scholarly journals Explaining the association between urbanicity and psychotic-like experiences in adolescence: The indirect effect of urban exposures

2021 ◽  
Author(s):  
Abhishek Saxena ◽  
David Dodell-Feder
Keyword(s):  
At Risk ◽  
Indirect Effect ◽  
Public Health Intervention ◽  
The United States ◽  
Urban Environments ◽  
Income Disparity ◽  
Lead Paint ◽  
Increased Risk ◽  
Worldwide Phenomenon ◽  
One Year

Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N=7,979), nationwide study of adolescence in the United States to clarify why urbanicity might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we find that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE and associated distress: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association could be explained by PM2.5 (23% of the urbanicity-PLE number association), families in poverty (57-67% of the urbanicity-PLE number and distress association), and income disparity (55-66% of the urbanicity-PLE number and distress association). Together, these findings suggest that specific urban-related exposures might help to explain why those in urban environments are disproportionately at-risk for psychosis and point towards areas for public health intervention.

scholarly journals 2205. Clinical Burden of Pneumococcal Disease in US Adults Aged 65 Years and Above with Chronic or Immunocompromising Conditions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S752-S752
Author(s):  
Arijita Deb ◽  
Kelly D Johnson ◽  
Wanmei Ou
Keyword(s):  
At Risk ◽  
High Risk ◽  
Pneumococcal Disease ◽  
Medical Condition ◽  
Pneumococcal Vaccination ◽  
The United States ◽  
Healthy Adults ◽  
Medical Conditions ◽  
Increased Risk ◽  
One Year

Abstract Background The presence of chronic and immunocompromising conditions is associated with a disproportionately high risk of developing pneumococcal disease at older ages. The objective of this study was to quantify the risk of all-cause pneumonia (ACP) and invasive pneumococcal disease (IPD) in older US adults aged 65 years and older with underlying medical conditions. Methods A retrospective observational study was conducted using the Humana claims database. The study cohorts were identified at January 1 of each calendar year of observation from 2012 to 2017 and comprised adults aged 65 years and older with continuous enrollment for at least one year before and at least one year after January 1 of each year. For each yearly cohort, medical conditions were identified during the one year before each calendar year and episodes of ACP and IPD were identified during the corresponding 1-year follow-up period from January 1 to December 31. Individuals were stratified into 3 groups: those without any medical conditions of interests (healthy), those with chronic conditions (at-risk) and those with immunocompromising conditions (high-risk). Rate of ACP or IPD was expressed as the number of cases per 100,000 person-years and the rate ratio (RR) was expressed as the rate of pneumococcal disease of patients with medical conditions divided by the rate of pneumococcal disease in healthy adults. Results Of the 10,766,827 adults included in the study, 75% of adults had an underlying medical condition linked to an increased risk of pneumococcal disease. In adults with at-risk conditions, rates of ACP and IPD were 3.1 and 3.6 times the rate in healthy adults, respectively. In adults with high-risk conditions, rates of ACP and IPD were 4.1 and 5 times the rate in healthy adults, respectively. Rate of pneumococcal disease increased substantially with the addition of medical conditions: RR for ACP and IPD increased from 2.1 and 2.2, respectively, in adults with one at-risk conditions to 4.8 and 6.2, respectively, among adults with 2 or more at-risk conditions. Conclusion Despite recommendations of universal pneumococcal vaccination in older adults aged 65 years and above in the United States, the burden of pneumococcal disease remains high, particularly among those with chronic and immunocompromising conditions. Disclosures All authors: No reported disclosures.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

scholarly journals Predictors of households at risk for food insecurity in the United States during the COVID-19 pandemic

2021 ◽  
pp. 1-19
Author(s):  
Brianna N. Lauren ◽  
Elisabeth R. Silver ◽  
Adam S. Faye ◽  
Alexandra M. Rogers ◽  
Jennifer A. Woo Baidal ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
Food Insecurity ◽  
The United States ◽  
Economic Stress ◽  
Household Food Security ◽  
Living Situation ◽  
Convenience Sample ◽  
Household Food ◽  
Increased Risk

Abstract Objective: To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak. Design: Cross-sectional online survey analyzed using univariable tests and a multivariable logistic regression model. Setting: The United States during the week of March 30, 2020. Participants: Convenience sample of 1,965 American adults using Amazon’s Mechanical Turk (MTurk) platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses. Results: 1,250 participants reported household food security before the COVID-19 outbreak. Among this subset, 41% were identified as at risk for food insecurity after COVID-19, 55% were women and 73% were white. On multivariable analysis, race, income, relationship status, living situation, anxiety, and depression were significantly associated with incident risk for food insecurity. Black, Asian, and Hispanic/Latino respondents, respondents with annual income less than $100,000, and those living with children or others were significantly more likely to be newly at risk for food insecurity. Individuals at risk for food insecurity were 2.60 (95% CI 1.91-3.55) times more likely to screen positively for anxiety and 1.71 (95% CI 1.21-2.42) times more likely to screen positively for depression. Conclusions: Increased risk for food insecurity during the COVID-19 pandemic is common, and certain populations are particularly vulnerable. There are strong associations between being at risk for food insecurity and anxiety/depression. Interventions to increase access to healthful foods, especially among minority and low-income individuals, and ease the socioemotional effects of the outbreak are crucial to relieving the economic stress of this pandemic.

scholarly journals One-Year Costs in Patients With a History of or at Risk for Atherothrombosis in the United States

2008 ◽  
Vol 1 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Elizabeth M. Mahoney ◽  
Kaijun Wang ◽  
David J. Cohen ◽  
Alan T. Hirsch ◽  
Mark J. Alberts ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
The United States ◽  
History Of Or ◽  
History Of ◽  
One Year

Risk factors for complicated grief (CG) and utilization of a hospice bereavement program.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19588-e19588
Author(s):  
Elizabeth Henry ◽  
Rong Guo ◽  
Aziz Ansari ◽  
Theresa Kristopaitis ◽  
Mark Speyer ◽  
...  
Keyword(s):  
At Risk ◽  
Average Length ◽  
Caregiver Relationship ◽  
Phone Calls ◽  
Increased Risk ◽  
Bereavement Counseling ◽  
One Year ◽  
Lost To Follow Up ◽  
Benefit Mandates

e19588 Background: The Medicare hospice benefit mandates that bereavement services be provided to a surviving caregiver for a period of one year following a patient’s (pt) death. Identifying caregivers at risk for CG is essential so that appropriate interventions can be provided. Methods: Our objective was to identify specific features predicting for CG in surviving caregivers of pts with a malignancy enrolled in an academic based hospice program and determine utilization of Medicare’s bereavement services. Hospice charts for 65 patients whose caregivers were consecutively discharged from bereavement follow-up between January 2009 and December 2011 were reviewed. Assessments for CG features were performed with use of chaplain and social worker visits, and phone calls from a trained bereavement volunteer to caregivers at 6-8 wks and 6 months after a pt’s death. A discharge assessment was completed at 13 months. Results: Fifty (77%) hospice pts had a cancer (ca) diagnosis and tended to have a shorter average length of hospice enrollment than non-ca pts (34 vs 60 days, p=0.11). There was no difference in risk of caregiver CG between ca vs non-ca diagnoses (p=0.12). Twenty-one (42%) of ca pt caregivers were identified at risk for CG. Ca pts ≤ 50 yrs at the time of hospice enrollment were more likely to have caregivers identified at risk for CG compared to those ≥ 50 yrs (3, 100% vs 18, 38%, p=0.07). At risk ca caregivers had a lower average pt age at time of hospice enrollment than lower risk caregivers (mean pt age 67 vs 76 yrs, p=0.03). Eight ca caregivers (38%) identified at risk for CG received intensive bereavement counseling; 13 (62%) subsequently received routine bereavement follow up; none were lost to follow up. Length of enrollment, caregiver employment status and caregiver relationship did not predict for risk of CG. No ca caregivers required intensive bereavement services beyond 12 months post pt death. Conclusions: Young patient age at time of hospice enrollment is associated with an increased risk of caregiver CG.Intensive bereavement counseling was required by 38% of ca caregivers, and none required >1 yr of service. Further study needs to be done to see if caregivers are receiving adequate bereavement support through the hospice benefit.

scholarly journals A Decline in Walking Speed is Associated with Incident Knee Replacement in Adults with and at Risk for Knee Osteoarthritis

2020 ◽  
pp. jrheum.200176
Author(s):  
Matthew S. Harkey ◽  
Kate L. Lapane ◽  
Shao-Hsien Liu ◽  
Grace H. Lo ◽  
Timothy E. McAlindon ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Risk ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Walking Speed ◽  
Error Variance ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
Combining Data ◽  
One Year

Objective To determine if a one-year change in walking speed is associated with receiving an incident knee replacement during the following year in adults with and at risk for knee osteoarthritis (OA). Methods Using data from the Osteoarthritis Initiative, we determined a one-year change in 20- meter walk speed from three observation periods (i.e., 0-12, 12-24, and 24-36 month). We operationally defined one-year change in walking speed as either: 1) decline: < -0.1 m/s change, 2) no change: between -0.1 and 0.1 m/s change, 3) increase: > 0.1 m/s change. Incident knee replacement was defined using each subsequent one-year period (i.e., 12-24, 24- 36, and 36-48 month). Combining data from the three observation periods, we performed a Poisson regression with robust error variance to determine the relative risk between a change in walking speed (exposure) and incident knee replacement over the following year (outcome). Results Of the 4,264 participants included within this analysis (11,311 total person visits), 115 (3%) adults received a knee replacement. Decline in walking speed was associated with a 104% increase in risk [adjusted relative risk (RR)=2.04; 95% confidence interval (CI)= 1.40-2.98], while an increase in walking speed associated with a 55% decrease in risk (RR=0.45; 95% CI=0.22-0.93) of incident knee replacement in the following year compared to a person with no change in walking speed. Conclusion A one-year decline in walking speed is associated with an increased risk, while one-year increase in walking speed is associated with a decreased risk of future incident knee replacement.

scholarly journals Estimation of Acutely Ill Medical Patients at Venous Thromboembolism Risk Eligible for Extended Thromboprophylaxis Using APEX Criteria in US Hospitals

2019 ◽  
Vol 25 ◽  
pp. 107602961988000 ◽  
Author(s):  
Anne-Céline Martin ◽  
Wei Huang ◽  
Samuel Z. Goldhaber ◽  
Russell D. Hull ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Venous Thromboembolism ◽  
The United States ◽  
Care Hospital ◽  
Medical Patients ◽  
Hospital Discharges ◽  
Increased Risk ◽  
History Of ◽  
History Of Cancer

Major medical illnesses place patients at risk of venous thromboembolism (VTE). Some risk factors including age ≥75 years or history of cancer place them at increased risk of VTE that extends for at least 5 to 6 weeks following hospital admission. Betrixaban thromboprophylaxis is now approved in the United States for this indication. We estimated the annual number of acutely ill medical patients at extended risk of VTE discharged from US hospital. Major medical illnesses (stroke, respiratory failure/chronic obstructive pulmonary disease, heart failure, pneumonia, other infections, and rheumatologic disorders) and 2 common risk factors for extended VTE risk, namely, age ≥75 years and history of cancer (active or past) were examined in 2014 US hospital discharges using the first 3 discharge diagnosis codes in the National Inpatient Sample (database of acute-care hospital discharges from the US Agency for Health Care Quality and Research). In 2014, there were 20.8 million discharges with potentially at risk of nonsurgical-related VTE. Overall, 7.2 million (35%) discharges corresponded to major medical illness that warranted thromboprophylaxis according to 2012 American College of Chest Physicians (ACCP) guideline. Among them, 2.79 million were aged ≥75 years and 1.36 million had a history of cancer (aged 40-74 years). Overall, 3.48 million discharges were at extended risk of VTE. Many medical inpatients at risk of VTE according to 2012 ACCP guideline might benefit from the awareness of continuing risk and some of these patients might benefit from extended thromboprophylaxis, depending on the risk of bleeding and comorbidities.

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

2016 ◽  
Vol 10 (4) ◽  
pp. 576-582 ◽  
Author(s):  
Jennifer S. Love ◽  
David Karp ◽  
M. Kit Delgado ◽  
Gregg Margolis ◽  
Douglas J. Wiebe ◽  
...  
Keyword(s):  
Public Health ◽  
At Risk ◽  
Emergency Department ◽  
The United States ◽  
Public Health Emergency ◽  
Study Cohort ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Referral ◽  
Increased Risk

AbstractObjectivesBoarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.MethodsA retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.ResultsA total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.ConclusionsUrban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576–582)

scholarly journals Diabetes Detection and Prevention in Dermatology

2021 ◽  
pp. e2021131
Author(s):  
Alexandra Ngo ◽  
Luise Froessl ◽  
John Wesley McWhorter ◽  
William Brett Perkison ◽  
Rajani Katta
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Primary Care Physician ◽  
Diabetes Prevention ◽  
The United States ◽  
Care Physician ◽  
Current Data ◽  
Cutaneous Manifestations ◽  
Screening Guidelines ◽  
Increased Risk

We are currently in the midst of an international epidemic of diabetes mellitus (DM) and prediabetes. The prevalence of DM in the United States is estimated at 9.4% of the population across all ages, while an estimated 1 in 3 Americans (33.9%) has prediabetes. According to the WHO, about 60 million people suffer from diabetes in the European Region. Dermatologists may play an important role in tackling this epidemic via efforts to improve early detection of both diabetes and prediabetes. Dermatologists often treat patients with, or at risk of, diabetes. This includes patients who present with cutaneous manifestations such as acanthosis nigricans, as well as patient populations at increased risk, including those with psoriasis, hidradenitis suppurativa, and polycystic ovarian syndrome. Simple screening guidelines can be used to identify patients at risk, and screening can be performed via a single non-fasting blood test. The diagnosis of prediabetes is a key feature in diabetes prevention, as interventions in this group can markedly reduce progression towards diabetes. In addition to referral to a primary care physician, dermatologists may refer these patients directly to structured behavioral lifestyle intervention programs known as diabetes prevention programs. A significant portion of the population lacks routine care by a primary care physician, and current data indicates need for improvement in diabetes screening and prevention among patient groups such as those with psoriasis. These factors highlight the importance of the dermatologist’s role in the detection and prevention of diabetes.

scholarly journals Incarceration, HIV Risk–Related Behaviors, and Partner Characteristics Among Heterosexual Men at Increased Risk of HIV Infection, 20 US Cities

2019 ◽  
Vol 134 (1_suppl) ◽  
pp. 63S-70S ◽  
Author(s):  
Akilah Wise ◽  
Teresa Finlayson ◽  
Catlainn Sionean ◽  
Gabriela Paz-Bailey
Keyword(s):  
United States ◽  
At Risk ◽  
Hiv Risk ◽  
Urban Areas ◽  
Prevalence Ratio ◽  
The United States ◽  
Sexual Partners ◽  
Heterosexual Men ◽  
The Past ◽  
Increased Risk

Objectives: The effect of incarceration on HIV risk–related behaviors among at-risk heterosexual men is understudied. The objective of our study was to examine the association between incarceration and HIV risk–related behaviors among a sample of predominantly non-Hispanic black and Hispanic heterosexual men residing in urban areas in the United States with a high prevalence of AIDS. Methods: We analyzed data from the 2013 National HIV Behavioral Surveillance system on 5321 at-risk heterosexual men using log-linked Poisson regression models, adjusted for demographic characteristics and clustered on city. Results: Of 5321 men, 1417 (26.6%) had recently been incarcerated (in the past 12 months), 2781 (52.3%) had ever been incarcerated but not in the past 12 months, and 1123 (21.1%) had never been incarcerated. Recent incarceration was associated with multiple casual female sexual partners (adjusted prevalence ratio [aPR] = 1.23; 95% confidence interval [CI], 1.05-1.44), condomless sex with multiple female sexual partners (aPR = 1.32; 95% CI, 1.06-1.66), injection drug use (aPR = 3.75; 95% CI, 2.64-5.32), and having sexual partners who were more likely to have ever injected drugs (aPR = 1.84; 95% CI, 1.48-2.28), been incarcerated (aPR = 2.28; 95% CI, 2.01-2.59), or had a concurrent sexual partner (aPR = 1.08; 95% CI, 1.05-1.11), as compared with never-incarcerated men. Conclusions: Incarceration history was associated with HIV risk–related behaviors among heterosexual men from urban areas in the United States. Correctional rehabilitation initiatives are needed to promote strategies that mitigate HIV risk–related behaviors and promote healthy reentry into communities among heterosexual men at high risk for HIV.

Sign in / Sign up

Export Citation Format

Share Document