Impact of Neighborhood Socioeconomic Disadvantage on Staffing Hours in US Nursing Homes

Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.

Pratiques Liées aux Représentations Sociales des Excréments Humains chez les Populations des Quartiers Défavorisés du District d’Abidjan en Côte d’Ivoire

La gestion des excréments humains révèle des pratiques à risque pour l’environnement en général et pour la santé des populations en particulier. D’où l’intérêt de cette étude dans les quartiers défavorisés où les difficultés en assainissement sont plus accentuées. La présente recherche s’inscrit dans le cadre d’une approche mixte. Pour ce faire, les méthodes et les techniques correspondant à l’approche qualitative et quantitative ont été utilisées pour collecter les données. Il s’agit, de la grille d’observation, du guide d’entretien et du questionnaire. L’objectif est d’analyser les représentations sociales des excréments humains dans les quartiers défavorisés du District d’Abidjan précisément à bougounisso, sagbé antenne, gbebouto, grand campement, tofiato et zimbabwé. La théorie des représentations sociales développée par Bourdieu a été mobilisée à cet effet. Elle a permis de mettre en exergue les représentations sociales des excréments humains chez les populations des quartiers défavorisés. Les résultats ont montré que la gestion des excréments humains est animée par un ensemble d’idéologie qui se résume en des croyances, des tabous et des sanctions. Il ressort que les différentes définitions des excréments humains se rapportent à la saleté, à l’impureté, aux déchets. Ils sont associés à tout ce qui est synonyme de mal, maladie, malédiction, malheur. Les croyances en rapport avec la gestion des excréments humains sont observées sur le plan religieux et culturel. Ce sont des dispositions relatives au choix du lieu de défécation et des règles d’hygiènes que le croyant doit observer. Les tabous concernent les lieux publics où il est défendu de déféquer. The management of human excreta reveals risky practices for the environment in general and for the health of populations in particular. Hence the interest of this study in disadvantaged neighborhoods where sanitation difficulties are more accentuated. This research subscribe to a mixed approach. To be done, the methods and techniques corresponding to the qualitative and quantitative approach were used to collect the data. These are observation grid, the interview guide and the questionnaire. The objective is to analyse the social representations of human excreta in disadvantaged neighborhoods of the District of Abidjan specifically in bougounisso, sagbé antenne, gbebouto, grand campement, tofiato and zimbabwé. The theory of social representations developed by Bourdieu was used for this purpose. It has made it possible to highlight the social representations of human excreta among populations in disadvantaged neighborhoods. The results showed that in traditional societies the management of human faeces is driven by a set of ideologies that boil down to beliefs, taboos and sanctions developed around human faeces and the act of defecation. It appears that the different definition of human excreta relate to dirt, impurity and waste. They are associated with everything that is synonymous with evil; disease, curse, misfortune. Beliefs related to the management of human excreta are observed on a religious and cultural level. These provisions relating of the choice of the place of defecation and the rules of hygiene that the believer must observe. The taboos refers to public places where defecation is forbidden.

Improving the Elderly’s Mental Health by Using Public Open Spaces in Disadvantaged Urban Neighborhoods: Tehran, Iran

Background: Today, the beneficial impact of public open spaces(POS) on the mental and physical health of the elderly is considered worldwide. However, the knowledge about these effects on the mental health of older adults in disadvantaged urban neighborhoods, especially in developing countries, is still insufficient.Methods: This study investigates the relationship between POS use and the mental health status of elderly residents in the disadvantaged neighborhoods of Tehran, the capital of Iran. The data on the frequency of use of public open spaces and the health status include ten items collected from 420 older adults of disadvantaged neighborhoods in District 10 of Tehran. We used exploratory factor analysis to explore the main factors of the elderly mental health in the disadvantaged neighborhood. Finally, the multivariate multiple regression model was used to determine the relationship between the frequency of POS use and mental health status among older seniors.Results: These ten items identified two fundamental characteristics of mental health status, including “feeling worthless” and “social interaction,” using exploratory factor analysis. “Feeling of worthlessness” was negatively significantly associated with the level of gender, marital, occupation, and education, as well as frequently attending in POS. “Social interaction” was influenced by gender, occupation, and marital status, as well as frequent use of POS. The results showed that the frequency of public open space use has a negative correlation with the feeling of worthlessness and a positive correlation with the older residents’ social interactions and contacts.Conclusion: According to the findings, increasing the more senior residents’ access to public open spaces through planning can improve their mental health as well as their social interactions, especially in disadvantaged neighborhoods.

Association of Neighborhood Context, Cognitive Decline, and Cortical Change in an Unimpaired Cohort

Objective:To test the hypothesis that neighborhood-level disadvantage is associated with longitudinal measures of neurodegeneration and cognitive decline in an unimpaired cohort.Methods:Longitudinal MRI and cognitive testing data were collected from 601 cognitively unimpaired participants in the Wisconsin Registry for Alzheimer’s Prevention study and the Wisconsin Alzheimer’s Disease Research Center clinical cohort. Area Deprivation Index was geospatially determined based on participant residence geocode and ranked relative to state of residence. Linear regression models were fitted to test associations between neighborhood-level disadvantage and longitudinal change in cortical thickness and cognitive test performance. Mediation tests were used to assess whether neurodegeneration and cognitive decline were associated with neighborhood-level disadvantage along the same theoretical causal path.Results:In our middle to older aged study population (mean baseline age=59), living in the 20% most disadvantaged neighborhoods (N=19) relative to state of residence was associated with cortical thinning in Alzheimer’s signature regions (p=0.002) and decline in the Preclinical Alzheimer’s disease Cognitive Composite (p=0.04), particularly the Trails-Making Test Part B (p<0.001), but not Rey Auditory Verbal Learning Test (p=0.77) or Story Memory Delayed Recall (p=0.49) subtests. Associations were attenuated but remained significant after controlling for racial and demographic differences between neighborhood-level disadvantage groups. Cortical thinning partially mediated the association between neighborhood-level disadvantage and cognitive decline.Conclusions:In this longitudinal study of cognitively unimpaired adults, living in the most highly disadvantaged neighborhoods was associated with accelerated degeneration in Alzheimer’s signature regions and cognitive decline. This study provides further evidence for neighborhood-level disadvantage as a risk factor for preclinical neurodegeneration and cognitive decline in certain populations. Limitations of the present study, including a small number of participants from highly disadvantaged neighborhoods and a circumscribed geographic setting, should be explored in larger and more diverse study cohorts.

Socioeconomically Disadvantaged Neighborhoods Face Increased Persistence of SARS-CoV-2 Clusters

Objective: To investigate the association between socioeconomic deprivation and the persistence of SARS-CoV-2 clusters.Methods: We analyzed 3,355 SARS-CoV-2 positive test results in the state of Geneva (Switzerland) from February 26 to April 30, 2020. We used a spatiotemporal cluster detection algorithm to monitor SARS-CoV-2 transmission dynamics and defined spatial cluster persistence as the time in days from emergence to disappearance. Using spatial cluster persistence measured outcome and a deprivation index based on neighborhood-level census socioeconomic data, stratified survival functions were estimated using the Kaplan-Meier estimator. Population density adjusted Cox proportional hazards (PH) regression models were then used to examine the association between neighborhood socioeconomic deprivation and persistence of SARS-CoV-2 clusters.Results: SARS-CoV-2 clusters persisted significantly longer in socioeconomically disadvantaged neighborhoods. In the Cox PH model, the standardized deprivation index was associated with an increased spatial cluster persistence (hazard ratio [HR], 1.43 [95% CI, 1.28–1.59]). The adjusted tercile-specific deprivation index HR was 1.82 [95% CI, 1.56–2.17].Conclusions: The increased risk of infection of disadvantaged individuals may also be due to the persistence of community transmission. These findings further highlight the need for interventions mitigating inequalities in the risk of SARS-CoV-2 infection and thus, of serious illness and mortality.

Diversifying Recruitment Registries: Considering Neighborhood Health Metrics

BACKGROUND: Disparities in clinical research participation perpetuate broader health disparities. Recruitment registries are novel tools to address known challenges in accrual to clinical research. Registries may accelerate accrual, but the utility of these tools to improve generalizability is unclear. Objective: To examine the diversity of a local on-line recruitment registry using the Area Deprivation Index (ADI), a publicly available metric of neighborhood disadvantage. Design: Retrospective analysis. Setting: Data were collected in the University of California Irvine Consent-to-Contact Registry. Participants: We categorized N=2,837 registry participants based on the ADI decile (collapsed into quintiles) using a state-based rankings. Measurements: We examined the proportion of enrollees per ADI quintile and quantified the demographics of these groups. We assessed willingness to participate in studies involving unique research procedures among the ADI groups. Results: Although registry enrollees represented the full spectrum of the ADI, they disproportionately represented less disadvantaged neighborhoods (lowest to highest quintiles: 42%, 30%, 15%, 6%, 7%). Compared to participants from less disadvantaged neighborhoods, participants from more disadvantaged neighborhoods were more often female, of non-white race, and Hispanic ethnicity. Despite demographic differences, ADI groups were observed to have similar willingness to participate in research studies. Conclusions: People from more disadvantaged neighborhoods may be underrepresented in recruitment registries, increasing the risk that they will be underrepresented when using these tools to facilitate prospective recruitment to clinical research. Once enrolled in registries, participants from more disadvantaged neighborhoods may be equally willing to participate in research. Efforts to increase representation of participants from disadvantaged neighborhoods in registries could be an important first step toward increasing the generalizability of clinical research.