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This is a follow-up study of 54 years on disease risks to United States Shipyard Radiation Workers using the Standardized Mortality Ratio method, answering a simple but important question: if US shipyard workers have had any mortality risk associated with occupational radiation exposures compared to US general population. Objective: To examine the risk of diseases among industrial workers with low and fractionated radiation exposures. Method: The 372,047 US male shipyard radiation and non-radiation workers were followed for 54 years and compared with US men using standardized mortality ratio (SMR) method. Results: SMRs for both radiation and non-radiation workers had lower risks of death from all causes (0.74; 95% confidence interval [CI] 0.74 to 0.75 and 0.77; 95% Cl 0.77 to 0.78, respectively) and from all cancers (0.92; 95% CI 0.91 to 0.93 and 0.90; 95% CI 0.89 to 0.91, respectively) compared with US men. Asbestos-related diseases including pleural cancers, mesothelioma, and asbestosis, but not lung cancers, were statistically higher in both radiation and non-radiation workers compared with the US men. Conclusion: US shipyard male radiation and non-radiation workers did not show any elevated mortality risks that might be associated with radiation exposure. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective case series study.Objective: To analyze the epidemiology of diagnoses of degenerative cervical and lumbar spinal conditions among Major League Baseball (MLB) and Minor League Baseball (MiLB) players.Summary Of Background Data: Repetitive high-energy forces in professional baseball players may predispose them to degenerative cervical and lumbar spinal conditions. There is a lack of data concerning the epidemiology of these injuries in professional baseball.Methods: Deidentified data on spine injuries were collected from all MLB and MiLB teams from 2011 to 2016 from the MLB-commissioned Health and Injury Tracking System database. Rates of diagnoses of common degenerative spinal conditions as well as their impact on days missed due to injury, necessitation of surgery, and player participation and career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete-exposures in concordance with prior studies.Results: Over 2011 to 2016, 4246 days of play were missed due to 172 spine-related injuries. 73.3% were related to the lumbar spine and 26.7% to the cervical spine. There were similar rates of surgery required for these injuries (18.3% of lumbar injuries vs. 13.0% of cervical injuries, P = 0.2164). Mean age of players with cervical injuries was higher compared with the lumbar group (27.5 vs. 25.4, P = 0.0119). Average number of days missed due to lumbar injuries was significantly higher than those due to cervical injuries (34.1 vs. 21.6 d, P = 0.0468). Spine injury rates for pitchers were significantly higher than those of other position players (0.086 per 1000 athlete-exposures vs. 0.037, P < 0.0001).Conclusion: Neurologic diagnoses relating to the cervical and lumbar spine lead to substantial disability among MLB and MiLB players as well as days missed from play. Pitchers have over double the rates of injury compared with other position players. Lumbar conditions were associated with significantly higher numbers of days missed from play.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

With the incidence of Lyme and other tickborne diseases on the rise in the US and globally, there is a critical need for data-driven tools that communicate the magnitude of this problem and help guide public health responses. We present the Johns Hopkins Lyme and Tickborne Disease Dashboard (https://www.hopkinslymetracker.org/), a new tool that harnesses the power of geography to raise awareness and fuel research and scientific collaboration. The dashboard is unique in applying a geographic lens to tickborne diseases, aiming not only to become a global tracker of tickborne diseases but also to contextualize their complicated geography with a comprehensive set of maps and spatial data sets representing a One Health approach. We share our experience designing and implementing the dashboard, describe the main features, and discuss current limitations and future directions. [ABSTRACT FROM AUTHOR]

Objective: To compare predominantly-Black and predominantly-White Maryland areas with similar socioeconomic status to examine the role of both race and socioeconomic status on tobacco outlet availability and tobacco outlet access. Design: Maryland tobacco outlet addresses were geocoded with 2011–2015 American Community Survey sociodemographic data. Two-sample t-tests were conducted comparing the mean values of sociodemographic variables and tobacco outlet density per Census Tract, and spatial lag based regression models were conducted to analyze the direct association between covariables and tobacco outlet density while accounting for spatial dependence between and within jurisdictions. Results: Predominantly-White jurisdictions had lower tobacco outlet availability and access than predominantly-Black jurisdictions, despite similar socioeconomic status. Spatial lag model results showed that median household income and vacant houses had consistent associations with tobacco outlet density across most of the jurisdictions analyzed, and place-based spatial lag models showed direct associations between predominantly-Black jurisdictions and tobacco outlet availability and access. Conclusion: Predominantly-White areas have lower levels of tobacco outlet density than predominantly-Black areas, despite both areas having similar socioeconomic statuses. [ABSTRACT FROM AUTHOR]

Objective: To generate a summative report on the most commonly diagnosed illnesses in Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes with specific attention to their impact based on time out of play. Design: Retrospective analysis. Setting: Injury and illness data from the MLB Health and Injury Tracking System. Participants: All MLB and MiLB athletes active between 2011 and 2016. Assessment of risk factors: Illnesses were defined as atraumatic medical diagnoses that occurred during the MLB or MiLB season and resulted in at least 1 day out of play. Main outcome measures: Incidence of illness diagnoses and resulting time out play. Results: Eight thousand eight hundred thirty-four illnesses were reported, representing 14.7% of all diagnoses resulting in time out of play. Total days missed (DM) due to illness were 39 614, with a mean of 4.6 (SD 9.9 days) and median 2 DM per diagnosis. The annual incidence of illness per season was 20.3 per 100 athletes. The most common diagnosis was nonspecific viral illness (15.3%), followed by gastroenteritis (13.6%), other gastrointestinal illness (8.3%), influenza (7.0%), and upper respiratory infection (6.2%). Appendicitis (15.2%) and Epstein-Barr virus/cytomegalovirus (9.1%) were the most common season-ending diagnoses. Conclusions: Illnesses represent a significant cause of time out of play in MLB and MiLB. Prevention efforts should focus on limiting the spread of communicable viral, respiratory, and gastrointestinal disease among players, as the majority of diagnoses fell into these categories. This work may be used to guide future research into illness treatment and prevention in professional baseball. [ABSTRACT FROM AUTHOR]

Customary and routine practice of geostatistical modeling assumes that inter-point distances are a Euclidean metric (i.e., as the crow flies) when characterizing spatial variation. There are many real-world settings, however, in which the use of a non-Euclidean distance is more appropriate, for example, in complex bodies of water. However, if such a distance is used with current semivariogram functions, the resulting spatial covariance matrices are no longer guaranteed to be positive-definite. Previous attempts to address this issue for geostatistical prediction (i.e., kriging) models transform the non-Euclidean space into a Euclidean metric, such as through multi-dimensional scaling (MDS). However, these attempts estimate spatial covariances only after distances are scaled. An alternative method is proposed to re-estimate a spatial covariance structure originally based on a non-Euclidean distance metric to ensure validity. This method is compared to the standard use of Euclidean distance, as well as a previously utilized MDS method. All methods are evaluated using cross-validation assessments on both simulated and real-world experiments. Results show a high level of bias in prediction variance for the previously developed MDS method that has not been highlighted previously. Conversely, the proposed method offers a preferred tradeoff between prediction accuracy and prediction variance and at times outperforms the existing methods for both sets of metrics. Overall results indicate that this proposed method can provide improved geostatistical predictions while ensuring valid results when the use of non-Euclidean distances is warranted. [ABSTRACT FROM AUTHOR]

Background: The objective of this analysis was to compare measurement methods—counts, proximity, mean distance, and spatial access—of calculating alcohol outlet density and violent crime using data from Baltimore, Maryland. Methods: Violent crime data (n = 11,815) were obtained from the Baltimore City Police Department and included homicides, aggravated assaults, rapes, and robberies in 2016. We calculated alcohol outlet density and violent crime at the census block (CB) level (n = 13,016). We then weighted these CB‐level measures to the census tract level (n = 197) and conducted a series of regressions. Negative binomial regression was used for count outcomes and linear regression for proximity and spatial access outcomes. Choropleth maps, partial R2, Akaike's Information Criterion, and root mean squared error guided determination of which models yielded lower error and better fit. Results: The inference depended on the measurement methods used. Eight models that used a count of alcohol outlets and/or violent crimes failed to detect an association between outlets and crime, and 3 other count‐based models detected an association in the opposite direction. Proximity, mean distance, and spatial access methods consistently detected an association between outlets and crime and produced comparable model fits. Conclusions: Proximity, mean distance, and spatial access methods yielded the best model fits and had the lowest levels of error in this urban setting. Spatial access methods may offer conceptual strengths over proximity and mean distance. Conflicting findings in the field may be in part due to error in the way that researchers measure alcohol outlet density. [ABSTRACT FROM AUTHOR]

Background: While there are overwhelming data supporting the association between alcohol outlet density and violent crime, there remain conflicting findings about whether on‐ or off‐premise outlets have a stronger association. This inconsistency may be in part a result of the methods used to calculate alcohol outlet density and violent crime. This analysis uses routine activity theory and spatial access methods to study the association between access to alcohol outlets and violent crime, including type of outlet and type of crime in Baltimore, MD. Methods: The data in this analysis include alcohol outlets from 2016 (n = 1,204), violent crimes from 2012 to 2016 (n = 51,006), and markers of social disorganization, including owner‐occupied housing, median annual household income, drug arrests, and population density. The analysis used linear regression to determine the association between access to alcohol outlets and violent crime exposure. Results: Each 10% increase in alcohol outlet access was associated with a 4.2% increase in violent crime exposure (β = 0.43, 95% CI 0.33, 0.52, p < 0.001). A 10% increase in access to off‐premise outlets (4.4%, β = 0.45, 95% CI 0.33, 0.57, p < 0.001) and LBD‐7 outlets (combined off‐ and on‐premise outlets; 4.2%, β = 0.43, 95% CI 0.33, 0.52, p < 0.001) had a greater association with violent crime than on‐premise outlets (3.0%, β = 0.31, 95% CI 0.20, 0.41, p < 0.001). Conclusions: Access to outlets that allow for off‐site consumption had a greater association with violent crime than outlets that only permit on‐site consumption. The lack of effective measures to keep order in and around off‐premise outlets could attract or multiply violent crime. This is among the first analyses to use spatial access measures to compare the associations of on‐ and off‐premise alcohol outlets with violent crime. Each 10% increase in alcohol outlet access was associated with a 4.2% increase in violent crime exposure overall, and the association was stronger for off‐premise outlets than their on‐premise counterparts. Disadvantaged areas had greater access to the types of alcohol outlets associated with the most harms. [ABSTRACT FROM AUTHOR]

Background: Although sliding occurs frequently in professional baseball, little is known about the epidemiology and effect of injuries that occur during sliding in this population of elite athletes. Purpose: To describe the incidence and characteristics of sliding injuries, determine their effect in terms of time out of play, and identify common injury patterns that may represent appropriate targets for injury prevention programs in the future. Study Design: Descriptive epidemiologic study. Methods: All offensive sliding injuries occurring in Major League Baseball (MLB) and Minor League Baseball (MLB) that resulted in time out of play during a span of 5 seasons (2011-2015) were identified. In addition to player demographics, data extracted included time out of play, location on field where injury occurred, level of play, treatment (surgical vs nonsurgical), direction of slide (head vs feet first), body region injured, and diagnosis. Descriptive statistics were used to describe the distribution of these injuries, and injury rates were calculated per slide. Results: From 2011 to 2015, 1633 injuries occurred as a result of a slide. The total number of days missed per season was 4263. Surgical intervention was required for 134 (8.2%) injuries, and the mean days missed was 66.5 for players treated surgically and 12.3 days for players treated nonoperatively (P < .001). MLB players were more likely than MiLB players to require surgical intervention (12.3% vs 7.5%, P = .019). Injuries to the hands/fingers represented 25.3% of all injuries and 31.3% of those requiring surgery. Although the majority of injuries occurred at second base (57%), the per-slide injury rate was similar across all bases (P = .991). The estimated overall frequency of injury in MLB was once per every 336 slides, and the rate of injury for head- and feet-first slides was 1 in 249 and 413 slides, respectively (P = .119). Conclusion: Injuries occurring while sliding in professional baseball result in a significant amount of time out of play for these elite athletes. Injuries occurring at second base and those occurring to the hands and fingers were most prevalent and may be an appropriate target for future injury prevention programs. [ABSTRACT FROM AUTHOR]

We evaluated geographic heterogeneity in hepatitis C virus (HCV) treatment penetration among people who inject drug (PWID) across Baltimore, MD since the advent of direct‐acting antivirals (DAAs) using space–time clusters of HCV viraemia. Using data from a community‐based cohort of PWID, the AIDS Linked to the IntraVenous Experience (ALIVE) study, we identified space–time clusters with higher‐than‐expected rates of HCV viraemia between 2015 and 2019 using scan statistics. We used Poisson regression to identify covariates associated with HCV viraemia and used the regression‐fitted values to detect adjusted space–time clusters of HCV viraemia in Baltimore city. Overall, in the cohort, HCV viraemia fell from 77% in 2015 to 64%, 49%, 39% and 36% from 2016 to 2019. In Baltimore city, the percentage of census tracts where prevalence of HCV viraemia was ≥85% dropped from 57% to 34%, 25%, 22% and 10% from 2015 to 2019. We identified two clusters of higher‐than‐expected HCV viraemia in the unadjusted analysis that lasted from 2015 to 2017 in East and West Baltimore and one adjusted cluster of HCV viraemia in West Baltimore from 2015 to 2016. Neither differences in age, sex, race, HIV status, nor neighbourhood deprivation were able to explain the significant space–time clusters. However, residing in a cluster with higher‐than‐expected viraemia was associated with age, sex, educational attainment and higher levels of neighbourhood deprivation. Nearly 4 years after DAAs became available, HCV treatment has penetrated all PWID communities across Baltimore city. While nearly all census tracts experienced improvements, change was more gradual in areas with higher levels of poverty. [ABSTRACT FROM AUTHOR]

Asbestos and non-asbestos containing brake products are currently used in low- and middle-income countries like Colombia. Because brake products are distributed detached from their supports, they require manipulation before installation, which release fibers and expose workers. Previous studies of our research group have documented exposures in excess of the widely accepted 0.1 f/cm³ exposure guideline. The aim of this study is to identify factors associated with non-compliance of the 8-h time weighted average (TWA) 0.1 f/cm³ asbestos occupational limit among brake mechanics (i.e. riveters). Eighteen brake repair shops (BRS) located in Bogotá (Colombia) were sampled during 3 to 6 consecutive days for the entire work-shift. Personal and short-term personal samples were collected following NIOSH methods 7400 and 7402. Longitudinal based logistic regression models were used to determine the association between the odds of exceeding the 8-h TWA 0.1 f/cm³ asbestos occupational limit and variables such as type of tasks performed by workers, workload (number of products manipulated daily), years of experience as riveters, and shop characteristics. These models can be used to estimate the odds of being currently or historically overexposed when sampling data do not exist. Since the information required to run the models can vary for both retrospective and current asbestos occupational exposure studies, three models were constructed with different information requirements. The first model evaluated the association between the odds of non-compliance with variables related to the workload, the second model evaluated the association between the odds of non-compliance with variables related to the manipulation tasks, and the third model evaluated the association between the odds of non-compliance with variables related with both the type of tasks performed by workers and the workload. Variables associated with the odds of non-compliance included conducting at least one manipulation activity with beveling and grinding of asbestos and non-asbestos containing brake products during the work shift, the location of the worker in the shop during non-manipulation activities, cleaning activities of the manipulation area, the years of experience working as riveters, and the number of asbestos and non-asbestos containing brake products manipulated daily. These models could be useful for current and retrospective occupational studies, in determining the odds of non-compliance of the asbestos occupational limit among brake mechanics. [ABSTRACT FROM AUTHOR]

This study examined food availability along children's paths to and from elementary school, and associations with change in body mass index (BMI) and waist circumference over 1 year. Secondary data from 319 children aged 8-13 years from the 'Multiple Opportunities to Reach Excellence' Project was used. Child anthropometry and demographic variables were obtained at baseline (2007) and 1 year follow-up. Food outlet locations ( n = 1,410) were obtained from the Baltimore City Health Department and validated by ground-truthing. Secondary data on healthy food availability within select food stores in Baltimore City in 2007 were obtained via a validated food environment assessment measure, the Nutrition Environments Measures Study. Multilevel models were used to examine associations between availability of healthy food and number of various food outlets along paths to school and child anthropometric change over 1 year. Controlling for individual-, neighborhood-, and school-level characteristics, results indicated that higher healthy food availability within a 100 m buffer of paths to school was associated with 0.15 kg/m lower BMI gain ( p = 0.015) and 0.47 cm smaller waist circumference gain ( p = 0.037) over 1 year. Although prior research has illuminated the importance of healthy food choices within school and home environments, the current study suggests that exposure to the food environment along paths to school should be further explored in relation to child health outcomes. [ABSTRACT FROM AUTHOR]

Gentrification can drive residential displacement and exacerbate social inequities; however, no consensus about such impacts exists because gentrification definitions vary, and methods lack spatial statistics. Here, gentrification scores were calculated for census tracts in the Atlanta metropolitan area, 2000–2016. Spatial autocorrelation of gentrification was assessed, and spatial cluster detection identified hotspots and coldspots of gentrification. Sub-analyses evaluated the impact of time period (before/after 2010) and conceptualization of gentrification (purely economic changes or a combination of changes in economic, racial, and age composition) on the size and location of clusters. Extreme gentrification occurred around downtown Atlanta, while southern and eastern reaches experienced economic decline and decreases in older and non-Hispanic White residents. Leveraging spatial statistical analysis and examining gentrification hotspots across metrics, this study establishes critical understanding of historic gentrification in Atlanta and lays the groundwork to further examine gentrification's impact on the wellbeing of residents and communities to inform urban planning decisions to advance equity. • Spatial cluster detection analysis was used to identify gentrification in Atlanta. • Atlanta gentrification showed extreme spatial autocorrelation. • One hotspot of gentrification and two coldspots of gentrification were identified. • Size of the hotspot varied by time period and inclusion of race/ethnicity and age. • Coldspots' size and location varied by time period and inclusion of race and age. [ABSTRACT FROM AUTHOR]

Abstract: Coal abandoned mine lands (AMLs), persistent and prevalent across Pennsylvania, offer an instructive evaluation of potential contextual influences of chronic environmental contamination (CEC) on individual health. We evaluated associations between the burden of AMLs, represented by 10 contextual metrics at the community level, and individual-level type 2 diabetes using hemoglobin A1c (HbA1c) as a biomarker. Cross-sectional and longitudinal multilevel analyses were conducted with over 28,000 diabetic primary care patients of the Geisinger Clinic. Adjusted models revealed five AML burden measures were associated (p<0.05), and three additional were borderline associated (0.05≤p≤0.10), with higher and/or change in HbA1c levels. This study provides key empirical evidence of adverse impacts of CEC in communities on an important chronic disease, illustrating the contextual effects of living in long-term degraded landscapes and communities. [Copyright &y& Elsevier]

Background: Pennsylvania, with thousands of abandoned coal mines and miles of streams polluted with acid mine drainage, has the largest domestic coal mining burden contributing to deterioration of communities. Objectives. To evaluate contextual aspects by examining associations between coal abandoned mine lands (AML) and community measures of socioeconomic deprivation, social disorganization, and physical disorder. Methods. AML exposure data from the Reclaimed Abandoned Mine Land Inventory System were used to create density, diversity, accessibility, and clustering metrics. The three community context outcome measures were comprised of 14 census variables. In community-level analyses, 10 AML variables were evaluated separately with each dimension of community context, adjusting for covariates, in communities with and without abandoned mines. Results. We observed consistent associations between higher AML burden and worse socioeconomic deprivation, negative relations with social disorganization, but no statistically significant associations with physical disorder. Six of 10 AML variables were associated with socioeconomic deprivation, many consistently exhibiting exposure-effect patterns of worse deprivation with greater AML. Conclusions: Higher AML was associated with higher socioeconomic deprivation. These results can help prioritize the use of Surface Mining Control and Reclamation Act funds and inform decisions regarding Marcellus shale drilling to prevent analogous environmental degradation and public health impacts. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the association between the levels of ozone concentration and emergency department (ED) visits for respiratory and cardiovascular conditions in Maryland in the United States by considering temporal and spatial characteristics, including socioeconomic status (SES), as a covariate. This study used multiple large datasets derived from government agencies for data of ozone, weather, census, and ED visits to represent Maryland in the summer of 2002. Block kriging was used to estimate the daily ozone and weather factors by ZIP code-day level. Results from a negative binomial regression showed that a 10-ppb increment of the 8-hr ozone level as a three-day average was associated with increased respiratory ED visits by 2.4%, after adjusting for weather factors, SES, and day of the week. For cardiovascular ED visits, an increment of 10 ppb of the 8-hr ozone level as a five-day average increased by 3.5%. [ABSTRACT FROM AUTHOR]

Spatial interpolation methods are frequently used to estimate values of physical or chemical constituents in locations where they are not measured. Very little research has been conducted, however, to investigate the relative performance of different interpolation methods in surface waters. The study reported here uses archived water quality data from the Chesapeake Bay to compare three spatial interpolation methods: inverse distance weighting, ordinary kriging, and a universal kriging method that incorporates output from a process-based water quality model. Interpolations were performed on salinity, water temperature, and dissolved oxygen “snap shots” (cruise-based data sets) taken between 1985 and 1994 at 21 different depths for multiple locations in the mainstem Bay, using data compiled by the prototypical Chesapeake Bay Environmental Observatory. The kriging methods generally outperform inverse distance weighting for all parameters and depths. Incorporating output from the water quality model through universal kriging appears to improve some of the interpolations by specifically accounting for some physical and biogeochemical features of the estuary. Such integration of process-based information with statistical interpolation warrants further study. [ABSTRACT FROM AUTHOR]

Spring Valley, Washington, DC, was built over a World War I chemical weapons development site. Testing activities caused wide dispersal of arsenic in soil and waste disposal resulted in localized subsurface contamination. Spring Valley presents an interesting case study, a contaminated physical environment, but a strongly health-protective social environment. To address a possible “healthy community” bias we selected a nearby comparison community with similar health-protective characteristics. Our study included a community health assessment, a spatial analysis of disease clustering and a chemical hazard assessment. Community health in Spring Valley is good. Rates of major causes of mortality and incidence of selected cancers are 20–70% lower than the nation’s. Rates of hypertension and related kidney disease mortality and certain potentially arsenic-related cancers are slightly elevated in Spring Valley over a comparison community. Registry-confirmed cancers are not more likely to cluster in higher contamination areas, odds ratio (95% Confidence Interval) = 0.60 (0.30, 1.11). Chemicals detected in disposal pits are associated with cancer, kidney, neurological and blood effects. In context of a healthy community, the elevated rates of certain mortality and cancer outcomes warrant continued monitoring. Follow-up on kidney, neurological and blood diseases was recommended. Urban environments are complex with close proximity of residents to a wide variety of commercial and government activities, past and present. Each community will have a mix of health-damaging and health protective factors. Our assessment combined descriptive and analytical epidemiology and environmental risk analyses and represents a flexible tool kit adaptable to unique community conditions. [ABSTRACT FROM AUTHOR]

Background: The importance of geography as a source of variation in health research continues to receive sustained attention in the literature. The inclusion of geographic information in such research often begins by adding data to a map which is predicated by some knowledge of location. A precise level of spatial information is conventionally achieved through geocoding, the geographic information system (GIS) process of translating mailing address information to coordinates on a map. The geocoding process is not without its limitations, though, since there is always a percentage of addresses which cannot be converted successfully (nongeocodable). This raises concerns regarding bias since traditionally the practice has been to exclude nongeocoded data records from analysis. Methodology/Principal Findings: In this manuscript we develop and evaluate a set of imputation strategies for dealing with missing spatial information from nongeocoded addresses. The strategies are developed assuming a known zip code with increasing use of collateral information, namely the spatial distribution of the population at risk. Strategies are evaluated using prostate cancer data obtained from the Maryland Cancer Registry. We consider total case enumerations at the Census county, tract, and block group level as the outcome of interest when applying and evaluating the methods. Multiple imputation is used to provide estimated total case counts based on complete data (geocodes plus imputed nongeocodes) with a measure of uncertainty. Results indicate that the imputation strategy based on using available population-based age, gender, and race information performed the best overall at the county, tract, and block group levels. Conclusions/Significance: The procedure allows for the potentially biased and likely under reported outcome, case enumerations based on only the geocoded records, to be presented with a statistically adjusted count (imputed count) with a measure of uncertainty that are based on all the case data, the geocodes and imputed nongeocodes. Similar strategies can be applied in other analysis settings. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional survey that assessed population immunity to measles virus and the effect of HIV-1 infection after a mass vaccination campaign in Lusaka, Zambia. Households in Lusaka, Zambia were randomly selected for a cross-sectional survey three years after a measles supplemental immunisation activity (SIA). Children nine months to five years of age participated in the survey. Information about measles vaccination history and history of measles was obtained from the children's caregivers using a questionnaire. Children's oral fluid samples were tested for antibodies to measles virus and HIV-1. Researchers concluded that population immunity to measles was insufficient to interrupt measles virus transmission three years after an SIA.

Objectives To describe our experience using satellite image-based sampling to conduct a health survey of children in an urban area of Lusaka, Zambia, as an approach to sampling when the population is poorly characterized by existing census data or maps. Methods Using a publicly available Quickbird™ image of several townships, we created digital records of structures within the residential urban study area using ArcGIS 9.2. Boundaries were drawn to create geographic subdivisions based on natural and man-made barriers (e.g. roads). Survey teams of biomedical research students and local community health workers followed a standard protocol to enrol children within the selected structure, or to move to the neighbouring structure if the selected structure was ineligible or refused enrolment. Spatial clustering was assessed using the K-difference function. Results Digital records of 16 105 structures within the study area were created. Of the 750 randomly selected structures, six (1%) were not found by the survey teams. A total of 1247 structures were assessed for eligibility, of which 691 eligible households were enroled. The majority of enroled households were the initially selected structures (51%) or the first selected neighbour (42%). Households that refused enrolment tended to cluster more than those which enroled. Conclusions Sampling from a satellite image was feasible in this urban African setting. Satellite images may be useful for public health surveillance in populations with inaccurate census data or maps and allow for spatial analyses such as identification of clustering among refusing households. [ABSTRACT FROM AUTHOR]

BACKGROUND: The nontherapeutic use of antibiotics in swine feed can select for antibiotic resistance in swine enteric bacteria. Leaking swine waste storage pits and the land-application of swine manure can result in the dispersion of resistant bacteria to water sources. However, there are few data comparing levels of resistant bacteria in swine manure--impacted water sources versus unaffected sources. OBJECTIVES: The goal of this study was to analyze surface water and groundwater situated up and down gradient from a swine facility for antibiotic-resistant enterococci and other fecal indicators. METHODS: Surface water and groundwater samples (n = 28) were collected up and down gradient from a swine facility from 2002 to 2004. Fecal indicators were isolated by membrane filtration, and enterococci (n = 200) were tested for susceptibility to erythromycin, tetracycline, clindamycin, virginiamycin, and vancomycin. RESULTS: Median concentrations of enterococci, fecal coliforms, and Escherichia coli were 4- to 33-fold higher in down-gradient versus up-gradient surface water and groundwater. We observed higher minimal inhibitory concentrations for four antibiotics in enterococci isolated from down-gradient versus up-gradient surface water and groundwater. Elevated percentages of erythromycin- (p = 0.02) and tetracycline-resistant (p = 0.06) enterococci were detected in down-gradient surface waters, and higher percentages of tetracycline- (p = 0.07) and clindamycin-resistant (p < 0.001) enterococci were detected in down-gradient groundwater. CONCLUSIONS: We detected elevated levels of fecal indicators and antibiotic-resistant enterococci in water sources situated down gradient from a swine facility compared with up-gradient sources. These findings provide additional evidence that water contaminated with swine manure could contribute to the spread of antibiotic resistance. [ABSTRACT FROM AUTHOR]

In this study we evaluated residential location as a potential determinant for exposure to organochlorine compounds. We investigated the geographic distribution characteristics of organochlorine levels in approximately 1,374 blood samples collected in 1974 from residents of a community with a potential organochlorine source. Street addresses of Washington County, Maryland, residents were obtained and geocoded in a geographic information system. We used multivariate linear regression models to characterize the blood organochlorine levels of these residents that had been analyzed as part of previous studies using both environmental- and individual-level covariates. This was done to evaluate if the geographic distribution of blood levels in participants was related to the environmental source in the community. Model inference was based on generalized least squares to account for residual spatial variation. A significant inverse relationship was found between blood dieldrin levels and residential distance from the potential source. For every mile of distance from the source, blood dieldrin levels decreased 1.6 ng/g in study participants (p-value = 0.042), adjusting for age, sex, education level, smoking status, and drinking water source. 1,1-Dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) levels in the blood did not change significantly based on residential distance from the source, taking the same covariates into account. However, these results are limited by the inability to account for several potential confounders. This study demonstrates that spatially distributed covariates may play an important role in individual exposure patterns. Spatial information may enable researchers to detect a potential exposure pattern that may not be revealed with only nonspatial variables. [ABSTRACT FROM AUTHOR]

Background. This research explores area-level social influences on prostate cancer, to test whether area-level influences explain disparities in U.S. prostate cancer burden.Methods. The authors geocoded 23,993 1992–1997 Maryland prostate cancer cases, and linked cases to 1990 census data. The authors examined the effect of 17 area-level social variables, measured at block group, tract, and county, modeling individual and multilevel predictors of later stage and higher tumor grade.Results. Younger age, black race, higher grade or ungraded tumors, and earlier year of diagnosis were associated with later stage. Block group percentage of white-collar workers (O.R. = 0.93, 95% C.I. = 0.89, 0.98), and county resources (O.R. = 0.94, 95% C.I. = 0.89, 0.98), were protective of later stage. Older age, black race, and earlier year of diagnosis were associated with higher grade. Block group income was protective for white men (O.R. = 0.92, 95% C.I. = 0.87, 0.96), but for all men, county resources increased risk of higher grade (O.R. = 1.23, 95% C.I. = 1.16, 1.31).Conclusions. Social resources did not significantly reduce racial differences. Results suggest tumor biology is related to relative resources, with better outcomes associated with greater small-area wealth in low-resource counties, but stage at diagnosis is associated with absolute resources, with better outcomes associated with higher small-area social class in high-resource counties. [Copyright &y& Elsevier]

Geostatistics is a set of statistical techniques used in the analysis of georeferenced data that can be applied to environmental contamination and remediation studies. In this study, the 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) contamination at a Superfund site in western Maryland is evaluated. Concern about the site and its future clean up has triggered interest within the community because residential development surrounds the area. Spatial statistical methods, of which geostatistics is a subset, are becoming increasingly popular, in part due to the availability of geographic information system (GIS) software in a variety of application packages. In this article, the joint use of ArcGIS software and the R statistical computing environment are demonstrated as an approach for comprehensive geostatistical analyses. The spatial regression method, kriging, is used to provide predictions of DDE levels at unsampled locations both within the site and the surrounding areas where residential development is ongoing. [ABSTRACT FROM AUTHOR]

Clinical investigators are increasing their use of quantitative determinations of HIV viral load in their study populations. The distributions of these measures may be highly skewed, left-censored, and with an extra spike below the detection limit of the assay. We recommended use of a mixture model in this situation, with two sets of explanatory covariates. We extend this model to incorporate multiple measures across time, and to employ shared parameters as a way of increasing model efficiency and parsimony. Data from a cohort of HIV-infected men are used to illustrate these features, and simulations are performed to assess the utility of shared parameters. [ABSTRACT FROM AUTHOR]

Conclusions. The statistically significant association found between rainfall and disease in the United States is important for water managers, public health officials, and risk assessors of future climate change. (Am J Public Health. 2001;91:1194-1199) [ABSTRACT FROM AUTHOR]

Sustained viral suppression is one of the four strategies in the U.S. Department of Health and Human Services' (HHS) plan to end the HIV epidemic in the United States. Individuals living with HIV must understand their viral load accurately for this strategy to be effective. We conducted cross-sectional analyses using baseline data from the NNHIV longitudinal study among men who have sex with men (MSM) living with HIV in New York City to identify factors associated with concordant knowledge between self-reported and lab-confirmed viral load. Of 164 Black and/or Latine participants, 67% (n = 110) reported that their viral load was undetectable, however lab tests showed only 44% (n = 72) had an undetectable viral load (<20 copies/ml). Overall, 62% of the sample (n = 102) had concordant HIV viral load knowledge (agreement of self-reported and lab viral load). In multivariable regression, those with unstable housing (PR = 0.52, 0.30-0.92) and those who had higher levels of beliefs of racism in medicine scale (PR = 0.76, 0.59–0.97) were less likely to have concordant knowledge. Our study underscores the need for implementing measures to improve viral load knowledge, U = U messaging, and strategies to achieve and maintain undetectable viral load status to reduce the burden of HIV at the population level. [ABSTRACT FROM AUTHOR]

The original version of this article unfortunately contained a mistake in equation 9. [ABSTRACT FROM AUTHOR]

As a framework, population health emphasizes health outcomes for entire populations, the broad range of determinants of these outcomes, and the comparative effectiveness of medical and public health interventions. In practice, however, many contemporary population health programs instead focus on small subsets of patients who account for a disproportionate share of health care utilization, often with disappointing results. The authors proposed a new approach to operationalize population health in clinical settings, with the example of tobacco use. Electronic health record (EHR) data from a mid-Atlantic health system were used to: (1) define and describe a hospital-based population of current smokers, (2) analyze the demographic characteristics of the population to consider how the social context may impact treatment, and (3) join EHR data with public licensing data on tobacco retail locations to assess the relationship between the built environment and smoking status. Out of a total of 20,310 unique adult admissions to the health system, 3749 (18.5%) were current smokers. Compared to never smokers, current smokers were significantly younger, more likely to be male, more likely to be Black/African American, less likely to be Hispanic/Latino/a, and more likely to be on Medicaid or be self-pay. Current vs. former smokers had significantly higher exposure to tobacco retail locations, even after adjusting for demographic and other covariates. By defining populations around leading modifiable medical determinants of health, and accounting for the larger context of sociodemographic factors and the built environment, health systems can invest in comprehensive programs designed to produce the greatest population health returns. [ABSTRACT FROM AUTHOR]

Objective: To identify potential clusters of systemic lupus erythematosus (SLE) organ‐specific flares and their relationship to fine particulate matter pollution (PM2.5), temperature, ozone concentration, resultant wind, relative humidity, and barometric pressure in the Hopkins Lupus Cohort, using spatiotemporal cluster analysis. Methods: A total of 1,628 patients who fulfilled the Systemic Lupus International Collaborating Clinics classification criteria for SLE and who had a home address recorded were included in the analysis. Disease activity was assessed using the Lupus Activity Index. Assessment of rash, joint involvement, serositis, and neurologic, pulmonary, renal, and hematologic activity was quantified on a 0–3 visual analog scale (VAS). An organ‐specific flare was defined as an increase in VAS of ≥1 point compared to the previous visit. Spatiotemporal clusters were detected using SaTScan software. Regression models were used for cluster adjustment and included individual, county‐level, and environmental variables. Results: Significant clusters unadjusted for environmental variables were identified for joint flares (P < 0.05; n = 3), rash flares (P < 0.05; n = 4), hematologic flares (P < 0.05; n = 3), neurologic flares (P < 0.05; n = 2), renal flares (P < 0.001; n = 4), serositis (P < 0.001; n = 2), and pulmonary flares (P < 0.001; n = 2). The majority of the clusters identified changed in significance, temporal extent, or spatial extent after adjustment for environmental variables. Conclusion: We describe the first spatiotemporal clusters of lupus organ‐specific flares. Seasonal, as well as multi‐year, cluster patterns were identified, differing in extent and location for the various organ‐specific flare types. Further studies focusing on each individual organ‐specific flare are needed to better understand the driving forces behind these observed changes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020. METHODS: Physician registries identified the 2001-2020 gynecologic oncology workforce and were aggregated to each county. The at-risk cohort (women aged 18 years or older) was stratified by race and ethnicity and rurality demographics. We computed the distance from at-risk women to physicians. Relative access scores were computed by a spatial model for each contiguous county. Access scores were compared across urban or rural status and racial and ethnic groups. RESULTS: Between 2001 and 2020, the gynecologic oncologist workforce increased. By 2020, there were 1,178 active physicians and 98.3% practiced in urban areas (37.3% of all counties). Geographic disparities were identified, with 1.09 physicians per 100,000 women in urban areas compared with 0.1 physicians per 100,000 women in rural areas. In total, 2,862 counties (57.4 million at-risk women) lacked an active physician. Additionally, there was no increase in rural physicians, with only 1.7% practicing in rural areas in 2016-2020 relative to 2.2% in 2001-2005 (P5.35). Women in racial and ethnic minority populations, such as American Indian or Alaska Native and Hispanic women, exhibited the lowest level of access to physicians across all time periods. For example, 23.7% of American Indian or Alaska Native women did not have access to a physician within 100 miles between 2016 and 2020, which did not improve over time. Non- Hispanic Black women experienced an increase in relative accessibility, with a 26.2% increase by 2016-2020. However, Asian or Pacific Islander women exhibited significantly better access than non-Hispanic White, non-Hispanic Black, Hispanic, and American Indian or Alaska Native women across all time periods. CONCLUSION: Although the U.S. gynecologic oncologist workforce increased steadily over 20 years, this has not translated into evidence of improved access for many women from rural and underrepresented areas. However, health care utilization and cancer outcomes may not be influenced only by distance and availability. Policies and pipeline programs are needed to address these inequities in gynecologic cancer care. [ABSTRACT FROM AUTHOR]

Plant phenology (e.g. timing of spring green-up, flowering) is among the most sensitive indicator of ecological response to ongoing climate variability and change. While previous studies have documented changes in the timing of spring green-up and flowering across different parts of the world, empirical evidence regarding how such ongoing ecological changes impact allergic disease burden at population level is lacking. Because earlier spring green-up may increase season length for tree pollen, we hypothesized that early onset of spring (negative anomaly in start of season (SOS)) will be associated with increased hay fever burden. To test this, we first calculated a median cardinal date for SOS for each county within the contiguous US for the years 2001–2013 using phenology data from the National Aeronautics and Space Administration’s Moderate Resolution Imaging Spectroradiometer (MODIS). We categorized yearly deviations in SOS for each county from their respective long-term averages as: very early (>3 wks early), early (1–3 wks early), average (within 1 wk), late (1–3 wks late) and very late (> 3 wks late). We linked these data to 2002–2013 National Health Interview Survey data, and investigated the association between changes in SOS and hay fever prevalence using logistic regression. We observed that adults living in counties with a very early onset of SOS had a 14% higher odds of hay fever compared to the reference group, i.e. those living in counties where onset of spring was within the normal range (Odds Ratios (OR): 1.14. 95% Confidence Interval (CI): 1.03–1.27). Likewise, adults living in counties with very late onset of SOS had a 18% higher odds hay fever compared to the reference group (OR: 1.18, CI: 1.05–1.32). Our data provides the first-ever national scale assessment of the impact of changing plant phenology–linked to ongoing climate variability and change–on hay fever prevalence. Our findings are likely tied to changes in pollen dynamics, i.e early onset of spring increases the duration of exposure to tree pollen, while very late onset of spring increases the propensity of exposure because of simultaneous blooming. [ABSTRACT FROM AUTHOR]

The article discusses a study that applies the one health approach to show and address the issue of housing instability in Baltimore, Maryland, and extends the public health concept by connecting animal welfare and human health. It examines the hypothesis that people living in low income and vulnerable communities, who are at a high risk for housing loss through eviction, seek to surrender their pets before being evicted. It describes strategies to alleviate financial stress related to pets.

Background: Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC. This study investigated the relationship between cumulative neighborhood-level exposures and TNBC risk. Methods: This single-institution retrospective study was conducted on a cohort of 3316 breast cancer cases from New Castle County, Delaware (from 2012 to 2020), an area of the country with elevated TNBC rates. Cases were stratified into TNBC and "Non-TNBC" diagnosis and geocoded by residential address. Neighborhood exposures included census tract-level measures of unhealthy alcohol use, metabolic dysfunction, breastfeeding, and environmental hazards. An overall cumulative risk score was calculated based on tract-level exposures. Results: Univariate analyses showed each tract-level exposure was associated with greater TNBC odds. In multivariate analyses that controlled for patient-level race and age, tract-level exposures were not associated with TNBC odds. However, in a second multivariate model that included patient-level variables and considered tract-level risk factors as a cumulative exposure risk score, each one unit increase in cumulative exposure was significantly associated with a 10% increase in TNBC odds. Higher cumulative exposure risk scores were found in census tracts with relatively high proportions of Black residents. Conclusions: Cumulative exposure to neighborhood-level risk factors that disproportionately affect Black communities was associated with greater TNBC risk. [ABSTRACT FROM AUTHOR]

Background: Elbow injuries cause significant disability for the throwing athlete. Scant data are available on the distribution and characteristics of these injuries in elite baseball players. No study exists that focuses solely on the epidemiological characteristics of elbow injuries in professional baseball players using a comprehensive injury surveillance system. Hypothesis: Professional baseball players have a high occurrence of elbow injuries influenced by factors including length of time playing, time period within the annual baseball season, and specific position played. Study Design: Descriptive epidemiological study. Methods: Data on elbow injuries occurring during the 2011-2014 seasons were collected from Major League Baseball’s Health Injury and Tracking System, a comprehensive injury surveillance system. Each specific type of elbow injury was evaluated with respect to overall injury rate, years as a professional player, mechanism of injury, treatment, average time lost, and return to play. Results: During the study period, 3185 elbow injuries (n = 430 Major League; n = 2755 Minor League) occurred. The mean number of days missed and percentage requiring surgery were similar between Major and Minor League players. Overall, 20.0% (650/3185) of the injuries required surgical treatment. Pitchers were the most likely to incur an elbow injury (40.0% of injured athletes were pitchers), were the most likely to require surgery (34.2% of injured pitchers required surgery), and had the greatest mean number of days missed when treated nonsurgically (33.2 days). Medial injuries composed 42.1% (1342/3185) of all elbow injuries. Of all elbow surgeries performed during the study period, the highest percentage involved ligaments (372/650; 57.2%). Conclusion: Elbow injuries are a considerable source of disability in professional baseball players. Pitchers are most likely to incur these injuries, are most likely to require surgery, and have the highest mean number of days missed when treated nonsurgically. The most common injuries involve the medial elbow, with ligament injuries most often requiring surgery. This study represents the only investigation to date using a comprehensive injury surveillance system to examine elbow injuries in professional baseball players. It provides a basis for injury prevention and treatment recommendations, establishes the most thorough framework for determining elbow injury risk, and focuses continued research on elbow injury prevention in the elite baseball player. [ABSTRACT FROM AUTHOR]

Background Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. Methods The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. Results Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P <.001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk. Conclusions Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality. [ABSTRACT FROM AUTHOR]

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = -0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, -0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, -0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term. [ABSTRACT FROM AUTHOR]

Background: Missing data in cancer surveillance records are common; however, little information exists on the types of cases most likely to have missing data, or how missing data influence research or policy. Two clinical elements often missing in surveillance data are histologic grade and stage of disease. Missing data are either not clinically ascertained or not successfully abstracted. Methods: Prostate cancer cases (N=22,217) reported to the Maryland Cancer Registry during 1992–1997 were geocoded by residence and analyzed. Multi-level logistic regression was used to examine case attributes and area-level demographic, economic, and health services characteristics predictive of either missing stage or grade. A scanning statistic was used to explore geographic clustering of high and low rates of missing stage and grade within the state, before and after adjustment for significant variables from multi-level models. Results: Older age, black race, missing grade, and higher county-level median income increased the likelihood of missing stage, whereas more recent year of diagnosis, higher blockgroup-level median income, and county-level rurality decreased the likelihood. Older age, missing or later stage, higher blockgroup-level median income, and more urologists per case in one’s county of residence increased the likelihood of missing tumor grade, and more recent year of diagnosis, higher county-level median income, and rurality decreased the likelihood. Adjustment reduced statistically significant clusters of missing stage from six to two, and clusters of missing grade from three to zero. Conclusions: Results suggest systematic influences on missing stage and grade, which could be investigated with case–control follow-back studies. [Copyright &y& Elsevier]

Background: Location, frequency, and severity of in-game injuries by defensive position played have never been determined in professional baseball players. Hypothesis: Catchers would have a higher frequency of hip and knee injuries; infielders and outfielders would have a higher frequency of general lower extremity injuries; and pitchers would have a higher frequency and severity of shoulder and elbow/forearm injuries. Study Design: Descriptive epidemiology study. Methods: The Major League Baseball Health and Injury Tracking System database was queried for all injuries in Major League Baseball and Minor League Baseball during the 2011-2019 seasons. Injuries were stratified by the following variables: athlete's level of play at the time of injury, anatomic region injured, whether the injury occurred during a game, and position played at the time of injury (infielder, outfielder, catcher, or pitcher). Number of days missed from competition immediately after an injury was used as a surrogate for injury severity: mild (0 days missed), moderate (1-5 days), and severe (>5 days). Observed versus expected injury ratios were calculated for each anatomic region based on position played, and ratios were adjusted by the number of players per position type during a standard inning of play. Results: A total of 112,405 work-related injuries were reported, with the majority of injuries (86,520; 77%) occurring in Minor League Baseball athletes. Injuries to the leg, hand, shoulder, torso, and foot were the most common for athletes in both leagues, while hip/groin injuries were the least common. Catchers sustained the most in-game defensive head/neck injuries, while infielders and outfielders had the highest number of knee injuries. Starting and relief pitchers had the greatest total proportion of in-game defensive injuries across every other body region. Infielders and outfielders sustained injuries less frequently than expected across all body regions, while pitchers experienced more injuries than expected for all body parts. Catchers experienced more injuries than expected to the head/neck, hand, hip/groin, knee, and foot, and were more likely than other position players to sustain a knee injury that was categorized as severe based on time missed. Conclusion: The location, severity, and frequency of injuries vary by defensive position among professional baseball players. [ABSTRACT FROM AUTHOR]

A majority of black carbon (BC) emitted to the atmosphere in the Indo-Gangetic Plain (IGP) region is from burning biomass fuel used in traditional, open-design cookstoves. However, BC and particulate matter (PM) household emissions are not well characterized. Household emission information is needed to develop emission profiles to validate regional climate change models and serve as a baseline for assessing the impact of adopting improved stove technology. This paper presents field-based household PM and BC exfiltration (amount exiting) estimates from village homes in rural Nepal that utilize traditional, open-design cookstoves. Use of these stoves resulted in a 26% mean PM exfiltration, ranging from 6% to 58%. This is a significant departure from an 80% estimate cited in previous reports. Furthermore, having a window/door resulted in an 11% increase in exfiltration when an opening was present, while fuel type had a marginally significant impact on emission. Air-exchange rates (AER) were determined with average (95% CI) AER of 12 (10-14) per hour, consistent with previous studies. In addition, BC to PM2.5 mass-ratio composition during cooking was ascertained, with an average (95% CI) of 31% (24-39), agreeing with previous biomass fuel emission composition literature. [ABSTRACT FROM AUTHOR]

Background: Injury rates in baseball players of all ages are increasing. Identifying modifiable risk factors is paramount to implementing injury prevention programs. Purpose/Hypothesis: The purpose was to evaluate the influence of weather (temperature, humidity, atmospheric pressure, and heat index) and game factors (start time, duration, single vs doubleheader) on injury rates in professional baseball players. We hypothesized that colder temperatures would be associated with significantly more injuries per game. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective database study. Two data sets were combined: 1 containing all injuries in Major and Minor League Baseball between 2011 and 2017 and 1 containing all games played in Major and Minor League Baseball during the same period to determine the number of injuries per game. Temperature, humidity, atmospheric pressure, and heat index were determined for each game using the data from the US Environmental Protection Agency. Additional game variables included the level of play, the turf type (natural vs artificial grass), the stadium type (open vs dome vs retractable), the game start time, the game duration, and whether the game was a doubleheader. Then, a multivariate analysis was conducted to determine which factors were associated with the number of injuries per game. Results: In total, our analysis included 33,587 injuries and 76,747 games. A total of 25,776 (33.6%) games contained an injury, and 41% of injuries occurred as multiples per game, with up to 9 injuries per game. The multivariate analysis identified significant associations between game duration and injuries per game (P <.001; effect size, 0.013) and the level of play and injuries per game (P <.001; effect size, 0.011). There were significant associations between the venue type (P <.001), the game start time (P <.001), humidity (P <.001), the turf type (P =.016), and barometric pressure (P =.031); however, the effect size for each was <0.001, suggesting that these factors are clinically unimportant. Our overall model produced an R 2 of 0.04, indicating that these variables only predicted 4% of the variance in injury risk. Conclusion: In professional baseball, the weather is not associated with injury risk; however, game duration may contribute to injury risk. [ABSTRACT FROM AUTHOR]

Abstract: Background: Drug and alcohol use are risk factors for HIV transmission. Much of the HIV behavioural research has focused on risk without consideration of the social and spatial context of the behaviour. Yet, risk may be specific or unique to place. The purpose of this study was to examine the social and spatial characteristics of places where African American men who have sex with men (AA MSM) use drugs and/or alcohol. Specifically, we examined spatial intensity and clustering of drug/alcohol places and characteristics of their social networks at these places. Methods: Participants were recruited using outreach, on-line advertisements and word-of-mouth referrals. Inclusion criteria were: age 18 or older and sex with a man in the prior 90 days. Participants (n =51) completed a socio-spatial inventory in which they provided addresses of n =187 places where they most recently used drugs and/or drank alcohol. Participants described characteristics of people who were at these places. Results: The mean age of participants was 36.5 years (SD=10.9). Half (51%) identified as gay, 31% bisexual, 4% heterosexual and 10% as not sure/questioning and 27% self-reported HIV positive status. Drug/alcohol places were spatially concentrated in the inner part of the city and evidence of clustering by participant characteristics was present. Of n =187 places named where the participant drank alcohol or used drugs, 68% were described as a residence (participants or “someone one else's house”), 20% were bars/clubs or restaurants, 8% were outside places and 4% were miscellaneous (e.g. on the bus/car). There were differences in the characteristics of social network members by place-type. At residential places, a greater proportion of networks listed were sex partners or kin, compared to other place-types. A greater proportion of networks listed at bars/clubs/restaurants were gay, knew that the participant had sex with men, and were younger compared to other place-types. Conclusion: AA MSM drink alcohol and use drugs in a variety of place-types and with various social network members. Little research has been done on factors that shape the geography of AA MSM substance use. Future research is needed to explore these complex associations. [Copyright &y& Elsevier]

Background: Evidence of associations between the built environment and obesity risk has been steadily building, yet few studies have focused on the relationship between the built environment and aspects of metabolism related to obesity's most tightly linked comorbidity, type 2 diabetes.Purpose: To examine the relationship between aspects of the neighborhood built environment and insulin resistance using accurate laboratory measures to account for fat distribution and adiposity.Methods: Data on 453 Hispanic youth (aged 8-18 years) from 2001 to 2011 were paired with neighborhood built environment and 2000 Census data. Analyses were conducted in 2011. Walking-distance buffers were built around participants' residential locations. Body composition and fat distribution were assessed using dual x-ray absorptiometry and waist circumference. Variables for park space, food access, walkability, and neighborhood sociocultural aspects were entered into a multivariate regression model predicting insulin resistance as determined by the homeostasis model assessment.Results: Independent of obesity measures, greater fast-food restaurant density was associated with higher insulin resistance. Increased park space and neighborhood linguistic isolation were associated with lower insulin resistance among boys. Among girls, park space was associated with lower insulin resistance, but greater neighborhood linguistic isolation was associated with higher insulin resistance. A significant interaction between waist circumference and neighborhood linguistic isolation indicated that the negative association between neighborhood linguistic isolation and insulin resistance diminished with increased waist circumference.Conclusions: Reducing access to fast food and increasing public park space may be valuable to addressing insulin resistance and type 2 diabetes, but effects may vary by gender. [ABSTRACT FROM AUTHOR]

Background: Evidence of associations between the built environment and obesity risk has been steadily building, yet few studies have focused on the relationship between the built environment and aspects of metabolism related to obesity’s most tightly linked comorbidity, type 2 diabetes. Purpose: To examine the relationship between aspects of the neighborhood built environment and insulin resistance using accurate laboratory measures to account for fat distribution and adiposity. Methods: Data on 453 Hispanic youth (aged 8–18 years) from 2001 to 2011 were paired with neighborhood built environment and 2000 Census data. Analyses were conducted in 2011. Walking-distance buffers were built around participants’ residential locations. Body composition and fat distribution were assessed using dual x-ray absorptiometry and waist circumference. Variables for park space, food access, walkability, and neighborhood sociocultural aspects were entered into a multivariate regression model predicting insulin resistance as determined by the homeostasis model assessment. Results: Independent of obesity measures, greater fast-food restaurant density was associated with higher insulin resistance. Increased park space and neighborhood linguistic isolation were associated with lower insulin resistance among boys. Among girls, park space was associated with lower insulin resistance, but greater neighborhood linguistic isolation was associated with higher insulin resistance. A significant interaction between waist circumference and neighborhood linguistic isolation indicated that the negative association between neighborhood linguistic isolation and insulin resistance diminished with increased waist circumference. Conclusions: Reducing access to fast food and increasing public park space may be valuable to addressing insulin resistance and type 2 diabetes, but effects may vary by gender. [Copyright &y& Elsevier]

Abstract: This study examined temporal and spatial relationships between neighborhood drug markets and gonorrhea among census block groups from 2002 to 2005. This was a spatial, longitudinal ecologic study. Poisson regression was used with adjustment in final models for socioeconomic status, residential stability and vacant housing. Increased drug market arrests were significantly associated with a 11% increase gonorrhea (adjusted relative risk (ARR) 1.11; 95% CI 1.05, 1.16). Increased drug market arrests in adjacent neighborhoods were significantly associated with a 27% increase in gonorrhea (ARR 1.27; 95% CI 1.16, 1.36), independent of focal neighborhood drug markets. Increased drug market arrests in the previous year in focal neighborhoods were not associated with gonorrhea (ARR 1.04; 95% CI 0.98, 1.10), adjusting for focal and adjacent drug markets. While the temporal was not supported, our findings support an associative link between drug markets and gonorrhea. The findings suggest that drug markets and their associated sexual networks may extend beyond local neighborhood boundaries indicating the importance of including spatial lags in regression models investigating these associations. [Copyright &y& Elsevier]

Purpose: Early COVID-19 mitigation relied on people staying home except for essential trips. The ability to stay home may differ by sociodemographic factors. We analyzed how factors related to social vulnerability impact a community's ability to stay home during a stay-at-home order.Methods: Using generalized, linear mixed models stratified by stay-at-home order (mandatory or not mandatory), we analyzed county-level stay-at-home behavior (inferred from mobile devices) during a period when a majority of United States counties had stay-at-home orders (April 7-April 20, 2020) with the Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI).Results: Counties with higher percentages of single-parent households, mobile homes, and persons with lower educational attainment were associated with lower stay-at-home behavior compared with counties with lower respective percentages. Counties with higher unemployment, higher percentages of limited-English-language speakers, and more multi-unit housing were associated with increases in stay-at-home behavior compared with counties with lower respective percentages. Stronger effects were found in counties with mandatory orders.Conclusions: Sociodemographic factors impact a community's ability to stay home during COVID-19 stay-at-home orders. Communities with higher social vulnerability may have more essential workers without work-from-home options or fewer resources to stay home for extended periods, which may increase risk for COVID-19. Results are useful for tailoring messaging, COVID-19 vaccine delivery, and public health responses to future outbreaks. [ABSTRACT FROM AUTHOR]

To determine whether persons living in areas of high animal density are at increased risk for carrying livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), we used an existing dataset of persons in the Netherlands with LA-MRSA carriage and controls who carried other types of MRSA. Results of running univariate and multivariate logistic regression models indicated that living in livestock-dense areas increases the odds of nasal carriage of LA-MRSA. We found that doubling pig, cattle, and veal calf densities per municipality increased the odds of LA-MRSA carriage over carriage of other types of MRSA by 24.7% (95% CI 0.9%-54.2%), 76.9% (95% CI 11.3%-81.3%), and 24.1% (95% CI 5.5%-45.9%), respectively, after adjusting for direct animal contact, living in a rural area, and the probable source of MRSA carriage. Controlling the spread of LA-MRSA thus requires giving attention to community members in animal-dense regions who are unaffiliated with livestock farming. [ABSTRACT FROM AUTHOR]