scholarly journals Hepatitis A Seroprevalence and Risk Factors among Homeless Adults in San Francisco: Should Homelessness Be Included in the Risk-Based Strategy for Vaccination?

2009 ◽  
Vol 124 (6) ◽  
pp. 813-817 ◽  
Author(s):  
Karen A. Hennessey ◽  
David R. Bangsberg ◽  
Cindy Weinbaum ◽  
Judith A. Hahn
Keyword(s):  
Risk Factors ◽  
San Francisco ◽  
Hepatitis A ◽  
Black People ◽  
Homeless Population ◽  
Foreign Born ◽  
Homeless Adults ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Marginally Housed

Objectives. Homeless adults have an increased risk of infectious diseases due to sexual and drug-related behaviors and substandard living conditions. We investigated the prevalence and risk factors for presence of hepatitis A virus (HAV) antibodies among homeless and marginally housed adults. Methods. We analyzed serologic and questionnaire data from a study of marginally housed and homeless adults in San Francisco from April 1999 to March 2000. We tested seroprevalance for total antibodies to HAV (anti-HAV) and analyzed data using Chi-square tests and logistic regression. Results. Of the 1,138 adults in the study, 52% were anti-HAV positive. The anti-HAV prevalence in this study population was 58% higher than the expected prevalence based on age-specific prevalence rates from the general population. Number of years of homelessness (≤1, 2-4, and ≥5 years) was associated with anti-HAV prevalence (46%, 50%, and 61%, respectively, p<0.001). We found other differences in anti-HAV prevalence (p<0.05) for ever having injected drugs (63% vs. 42% for non-injectors), being foreign-born (75% vs. 51% among U.S.-born), race/ethnicity (72%, 53%, and 45% for Hispanic, white, and black people, respectively), and increasing age (38%, 49%, and 62% among those aged <35, 35-45, and >45 years, respectively). These variables all remained significant in a multivariate model. Conclusions. We found overall anti-HAV prevalence elevated in this San Francisco homeless population compared with the general U.S. population. These data show that anti-HAV was associated with homelessness independent of other known risk factors, such as being foreign-born, race/ethnicity, and injection drug use. This increase indicates an excess risk of HAV infection and the potential need to offer hepatitis A vaccination as part of homeless services.

Comorbid Conditions and GFR Predict Nonvertebral Fractures in Patients With Diabetes in an Ethnic-Specific Manner

2020 ◽  
Vol 105 (6) ◽  
pp. e2168-e2175
Author(s):  
Rajesh K Jain ◽  
Mark G Weiner ◽  
Huaqing Zhao ◽  
Tamara Vokes
Keyword(s):  
Risk Factors ◽  
Osteoporotic Fractures ◽  
Comorbid Conditions ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Major Osteoporotic Fractures ◽  
Specific Manner ◽  
Patients With Diabetes ◽  
Race Ethnicity ◽  
Insulin Use

Abstract Context Diabetes mellitus (DM) is associated with an increased risk of fracture, but it is not clear which diabetes and nondiabetes risk factors may be most important. Objective The aim of the study was to evaluate risk factors for incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African American (AA), Hispanic (HIS), and Caucasian (CA) subjects with DM. Methods This was a retrospective cohort study of 18 210 subjects with DM (7298 CA, 7009 AA and 3903 HIS) at least 40 years of age, being followed at a large healthcare system in Philadelphia, Pennsylvania. Results In a global model in CA with DM, MOF were associated with dementia (HR 4.16; 95% CI, 2.13-8.12), OSA (HR 3.35; 95% CI, 1.78-6.29), COPD (HR 2.43; 95% CI, 1.51-3.92), and diabetic neuropathy (HR 2.52; 95% CI, 1.41-4.50). In AA, MOF were associated with prior MOF (HR 13.67; 95% CI, 5.48-34.1), dementia (HR 3.10; 95% CI, 1.07-8.98), glomerular filtration rate (GFR) less than 45 (HR 2.05; 95% CI, 1.11-3.79), thiazide use (HR 0.54; 95% CI, 0.31-0.93), metformin use (HR 0.59; 95% CI, 0.36-0.97), and chronic steroid use (HR 5.03; 95% CI, 1.51-16.7). In HIS, liver disease (HR 3.06; 95% CI, 1.38-6.79) and insulin use (HR 2.93; 95% CI, 1.76-4.87) were associated with MOF. Conclusion In patients with diabetes, the risk of fracture is related to both diabetes-specific variables and comorbid conditions, but these relationships vary by race/ethnicity.

scholarly journals Diabetes management interventions for homeless adults: a systematic review

2020 ◽  
Vol 65 (9) ◽  
pp. 1773-1783
Author(s):  
Janice Constance ◽  
Joanne M. Lusher
Keyword(s):  
Diabetes Management ◽  
Diabetes Education ◽  
Patient Empowerment ◽  
Homeless People ◽  
Models Of Care ◽  
Homeless Population ◽  
Homeless Adults ◽  
Management Interventions ◽  
Increased Risk ◽  
Health Complications

Abstract Objectives Recent studies investigating diabetes show that inequalities to access appropriate care still persists. Whilst most of the general population are able to access a suitable quality of care, there are a number of groups who fail to receive the same standard. The objective of this review was to identify existing diabetes management interventions for homeless adults. Methods A literature search was conducted in February 2017, and repeated in September 2020. Results Of the 223 potentially relevant articles identified, only 26 were retrieved for detailed evaluation, and 6 met the inclusion criteria. Papers focusing on the management of diabetes in homeless people were included. The studies used interventions including diabetes education; medication support and supplies for blood monitoring; improvements in self-care behaviours; improvements in diabetes control; patient empowerment/engagement; and community engagement/partnerships. Conclusions Effective strategies for addressing the challenges and obstacles that the homeless population face, requires innovative, multi-sectored, flexible and well-coordinated models of care. Without appropriate support, these groups of people are prone to experience poor control of their diabetes; resulting in an increased risk of developing major health complications.

scholarly journals The Effect of Housing Circumstances on Recidivism: Evidence From a Sample of People on Probation in San Francisco

2020 ◽  
Vol 47 (9) ◽  
pp. 1097-1115
Author(s):  
Leah A. Jacobs ◽  
Aaron Gottlieb
Keyword(s):  
Risk Factors ◽  
San Francisco ◽  
Low Risk ◽  
Longitudinal Analyses ◽  
Residential Instability ◽  
Low Level ◽  
Property Crimes ◽  
Increased Risk ◽  
Unique Dataset

The relationships between housing circumstances and recidivism are well established among people released from prison. Despite probation being far more common than prison or parole, we know little about living situations, homelessness, and residential instability among people on probation, and we know even less regarding how these housing circumstances may affect their risk of recidivism. Using a unique dataset of 2,453 people on probation and longitudinal analyses, this study finds that housing insecurity is common and is associated with an increased risk of recidivism among people on probation, above and beyond an array of other recidivism risk factors. Furthermore, we find housing effects are particularly strong for relatively low risk people and for relatively low-severity offenses (i.e., property crimes, minor crimes, and revocations). Interventions that increase housing access for people on probation may reduce recidivism, especially for those who are relatively low risk and low-level reoffending.

scholarly journals Risk factors for childhood and adult primary brain tumors

2019 ◽  
Vol 21 (11) ◽  
pp. 1357-1375 ◽  
Author(s):  
Quinn T Ostrom ◽  
Maral Adel Fahmideh ◽  
David J Cote ◽  
Ivo S Muskens ◽  
Jeremy M Schraw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ionizing Radiation ◽  
Brain Tumors ◽  
The United States ◽  
Primary Brain Tumors ◽  
Clinical Databases ◽  
Increased Risk ◽  
History Of ◽  
Adults And Children ◽  
Race Ethnicity

Abstract Primary brain tumors account for ~1% of new cancer cases and ~2% of cancer deaths in the United States; however, they are the most commonly occurring solid tumors in children. These tumors are very heterogeneous and can be broadly classified into malignant and benign (or non-malignant), and specific histologies vary in frequency by age, sex, and race/ethnicity. Epidemiological studies have explored numerous potential risk factors, and thus far the only validated associations for brain tumors are ionizing radiation (which increases risk in both adults and children) and history of allergies (which decreases risk in adults). Studies of genetic risk factors have identified 32 germline variants associated with increased risk for these tumors in adults (25 in glioma, 2 in meningioma, 3 in pituitary adenoma, and 2 in primary CNS lymphoma), and further studies are currently under way for other histologic subtypes, as well as for various childhood brain tumors. While identifying risk factors for these tumors is difficult due to their rarity, many existing datasets can be leveraged for future discoveries in multi-institutional collaborations. Many institutions are continuing to develop large clinical databases including pre-diagnostic risk factor data, and developments in molecular characterization of tumor subtypes continue to allow for investigation of more refined phenotypes. Key Point 1. Brain tumors are a heterogeneous group of tumors that vary significantly in incidence by age, sex, and race/ethnicity.2. The only well-validated risk factors for brain tumors are ionizing radiation (which increases risk in adults and children) and history of allergies (which decreases risk).3. Genome-wide association studies have identified 32 histology-specific inherited genetic variants associated with increased risk of these tumors.

scholarly journals Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis

2019 ◽  
Vol 70 (8) ◽  
pp. 1562-1572 ◽  
Author(s):  
Mary R Reichler ◽  
Awal Khan ◽  
Timothy R Sterling ◽  
Hui Zhao ◽  
Bin Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skin Test ◽  
Index Patient ◽  
Preventive Therapy ◽  
Patient Contact ◽  
Foreign Born ◽  
Ltbi Treatment ◽  
Increased Risk ◽  
Latent Tb Infection ◽  
Close Contacts

Abstract Background Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease. Methods We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined. Results Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P &lt; .05 for each). Of 1406 skin test–positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P &lt; .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P &lt; .001). Conclusions Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts.

scholarly journals The association of maternal psychosocial stress with newborn telomere length

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242064
Author(s):  
Monika A. Izano ◽  
Lara J. Cushing ◽  
Jue Lin ◽  
Stephanie M. Eick ◽  
Dana E. Goin ◽  
...  
Keyword(s):  
Linear Regression ◽  
Telomere Length ◽  
San Francisco ◽  
Perceived Stress ◽  
Multiple Stressors ◽  
Unplanned Pregnancy ◽  
Financial Strain ◽  
Blood Leukocytes ◽  
Increased Risk ◽  
Race Ethnicity

Background Telomere length in early life predicts later length, and shortened telomere length among adults and children has been linked to increased risk of chronic disease and mortality. Maternal stress during pregnancy may impact telomere length of the newborn. Methods In a diverse cohort of 355 pregnant women receiving prenatal and delivery care services at two hospitals in San Francisco, California, we investigated the relationship between self-reported maternal psychosocial stressors during the 2nd trimester of pregnancy and telomere length (T/S ratio) in newborn umbilical cord blood leukocytes. We examined financial strain, food insecurity, high job strain, poor neighborhood quality, low standing in one’s community, experience of stressful/traumatic life events, caregiving for a dependent family member, perceived stress, and unplanned pregnancy. We used linear regression and Targeted Minimum Loss-Based Estimation (TMLE) to evaluate the change in the T/S ratio associated with exposure to each stressor controlling for maternal age, education, parity, race/ethnicity, and delivery hospital. Results In TMLE analyses, low community standing (-0.09; 95% confidence interval [CI]-0.19 to 0.00) and perceived stress (-0.07; 95% CI -0.15 to 0.021 was marginally associated with shorter newborn telomere length, but the associations were not significant after adjusting for multiple comparisons. All linear regression estimates were not statistically significant. Our results also suggest that the association between some maternal stressors and newborn telomere length varies by race/ethnicity and infant sex. Conclusions This study is the first to examine the joint effect of multiple stressors during pregnancy on newborn TL using a flexible modeling approach.

scholarly journals Stillbirth and Live Birth at Periviable Gestational Age: A Comparison of Prevalence and Risk Factors

2018 ◽  
Vol 36 (05) ◽  
pp. 537-544 ◽  
Author(s):  
Suzan Carmichael ◽  
Yair Blumenfeld ◽  
Jonathan Mayo ◽  
Jochen Profit ◽  
Gary Shaw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Live Birth ◽  
Gestational Age ◽  
Pregnancy Hypertension ◽  
Live Births ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Lower Education ◽  
Prevalence Ratios ◽  
Racial Ethnic

Objective We compared the prevalence of and risk factors for stillbirth and live birth at periviable gestational age (20–25 weeks). Study Design This is a cohort study of 2.5 million singleton births in California from 2007 to 2011. We estimated racial–ethnic prevalence ratios and used multivariable logistic regression for risk factor comparisons. Results In this study, 42% of deliveries at 20 to 25 weeks' gestation were stillbirths, and 22% were live births who died within 24 hours. The prevalence of delivery at periviable gestation was 3.4 per 1,000 deliveries among whites, 10.9 for blacks, 3.5 for Asians, and 4.4 for Hispanics. Nonwhite race–ethnicity, lower education, uninsured status, being U.S. born, older age, obesity, smoking, pre-pregnancy hypertension, nulliparity, interpregnancy interval, and prior preterm birth or stillbirth were all associated with increased risk of both stillbirth and live birth at 20 to 25 weeks' gestation, compared with delivery of a live birth at 37 to 41 weeks. Conclusion Inclusion of stillbirths and live births in studies of deliveries at periviable gestations is important.

scholarly journals Venous-Thromboembolism in Elderly Patients with Acute Myeloid Leukemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4679-4679 ◽  
Author(s):  
Radhika Gangaraju ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Myeloid Leukemia ◽  
Peripheral Vascular ◽  
Increased Risk ◽  
Elderly Aml ◽  
History Of ◽  
Race Ethnicity ◽  
Morbid Conditions ◽  
New Onset

BACKGROUND: Venous-thromboembolism (VTE) is a debilitating condition and is associated with excess mortality. Small, single institution studies suggest that the risk of VTE in acute myeloid leukemia (AML) patients is elevated and is similar to that seen in solid tumor patients. However, population-based studies describing VTE risk and predictors of VTE in elderly AML patients are lacking. We used Medicare-linked SEER (Surveillance, Epidemiology, and End Results) data to address this knowledge gap. METHODS: We identified 4,166 Medicare beneficiaries diagnosed with AML at age ≥67y between 2007 and 2013. We ascertained baseline sociodemographics and pre-existing comorbidities for 2y prior to AML diagnosis. Patients were followed from AML diagnosis until development of post-AML VTE, or, in the absence of VTE diagnosis, for 2y (if alive), or until death, blood or marrow transplant, or end of study (12/31/2014), whichever came first. VTE diagnosis was based on ICD 9 codes using validated claims algorithms, and included deep vein thrombosis (DVT), pulmonary embolism (PE) and thrombophlebitis. Statistical Analysis: Cumulative incidence functions were used to assess post-AML VTE risk (overall, new-onset). Cox regression models examined the following risk factors associated with VTE: age at AML diagnosis, sex, race/ethnicity, socioeconomic status, history of pre-AML VTE, and pre-existing co-morbid conditions (hypertension, dyslipidemia, diabetes, stroke, rheumatoid arthritis, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, atrial fibrillation, anemia and peripheral vascular disease). RESULTS: Median age at AML diagnosis was 79y (range: 67-105y); 52% were male, 83% non-Hispanic white and 20% resided in an area where >20% of the population lived below poverty level; 50% of the cohort received chemotherapy. Prior to AML diagnosis, 15% were receiving anticoagulants; 2% were on anticoagulation for pre-AML VTE. Cumulative Incidence of VTE: Overall, 167 (4.0%) patients were diagnosed with post-AML VTE (DVT [63%], PE [32%], thrombophlebitis [5%]); 38% had >1 VTE. Of the 167 patients with post-AML VTE, only 25 (15%) had new-onset VTE; the remaining 142 carried a history of pre-AML VTE. The 2y cumulative incidence of any post-AML VTE was 4.3% (95%CI: 3.6%-5.1%) (Fig 1). Fifty-six percent of VTE episodes occurred within 3 months of AML diagnosis. The incidence was 0.6% (95% CI: 0.5%-0.8%) for new-onset VTE and was 1.9% (95%CI 1.3-2.6) for multiple VTEs. The 2y cumulative incidence of post-AML VTE among those with a history of pre-AML VTE was 17.1% (95% CI: 13.3-21.9%). Risk factors for VTE: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty, and co-morbid conditions, AML patients who had pre-AML VTE, were at 7.6-fold increased risk of post-AML VTE (95%CI: 4.8-12.0, p<0.001). No other risk factors were associated with post-AML VTE risk, with the exception of a marginal association between a prior history of peripheral vascular disease and new-onset VTE (HR=3.5, 95%CI: 0.9-14.8, p=0.08) (Table 1). Risk factors for VTE among patients receiving chemotherapy: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty and co-morbid conditions, AML patients with pre-AML VTE were at 8.1-fold increased risk of any post-AML VTE (95%CI: 4.4-14.7, p<0.001). Mortality associated with VTE: The 2y cumulative incidence of mortality for those with no pre-AML VTE was 91%, compared to 95% for those with a pre-AML VTE (HR 1.23, p=0.017). New-onset VTE after the diagnosis of AML was not associated with an increased risk in mortality (HR 1.04, p=0.705). CONCLUSION: History of VTE prior to diagnosis of AML significantly increases the risk of post-AML VTE and overall mortality. These findings can be used to inform appropriate thromboprophylaxis in elderly AML patients who carry a pre-AML diagnosis of VTE. Disclosures No relevant conflicts of interest to declare.

Evaluation of leukocytosis: Benign or malignant.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 245-245
Author(s):  
Elizabeth Ann Bowhay-Carnes ◽  
Shuko Lee ◽  
Paromita Datta
Keyword(s):  
Risk Factors ◽  
Hematologic Malignancy ◽  
Cost Effective ◽  
Final Diagnosis ◽  
Laboratory Evaluation ◽  
Improvement Project ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Race Ethnicity ◽  
Secondary Causes

245 Background: Hematologists frequently evaluate patients with leukocytosis to differentiate between benign and malignant causes. The objective of this quality improvement project was to identify risk factors for malignant leukocytosis. Methods: A retrospective analysis of 1,330 consults in ALM VA Outpatient Hematology Clinic between 1/1/2011 and 2/22/2015 was performed. 147 patients referred for evaluation of leukocytosis were included in this study. The following data was collected: sex, age, race, ethnicity, BMI, tobacco use, total WBC, tempo of leukocytosis (constant vs intermittent), Hg level, plt count, ANC, ALC, AMC, AEC, ABC, laboratory tests performed during work-up, final diagnosis (primary hematologic malignancy vs secondary causes). 35 patients (24%) with a diagnosis of primary hematologic malignancy were compared with 112 patients (76%) with secondary causes and the relative risk of a primary hematology malignancy related to various risk factors was calculated. Results: See Table. Conclusions: Statistically significant independent risk factors for the presence of a primary hematologic malignancy as the cause of leukocytosis were identified. There was no increased risk based on race, ethnicity, BMI, AMC, or AEC. By identifying risk factors for malignant leukocytosis, we have created and implemented an algorithm outlining clinically appropriate and cost-effective laboratory evaluation for patients with leukocytosis.[Table: see text]

Neighborhood Income Inequality and Adolescent Relationship Aggression: Results of a Nationally Representative, Longitudinal Study

2020 ◽  
pp. 088626052090802
Author(s):  
Nnenna Okeke ◽  
Emily F. Rothman ◽  
Elizabeth A. Mumford
Keyword(s):  
Risk Factors ◽  
Income Inequality ◽  
Community Level ◽  
Public Health Issue ◽  
Intimate Violence ◽  
Relationship Aggression ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Neighborhood Income ◽  
Adolescent Relationship

Adolescent relationship aggression (ARA) is a prevalent public health issue with myriad adverse health outcomes. Experts suggest that a research focus on individual- and family-level risk factors for ARA has been too limited, proposing that research on the “outer layers” of the social-ecological model, including community-level risk factors, may hold promise for the development of interventions targeting ARA. This study assessed the longitudinal association between one community-level risk factor—income inequality—and ARA victimization and perpetration. The study also examined variations of this association by race/ethnicity, income, and/or sex. This study is based on 723 participants (351 male and 372 female participants) from the Survey on Teen Relationships and Intimate Violence (STRiV). We assessed data across two waves (2013 and 2016). Logistic regression models were used to assess the association between neighborhood income inequality and both ARA victimization and perpetration. We included interaction terms to assess whether these associations varied by race/ethnicity and/or income, and we stratified analyses by sex. We did not detect associations between income inequality and ARA victimization or perpetration in the overall sample. However, for female participants from families with more income, living in a neighborhood with more income inequality was associated with increased risk of ARA victimization (odds ratio [OR] = 1.163; p < .05). More affluent, compared with less affluent, adolescent girls in mixed-income neighborhoods may be at increased risk of ARA victimization.

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