Law Enforcement and Suicide Calls for Service: A Mixed-Methods Study of Suicide Attempts and Deaths

Introduction Suicide is a major public health issue, however, little is known about the characteristics/circumstances of suicide events. Data from law enforcement (LE) call reports are an important source of information related to suicide. Hence, this study explores suicide events captured in LE call reports. Method This mixed-methods study used data from call reports collected in a metropolitan county in 2017 in a Midwestern state wherein LE responded to suicide incidents (N=213). Descriptive and bivariate analyses of quantitative data were used to assess differences between incident type (i.e. attempts vs. deaths). Themes of suicide emerged from the qualitative data. Results Findings revealed that suicide decedents tended to be male, older, and had at least one intrapersonal issue as a precipitating factor. The qualitative sections illuminated three themes across suicide attempts: self-harm as an autonomy seeking strategy; challenging claims of suicidality; and promising to not self-harm. Conclusions Suicide incidents that rise to the level of crisis requiring a LE response is understudied in both the suicide and LE literature. Increasing the sophistication of call report documentation procedures would allow for communities to deepen their understanding of how suicide manifests and could create pathways to non-institutionalized care.

Using Community-Based Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

Aging is linked to an increased risk of disability. Disabilities that limit major life activities such as seeing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults may put them at risk for social isolation. The purpose of this paper is to illustrate how community-based participatory research (CBPR) was used to engage older residents in the development of alternative transportation options in a metropolitan county in the Midwestern U.S. Older residents worked as co-investigators to develop, use and evaluate alternative transportation options including walking, biking, fixed route busing, senior circulator, ride sharing, and transit training. Data were collected through mapping the built environment, an electronic daily transportation diary app called “MyAmble” on tablets, walk audits and focus groups. CBPR approaches led by interdisciplinary teams resulted in community engagement and more equitable strategies for transportation planning and utilization.

Lessons of mortality following COVID-19 epidemic in the United States especially in the geriatrics

COVID-19 is spreading all around the world, and is considered as the most widespread infectious disease of the century. Coronavirus transmits through respiratory droplets when in close contact with the infected person. Therefore, populous places are more likely to be the source of the novel coronavirus that is threatening the health of everyone especially the geriatric population. This study aimed to compare the transmission of coronavirus between metropolitan and non- metropolitan counties as lessons of mortality (especially in geriatric) following COVID-19 epidemic. The USAFact.org public website (https://usafacts.org/visualizations) was used to determine the transmission between metro and non- metropolitan counties. In this study, four different time periods were considered for the COVID-19 incremental trend (April 1, May 1, June 1, and July 1, 2020). The number of cases was determined per each 10,000 population. Yellow color means no case in the metropolitan county (metro). Orange color means less than 10 cases/10,000 of the population in metro. Figure and maps were used to show the objectives of the study. In metropolitan counties, the spread of COVID-19 is very fast, which is significantly different from the non-metro counties (P<0.001). The results show the sharp increasing trend of infected people in metropolitan counties. In metropolitan counties the number of infected people reached 2 420 316 cases per 10 000 populations but the number of infected people reached 231 459 cases per 10 000 populations. Over the four months period, the frequency of the light colors was decreased. According to the results, susceptible people especially the elderly should move to non- metropolitan counties during the COVID-19 pandemic to be less likely at risk.

The design and implementation of a theory-based interdisciplinary falls prevention pilot program for community dwelling older adults

The purpose of this research was to describe the development of an interdisciplinary community-based falls prevention program that integrated self-efficacy theory and to evaluate its impact on awarenessof fall risk factors and self-efficacy to engage in behaviors that reduce fall risk. Twenty-three communitydwelling older adults participated in a five-week falls prevention program held at a community centerin a large metropolitan county in the Mid-Atlantic. Positive improvements were demonstrated across alloutcome measures. Our findings indicate that a theory-based interdisciplinary falls prevention programincreased self-efficacy and awareness of falls risk factors in older adults.

Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A CIBMTR Analysis

Introduction: Allogeneic stem cell transplant is an intensive procedure, offered in a limited number of medical centres. We sought to describe how sociodemographic variables impacted access to transplant across the United States, and if disadvantaged populations had inferior access to transplant. Methods: Data from the Surveillance, Epidemiology and End Results Program (SEER) and the Center for International Blood and Marrow Transplant Research (CIBMTR) was integrated to determine the rate of unrelated donor transplantation between 2000 and 2010 in each of the 612 counties included in the SEER registry. Patients under the age of 65 with AML, ALL, and MDS were included, and the analysis was restricted to unrelated donors due to limited availability of ZIP code in CIBMTR data. New incident cases were determined from SEER, and the number of transplants was determined from CIBMTR. The transplant rate was calculated (transplants performed divided by incident cases) for each county. County attributes (percent minority, rural/urban status, percentage below the poverty line, and median family size) were obtained from US Census data. Poisson regression was used to describe how county attributes impacted transplant rates. Transplant rates were calculated separately for AML, White residents, and pediatric ALL. Results: 3147 patients were identified in the CIBMTR dataset that met inclusion criteria. The estimated ZIP code completeness was 75%. There were 30,468 new incident diagnoses of ALL, AML, and MDS. For AML, patients from rural areas (less than 20,000 residents) and patients from areas with higher poverty levels had lower transplant rates (Table 1). Minority status and family size did not impact transplant rate. In regression models, higher levels of poverty remained associated with lower transplant rates, while rurality did not (Table 2). The results were similar among White residents. In contrast, in pediatric ALL, no county attributes (poverty, rurality, percent minority, and family size) were significantly associated with a difference in transplant rate (Table 1). However, numbers of transplants were smaller, limiting power. Discussion: Patients with AML from disadvantaged areas had lower rates of unrelated donor transplant. While patients from disadvantaged areas were also more likely to be non-White, and non-White Americans are less likely to have an available unrelated donor, this difference was also seen in White Americans from disadvantaged areas. This suggests the lower transplant rate is due impaired access to transplant. Poverty rate was the most important predictor of transplant rate. The results of this study suggest that improving access to transplant in disadvantaged populations should be a priority for health care administrators. Based on these results, approximately 2500 Americans do not undergo allogeneic transplant annually due to inferior access associated with higher poverty rates. Table 1 Univariate Analysis Table 1. Univariate Analysis Table 2 Acute Myeloid Leukemia, Regression Model * Metropolitan = county > 50,000 people, micropolitan = county > 20,000, rural county < 20,000. Table 2. Acute Myeloid Leukemia, Regression Model. / * Metropolitan = county > 50,000 people, micropolitan = county > 20,000, rural county < 20,000. Disclosures Hahn: Novartis: Equity Ownership; NIH: Research Funding.