Shelter Characteristics, Infection Prevention Practices, and Universal Testing for SARS-CoV-2 at Homeless Shelters in 7 US Urban Areas

2021 ◽  
pp. e1-e6
Author(s):  
Julie L. Self ◽  
Martha P. Montgomery ◽  
Karrie-Ann Toews ◽  
Elizabeth A. Samuels ◽  
Elizabeth Imbert ◽  
...  
Keyword(s):  
Urban Areas ◽  
Infection Prevention ◽  
The United States ◽  
Homeless Shelters ◽  
Infection Prevalence ◽  
Universal Testing ◽  
Modifiable Factors ◽  
High Infection ◽  
Sleeping Arrangements ◽  
Risk Ratios

Objectives. To examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection point prevalence during universal testing at homeless shelters in the United States. Methods. SARS-CoV-2 testing was offered to clients and staff at homeless shelters, irrespective of symptoms. Site assessments were conducted from March 30 to June 1, 2020, to collect information on shelter characteristics and infection prevention practices. We assessed the association between SARS-CoV-2 infection prevalence and shelter characteristics, including 20 infection prevention practices by using crude risk ratios (RRs) and exact unconditional 95% confidence intervals (CIs). Results. Site assessments and SARS-CoV-2 testing results were reported for 63 homeless shelters in 7 US urban areas. Median infection prevalence was 2.9% (range = 0%–71.4%). Shelters implementing head-to-toe sleeping and excluding symptomatic staff from working were less likely to have high infection prevalence (RR = 0.5; 95% CI = 0.3, 0.8; and RR = 0.5; 95% CI = 0.4, 0.6; respectively); shelters with medical services available were less likely to have very high infection prevalence (RR = 0.5; 95% CI = 0.2, 1.0). Conclusions. Sleeping arrangements and staffing policies are modifiable factors that might be associated with SARS-CoV-2 infection prevalence in homeless shelters. Shelters should follow recommended practices to reduce the risk of SARS-CoV-2 transmission. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306198 )

scholarly journals Perceptions and Experiences of Frontline Urban Indian Organization Healthcare Workers With Infection Prevention and Control During the COVID-19 Pandemic

2021 ◽  
Vol 6 ◽  
Author(s):  
Noah Collins ◽  
Jolie Crowder ◽  
Jamie Ishcomer-Aazami ◽  
Dionne Apedjihoun
Keyword(s):  
Native American ◽  
Urban Areas ◽  
Prevention And Control ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
The United States ◽  
Infection Prevention And Control ◽  
National Council ◽  
Urban Indian ◽  
And Control

Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's Project Firstline, NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.

scholarly journals Congregate Shelter Characteristics and Prevalence of Asymptomatic SARS-CoV-2

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Rebecca Karb ◽  
Rahul Vanjani ◽  
M. Catherine Trimbur ◽  
Anthony Napoli
Keyword(s):  
Rhode Island ◽  
A Priori ◽  
Mitigation Strategies ◽  
Homeless Shelters ◽  
Infection Prevalence ◽  
Multicenter Cohort Study ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Increased Risk ◽  
Sleeping Arrangements

AbstractBackgroundIndividuals experiencing homelessness residing in congregate shelters have increased risk for SARS-CoV-2 infection. Prevalence of asymptomatic SARS-CoV-2 in congregate shelters is high, but shelter characteristics associated with SARS-CoV-2 transmission are currently unknown.MethodsWe conducted a cross-sectional, multicenter cohort study across five congregate shelters in Rhode Island. We tested people 18 years of age and older staying in Rhode Island congregate shelters in April 2020 during the COVID-19 pandemic. A survey instrument was designed and implemented based on an a priori sample size. All consented participants reported basic demographics, recent travel, duration of time at the shelter, any symptomatology, and had their temperature and pulse oximetry measured. Each participant was tested for COVID-19 using nasopharyngeal swabbing. Shelter characteristics about location, occupancy, resident length of stay, and COVID-19 mitigation strategies were collected through structured phone questionnaire with shelter staff.ResultsA total of 302 individuals were screened and 299 participated across five homeless shelters. The median age was 47.9 (range 18-85) and 20% were female. Of the 299 participants, 35 (11.7%) were positive for SARS-CoV-2; rates varied among shelters, ranging from 0% to 35%. Among the participants in the study, 5% had a new cough, 4% shortness of breath, and 3% reported loss of taste or smell. Symptom prevalence did not vary significantly between positive and negative SARS-CoV-2 groups. Regular symptom screening was not associated with lower infection rates. Shelters with higher rates of positivity were in more densely populated areas, cared for a more transient populations, and instituted fewer social distancing practices for sleeping arrangements or mealtimes.Conclusions and RelevanceResidents of congregate shelters are at increased risk for asymptomatic transmission of SARS-CoV-2. To reduce transmission and enable continuation of low-threshold shelter services, there is a need for universal testing, implementation of infection control and physical distancing measures within congregate shelters, and expansion of non-congregate supportive housing.

scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p < .001) and 1.08-fold (95% CI = 1.05–1.10, p < .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p < .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p < .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p < .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

scholarly journals Dengue-2 and Guadeloupe Mosquito Virus RNA Detected in Aedes (Stegomyia) spp. Collected in a Vehicle Impound Yard in Santo André, SP, Brazil

Insects ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 248
Author(s):  
Marina E. O. Rangel ◽  
Luana P. R. Oliveira ◽  
Aline D. Cabral ◽  
Katharyna C. Gois ◽  
Marcos V. M. Lima ◽  
...  
Keyword(s):  
Urban Areas ◽  
Mosquito Species ◽  
Infection Rates ◽  
Serra Do Mar ◽  
Virus Rna ◽  
High Infection ◽  
Human Landing ◽  
Environmental Protection Area ◽  
Protection Area ◽  
Minimum Infection Rate

In 2018–2019, we conducted mosquito collections in a municipal vehicle impound yard, which is 10 km from the Serra do Mar Environmental Protection Area in Santo André, SP, Brazil. Our aim is to study arboviruses in the impound yard, to understand the transmission of arboviruses in an urban environment in Brazil. We captured the mosquitoes using human-landing catches and processed them for arbovirus detection by conventional and quantitative RT-PCR assays. We captured two mosquito species, Aedes aegypti (73 total specimens; 18 females and 55 males) and Ae. albopictus (34 specimens; 27 females and 7 males). The minimum infection rate for DENV-2 was 11.5 per 1000 (CI95%: 1–33.9). The detection of DENV-2 RNA in an Ae. albopictus female suggests that this virus might occur in high infection rates in the sampled mosquito population and is endemic in the urban areas of Santo André. In addition, Guadeloupe mosquito virus RNA was detected in an Ae. aegypti female. To our knowledge, this was the first detection of the Guadeloupe mosquito virus in Brazil.

Identification of Potential Freight Parking Locations in Urban Areas

2021 ◽  
pp. 036119812110130
Author(s):  
Glenn Vorhes ◽  
Ernest Perry ◽  
Soyoung Ahn
Keyword(s):  
United States ◽  
Information System ◽  
Satellite Imagery ◽  
Urban Areas ◽  
The United States ◽  
Truck Drivers ◽  
Short List ◽  
Automated Processes ◽  
Parking Facilities ◽  
Urban Sites

Truck parking is a crucial element of the United States’ transportation system as it provides truckers with safe places to rest and stage for deliveries. Demand for truck parking spaces exceeds supply and shortages are especially common in and around urban areas. Freight operations are negatively affected as truck drivers are unable to park in logistically ideal locations. Drivers may resort to unsafe practices such as parking on ramps or in abandoned lots. This report seeks to examine the potential parking availability of vacant urban parcels by establishing a methodology to identify parcels and examining whether the identified parcels are suitable for truck parking. Previous research has demonstrated that affordable, accessible parcels are available to accommodate truck parking. When used in conjunction with other policies, adaptation of urban sites could help reduce the severity of truck parking shortages. Geographic information system parcel and roadway data were obtained for one urban area in each of the 10 Mid America Association of Transportation Officials region states. Area and proximity filters were applied followed by spectral analysis of satellite imagery to identify candidate parcels for truck parking facilities within urban areas. The automated processes created a ranked short list of potential parcels from which those best suited for truck parking could be efficiently identified for inspection by satellite imagery. This process resulted in a manageable number of parcels to be evaluated further by local knowledge metrics such as availability and cost, existing infrastructure and municipal connections, and safety.

The Rural-Urban Continuum of Polarization: Understanding the Geography of the 2018 Midterms

The Forum ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kenneth M. Johnson ◽  
Dante J. Scala
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Metropolitan Areas ◽  
Political Attitudes ◽  
The United States ◽  
Rural America ◽  
Rural Regions ◽  
Urban America ◽  
Urban And Rural Areas ◽  
The Continuum

Abstract This study of the 2018 congressional midterms demonstrates how voting patterns and political attitudes vary across a spectrum of urban and rural areas in the United States. Rural America is no more a monolith than is urban America. The rural-urban gradient is better represented by a continuum than a dichotomy. This is evident in the voting results in 2018, just as it was in 2016. We found that the political tipping point lies beyond major metropolitan areas, in the suburban counties of smaller metropolitan areas. Democrats enjoyed even greater success in densely populated urban areas in 2018 than in 2016. Residents of these urban areas display distinctive and consistent social and political attitudes across a range of scales. At the other end of the continuum in remote rural areas, Republican candidates continued to command voter support despite the challenging national political environment. Voters in these rural regions expressed social and political attitudes diametrically opposed to their counterparts in large urban cores.

scholarly journals Infection Prevention Considerations for a Multi-Mission Convention Center Field Hospital in Baltimore, Maryland during the COVID-19 Pandemic

2021 ◽  
pp. 1-21
Author(s):  
Jennifer A. Jones ◽  
Zishan K. Siddiqui ◽  
Charles Callahan ◽  
Surbhi Leekha ◽  
Sharon Smyth ◽  
...  
Keyword(s):  
Best Practices ◽  
Infection Prevention ◽  
Diagnostic Testing ◽  
The United States ◽  
Infection Prevention And Control ◽  
Field Hospital ◽  
First Case ◽  
Convention Center ◽  
Set Up ◽  
And Control

Abstract The state of Maryland identified its first case of COVID-19 on March 5, 2020. The Baltimore Convention Center (BCCFH) quickly became a selected location to set up a 250-bed inpatient Field Hospital and Alternate Care Site. In contrast to other field hospitals throughout the United States, the BCCFH remained open throughout the pandemic and took on additional COVID-19 missions, including community SARS-CoV-2 diagnostic testing, monoclonal antibody infusions for COVID-19 outpatients, and community COVID-19 vaccinations. At the time of publication, the BCCFH had cared for 1,478 COVID-19 inpatients, performed 108,155 COVID-19 tests, infused 2,166 COVID-19 patients, and administered 115,169 doses of COVID-19 vaccine. To prevent the spread of pathogens during operations, infection prevention and control guidelines were essential to ensure the safety of staff and patients. Through multi-agency collaboration, utilization of infection prevention best practices, and answering what we describe as “PPE-ESP”, an operational framework was established to reduce infection risks for those providing or receiving care at the BCCFH during the COVID-19 pandemic.

Housing Finance Reform: Should There Be a Government Guarantee?

2011 ◽  
Vol 01 (04) ◽  
pp. 811-822 ◽  
Author(s):  
Richard K. Green
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Economic Stress ◽  
Mortgage Market ◽  
Best Interest ◽  
Finance Reform ◽  
Fixed Rate ◽  
The Great Depression ◽  
The Republic

In 2007 and 2008, the mortgage market failed. It failed in a number of dimensions: Default rates rose to their highest levels since the great depression, and mortgage liquidity ground to a halt. This failure has produced recriminations: Blame has been laid at the feet of borrowers, brokers, lenders, investment banks, investors and government and quasi-government entities that guaranteed mortgages. These recent events have produced an important debate: Whether the U.S. mortgage market requires a federal guarantee in order to best serve consumers, investors and markets. My view is that such a guarantee is necessary. I will divide my argument into four areas: (1) I will argue that the United States has had a history of providing guarantees, either implicit or explicit, regardless of its professed position on the matter. This phenomenon goes back to the origins of the republic. It is in the best interest of the country to acknowledge the existence of such guarantees, and to price them appropriately before, rather than after, they become necessary. (2) I will argue that in times of economic stress, such as now, the absence of government guarantees would lead to an absence of mortgages. (3) I will argue that a purely "private" market would likely not provide a 30 year fixed rate pre-payable mortgage. I think that this is no longer a particularly controversial statement; what is more controversial is whether such a mortgage is necessary — I will argue that it is. (4) I will argue that in the absence of a federal guarantee, the price and quantity of mortgages will vary across geography. In particular, rural areas will have less access to mortgage credit that urban areas, central cities will have less access than suburbs. Condominiums already are treated less favorably than detached houses, and this difference is likely to get larger in the absence of a guarantee.

scholarly journals The effects of global changes upon regional ozone pollution in the United States

2009 ◽  
Vol 9 (4) ◽  
pp. 1125-1141 ◽  
Author(s):  
J. Chen ◽  
J. Avise ◽  
B. Lamb ◽  
E. Salathé ◽  
C. Mass ◽  
...  
Keyword(s):  
Urban Areas ◽  
The United States ◽  
Base Case ◽  
Global Changes ◽  
Ozone Pollution ◽  
Modeling Framework ◽  
Voc Emissions ◽  
The Us ◽  
The Future ◽  
Future Case

Abstract. A comprehensive numerical modeling framework was developed to estimate the effects of collective global changes upon ozone pollution in the US in 2050. The framework consists of the global climate and chemistry models, PCM (Parallel Climate Model) and MOZART-2 (Model for Ozone and Related Chemical Tracers v.2), coupled with regional meteorology and chemistry models, MM5 (Mesoscale Meteorological model) and CMAQ (Community Multi-scale Air Quality model). The modeling system was applied for two 10-year simulations: 1990–1999 as a present-day base case and 2045–2054 as a future case. For the current decade, the daily maximum 8-h moving average (DM8H) ozone mixing ratio distributions for spring, summer and fall showed good agreement with observations. The future case simulation followed the Intergovernmental Panel on Climate Change (IPCC) A2 scenario together with business-as-usual US emission projections and projected alterations in land use, land cover (LULC) due to urban expansion and changes in vegetation. For these projections, US anthropogenic NOx (NO+NO2) and VOC (volatile organic carbon) emissions increased by approximately 6% and 50%, respectively, while biogenic VOC emissions decreased, in spite of warmer temperatures, due to decreases in forested lands and expansion of croplands, grasslands and urban areas. A stochastic model for wildfire emissions was applied that projected 25% higher VOC emissions in the future. For the global and US emission projection used here, regional ozone pollution becomes worse in the 2045–2054 period for all months. Annually, the mean DM8H ozone was projected to increase by 9.6 ppbv (22%). The changes were higher in the spring and winter (25%) and smaller in the summer (17%). The area affected by elevated ozone within the US continent was projected to increase; areas with levels exceeding the 75 ppbv ozone standard at least once a year increased by 38%. In addition, the length of the ozone season was projected to increase with more pollution episodes in the spring and fall. For selected urban areas, the system projected a higher number of pollution events per year and these events had more consecutive days when DM8H ozone exceed 75 ppbv.

Identifying Discrete Subgroups of Chronically Homeless Frequent Utilizers of Jail and Public Mental Health Services

2016 ◽  
Vol 44 (4) ◽  
pp. 511-530 ◽  
Author(s):  
Courtney S. Harding ◽  
Caterina G. Roman
Keyword(s):  
Mental Health ◽  
Unmet Need ◽  
Public Mental Health ◽  
The United States ◽  
Public Institutions ◽  
Homeless Shelters ◽  
Mental Health Systems ◽  
Discrete Subgroups ◽  
Public Mental Health Services ◽  
Current Mood

A sizable group of individuals in the United States cycle in and out of jails, prisons, mental health hospitals, homeless shelters, and other expensive public institutions over time. This little-studied population represents significant unmet need and the inadequacy of services for complex consumers. The current study examined a sample ( N = 161) of chronically homeless frequent utilizers of jail and mental health systems in Chicago, Illinois. Cluster analysis was used to differentiate the sample into four reliable subgroups based on measures for prior homelessness, jail incarcerations, mental health hospitalizations, poor current mood, and limitations due to physical health. Logistic regression revealed that clusters differed significantly on reincarceration at 6 months postrelease. Implications for programming and policy for each cluster are discussed, including suggestions for targeting services to distinguishing characteristics for each subgroup. These findings argue for the importance of coordinating efforts across services systems to better identify and serve shared clients.

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