher levels of households without cars (P < 0.001), and higher levels of non-owner-occupied homes (P < 0.001). Overall, there was evidence of spatial clustering (P = 0.001). The findings confirm that overall incidence of PBC did not rise over time, but sociodemographic variations suggest that certain aspects of deprivation are involved in its etiology.
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Affiliation(s)
- Richard J. Q. McNally
- Correspondence to Dr. Richard J. Q. McNally, Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, United Kingdom (e-mail: )
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Kopp BT, Wang W, Chisolm DJ, Kelleher KJ, McCoy KS. Inpatient healthcare trends among adult cystic fibrosis patients in the U.S. Pediatr Pulmonol 2012; 47:245-51. [PMID: 21901854 PMCID: PMC3805019 DOI: 10.1002/ppul.21535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adult cystic fibrosis (CF) patients are an expanding cohort that is taken care of in a variety of hospital settings including adult centers located within pediatric institutions. This study compared costs and discharge rates among adult CF patient hospitalizations in terms of location of hospitalization. METHODS The 2007 Nationwide Inpatient Sample was utilized to identify adult CF patient admission data on patients aged 18-44. Data were separated into pediatric and adult facilities based on percentage discharge rate for patients >18. Primary outcomes measures were length of stay (LOS) and total hospital charges. Secondary predictors were geographic, primary payer, and co-morbidity effects on LOS and total hospital charges. RESULTS LOS was higher for adult CF patient admissions in pediatric facilities compared to adult facilities by a mean of 2.5 days. Mean total hospital charges were not significantly different. Adult hospitals in the Western U.S. had a mean total charge more than $50,000 greater than any region in the U.S. Self-pay patients had significantly fewer hospital days and charges across all hospital types. Adult facilities had 7% more CF patients discharged home with home healthcare use. Depressed CF patients had longer LOS by 1.5 days regardless of facility type. CONCLUSIONS LOS for adult CF inpatient admissions was significantly lower in adult facilities compared to pediatric facilities without a significant difference in hospital charges and is influenced by geographic hospital location. Depressed patients had longer lengths of stay regardless of facility type. Self-insured adult CF patients have a significant reduction in LOS and hospital charges when compared to all other payers regardless of hospital type.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Abstract
STUDY OBJECTIVES Social and demographic influences are important for sleep attainment. Geographic location has not been previously explored. METHODS Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were used (N = 157,319). Participants answered a question on Sleep Disturbance and Daytime Fatigue. Thirty-six states/regions provided data on these items. Prevalence estimates were adjusted for age, sex, ethnoracial group, education, income, employment, general health, healthcare access, and depression. Chi-squared tests were conducted across states and census regions, and pseudo-R(2) values were computed for the effect of state, relative to other predictors. To evaluate potential mediators of census region differences, an analysis of p value change associated with specific covariates and covariate groups was undertaken. RESULTS Adjusted prevalence rates of Sleep Disturbance differed across states/regions overall (χ(2) = 412.3, p < 0.0001), as well as separately for men (χ(2) = 139.5, p < 0.0001) and women (χ(2) = 350.0, p < 0.0001), as did rates of Daytime Fatigue overall (χ(2) = 245.7, p < 0.0001), and separately for men (χ(2) = 117.5, p < 0.0001) and women (χ(2) = 181.2, p < 0.0001). Analysis of pseudo-R(2) values revealed that despite these significant findings, state differences were an overall weak predictor, representing 1.30% to 1.73% of the magnitude of the effect of the best predictor (mental health). When Census regions were compared, significant differences were found for Sleep Disturbance (p = 0.002), but after adjustment for covariates, these were no longer significant. Differences existed for Daytime Fatigue in adjusted analyses overall (p < 0.0001), with the West reporting the fewest complaints and the South reporting the most. CONCLUSIONS These results demonstrate that reports of sleep related complaints vary across states, independent (at least partially) of factors that influence circadian rhythms (e.g., latitude).
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Affiliation(s)
- Michael A Grandner
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Hillier SD, Booth M, Muhangi L, Nkurunziza P, Khihembo M, Kakande M, Sewankambo M, Kizindo R, Kizza M, Muwanga M, Elliott AM. Plasmodium falciparum and helminth coinfection in a semi urban population of pregnant women in Uganda. J Infect Dis 2008; 198:920-7. [PMID: 18721060 PMCID: PMC2886962 DOI: 10.1086/591183] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Helminth infections and malaria are widespread in the tropics. Recent studies suggest helminth infections may increase susceptibility to Plasmodium falciparum infection. If confirmed, this increased susceptibility could be particularly important during pregnancy-induced immunosuppression. OBJECTIVE To evaluate the geographical distribution of P. falciparum-helminth coinfection and the associations between P. falciparum infection and infection with various parasite species in pregnant women in Entebbe, Uganda. METHODS A cross-sectional study was conducted at baseline during a trial of antihelminthic drugs during pregnancy. Helminth and P. falciparum infections were quantified in 2,507 asymptomatic women. Subjects' socioeconomic and demographic characteristics and geographical details were recorded. RESULTS Hookworm and Mansonella perstans infections were associated with P. falciparum infection, but the effect of hookworm infection was seen only in the absence of M. perstans infection. The odds ratio [OR] for P. falciparum infection, adjusted for age, tribe, socioeconomic status, HIV infection status, and location was as follows: for individuals infected with hookworm but not M. perstans, 1.53 (95% confidence interval [CI], 1.09-2.14); for individuals infected with M. perstans but not hookworm, 2.33 (95% CI, 1.47-3.69); for individuals infected with both hookworm and M. perstans, 1.85 (CI, 1.24-2.76). No association was observed between infection with Schistosoma mansoni, Trichuris, or Strongyloides species and P. falciparum infection. CONCLUSIONS Hookworm-P. falciparum coinfection and M. perstans-P. falciparum coinfection among pregnant women in Entebbe is more common than would be expected by chance. Further studies are needed to elucidate the mechanism of this association. A helminth-induced increase in susceptibility to P. falciparum could have important consequences for pregnancy outcome and responses to P. falciparum infection in infancy.
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Affiliation(s)
- Stephen D Hillier
- The University of Birmingham Medical School, Birmingham, United Kingdom.
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