High Vulnerability Index Research Articles

Spatial Patterns of Emergency Dental Care Utilization: Assessing the Influence of Social Vulnerability and Dental Provider Availability.

Our aim was to examine the association between emergency dental care use and dental providers' availability and ZIP code social vulnerability index. This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.

Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach

BackgroundRural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents. MethodsThis retrospective study included adult patients captured in the Surveillance, Epidemiology, and End Results–Medicare data between January 2008 and December 2015 with an incident stage I to IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was a nonelective cancer-directed surgery among rural vs urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering. ResultsThe sample included 10,136 patients who underwent a surgical intervention; 2941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural than urban patients (351 [27%] and 2590 [29%]; P = .05). There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents (odds ratio, 0.88; 95% CI, 0.76–1.03; P = .11; adjusted odds ratio [aOR], 0.86; 95% CI, 0.72–1.02; P = .080). In addition, high social vulnerability index (SVI) counties or Black race was significantly associated with increase odds of nonelective surgery (aOR, 1.33; 95% CI, 1.07–1.65; P = .009; aOR, 1.49; 95% CI, 1.26–1.77; P < .0001, respectively). ConclusionThis study found no difference in the odds of receiving nonelective surgery for gastrointestinal foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore whether disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

Upper gastrointestinal cancers: Trends and determinants of location of death

BackgroundPatients diagnosed with upper gastrointestinal cancers often require extensive end-of-life care. We sought to investigate social determinants of health associated with disparities in the location of death among patients who died of upper gastrointestinal cancers. MethodsPatients who died between 2003 and 2020 from esophageal cancer, gastric cancer, hepatobiliary cancer, and pancreatic cancer were identified using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Social determinants of health were assessed using the Social Vulnerability Index. Patients were categorized on the basis of location of death: inpatient hospital, home, nursing home, hospice, and outpatient medical facility/emergency department. Multivariable regression and mediation analyses defined the association of patient race as well as social determinants of health with location of death. ResultsAmong 815,780 decedents (esophageal cancer: 15.3%; gastric cancer: 3.6%; hepatobiliary cancer: 36.6%; pancreatic cancer: 54.5%), most were male (60.8%), aged 55–74 years (52.3%), and White (89.1%). Most decedents died at home (55.7%), followed by inpatient hospital (24.8%), hospice (9.0%), nursing home (8.1%), and outpatient medical facility/emergency department (2.5%). During the study period, location of death shifted notably from inpatient hospital (36.8% to 21.3%) to home (45.8% to 56.3%). Residents of high Social Vulnerability Index areas were more likely to die at inpatient hospital compared with home (31.8% vs 24.3%) (P < .001). Black race (reference: White; odds ratio; 0.41, 95% confidence interval, 0.40–0.42) and social vulnerability (reference: low Social Vulnerability Index; odds ratio, 0.64, 95% confidence interval, 0.63–0.65) remained independently associated with lower odds of dying at home compared with an inpatient hospital. Notably, 65% of the overall race-based association with death at inpatient hospital was driven indirectly through social determinants of health. ConclusionSocial determinants are important drivers of end-of-life care and impact the potential ability of patients with cancer to die at home.

Vulnerable populations and the emergency ventral hernia: A retrospective cohort study

IntroductionVentral hernias can be repaired electively; however, many circumstances require emergency repair. The association between sociodemographic status and rate of emergency repair are unclear and the Social Vulnerability Index may be a useful tool to better understanding this association. The purpose of this study was to investigate the association between Social Vulnerability Index and emergency ventral hernia repair. MethodsThis was a retrospective cohort study using the National Surgical Quality Improvement Program (2012–2018) data for patients at a level 1 trauma center. We included patients who had an open ventral hernia repair. Social Vulnerability Index was based on residential address at the time of surgery. We conducted univariate and bivariate statistics, including χ2 and Mann-Whitney U tests to compare high and low social vulnerability. ResultsOur sample had 1,017 patients. Patients who underwent emergency operations were older (P = .025) and had higher Social Vulnerability Index (P = .029). Patients in the high Social Vulnerability Index group were 1.5 times more likely to receive emergency surgery (P = .047). Emergency repair was also associated with increased frequency of nonhome discharge (9% vs 2%, P = .001) and higher mean work relative value unit (15.4 vs 11.9, P < .001). ConclusionPatients requiring emergency ventral hernia repair have significantly higher Social Vulnerability Index than those undergoing elective repair. This vulnerable population also has increased cost associated with the repair and higher rates of nonhome discharge. This work provides a foundation for efforts to reach patients in high Social Vulnerability Index environments at an earlier stage to achieve earlier elective repair.

Soil Vulnerability Analysis Using the Microtremor Method for Mapping the Landslide Susceptibility Area in Batu City, Indonesia

Based on Regional Agency for Disaster Management (BPBD) Batu City data, Indonesia, 36 landslides have been recorded in the last three years around the Payung area, where this area connects several regions around Batu City. So, it is necessary to map areas with potential ground movement as an initial step for the local government in formulating a landslide disaster management strategy. This research aims to map landslide susceptibility areas around Payung, Batu City, identified based on the soil vulnerability index value range in the peak ground acceleration (PGA) mapping results. The data was measured using the microtremor method. There were 22 measurement points in 3 zones with different heights, and the microtremor signal was recorded for 35-40 minutes at each point. The microtremor signal from seismic recording is composed of three components (NS, EW, and Up-Down), which are used to develop the Horizontal to Vertical Spectral Ratio (HVSR) technique, where the ratio value is obtained by comparing horizontal (H) components (HNS and HEW) to the vertical component (Up-Down (V)). The research results show that landslide susceptibility areas are located at points M10, M13, and M16, with a soil vulnerability index range of 21-40.1. When a landslide occurs in that area with high vulnerability, it will impact points along Payung Street at points M3–M9. The points with high soil vulnerability index values need special treatment to reduce the impact of landslides.

WOOD ANATOMY INDICES AND REVEGETATION POTENTIALS OF THREE TAXA OF THE EUPHORBIACEAE

The suitability of three plant taxa namely: Bridelia ferruginea, Hura crepitans and Ricinodendron heudelotii as potential revegetation plants in desertified areas were assessed using Calquist’s wood anatomy indices (vulnerability and mesomorphy) using an ecological survey design. Temporal and permanent slides of transverse sections were prepared and vessel length and diameter (µm) measured using a Motic B3 Compound Microscope and vessel density determined for each of the plant taxa. The observed high vulnerability and high mesomorphy index values in Hura crepitans and Ricinodendron heudelotii indicates that they did not fall within the required ranges of 0 – 2.5 and 0 – 99 for the two indices respectively and cannot adapt well in xeric areas. However, Bridelia ferruginea fell within the range. In conclusion, Hura crepitans and Ricinodendron heudelotii are mesophytes while Bridelia ferruginea was xerophytic and can flourish in xeric areas, therefore, it possesses a great revegetation potential.

Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates.

We sought to characterize postoperative outcomes among patients who underwent an oncologic operation relative to whether the treating surgeon was an international medical graduate (IMG) versus a United States medical graduate (USMG). IMGs comprise approximately one quarter of the physician workforce in the United States. The 100% Medicare Standard Analytic Files were utilized to extract data on patients with breast, lung, hepato-pancreato-biliary (HPB), and colorectal cancer who underwent surgical resection between 2014 and 2020. Entropy balancing and multivariable regression analysis were performed to evaluate the association between postoperative outcomes among USMG and IMG surgeons. Among 285,930 beneficiaries, 242,914 (85.0%) and 43,016 (15.0%) underwent surgery by a USMG or IMG surgeon, respectively. Overall, 129,576 (45.3%) individuals were male, and 168,848 (59.1%) patients had a Charlson Comorbidity Index score >2. Notably, IMG surgeons were more likely to care for racial/ethnic minority patients (14.7% vs 12.5%) and individuals with a high social vulnerability index (33.3% vs 32.1%) (all P <0.001). On multivariable analysis after entropy balancing, patients treated by an IMG surgeon were less likely to experience adverse postoperative outcomes, including 90-day readmission [odds ratio (OR) 0.89, 95% CI: 0.80-0.99] and index complications (OR: 0.84, 95% CI: 0.74-0.95) versus USMG surgeons (all P <0.05). Patients treated by IMG versus USMG surgeons had no difference in likelihood to achieve a textbook outcome (OR: 1.10, 95% CI: 0.99-1.21; P =0.077). Postoperative outcomes among patients treated by IMG surgeons were roughly equivalent to those of USMG surgeons. In addition, IMG surgeons were more likely to care for patients with multiple comorbidities and individuals from vulnerable communities.

Beyond Multidimensional Vulnerability Approach: A Triple Network Notion for Urban Cohesion in At-Risk Neighborhoods of Jaen’s Historic Center

Today’s cities need more than ever methodological devices that ensure a specific urbanism, in keeping with the complexity of relationships that occur in the urban space. Networks or systems of a diverse nature must be activated to achieve a certain success of the city, even more so in its fragile central fabric. This study is focused on the historic neighborhoods of the city of Jaén (Spain), which have a high vulnerability index. The aim is to establish a strategy to revitalize their urban and social capital and improve their articulation with the rest of the urban and territorial structure. A methodological proposal for the analysis of vulnerability factors and an urban and cartographic analysis of the public space is addressed through an interweaving of a triple network: environmental, social, and urban. For this purpose, the configuration of this overlapping network of analysis and the formulation of criteria is presented, which considers the urban multiplicity and promotes new dynamics for the integrated urban regeneration of the area and for the activation of public and collective urban spaces.

Impact of a proactive patient assistance program for diverse ambulatory oncology patients: A retrospective cohort study.

e13513 Background: Significant differences persist in cancer incidence, survival, morbidity, and mortality among populations in the U.S. Individuals of lower socioeconomic status (SES) suffer disproportionately from cancer and other disease burdens compared to individuals with higher SES. Financial hardship is increasingly common, with many cancer survivors reporting difficulty paying medical bills, high financial distress, and delaying or forgoing care because of cost. Cancer patients reporting financial hardship are more likely to have psychosocial distress. Financial distress has been linked with several clinically relevant patient outcomes including quality of life, symptom burden, compliance, and survival. An NCI-designated comprehensive cancer center (CCC) with a diverse racial, ethnic, and linguistic patient population utilizes My Wellness Check (MWC) program to identify patients experiencing emotional, physical, practical, and social concerns. Among 4,117 MWC patient responders representing 43.1% of eligible patients during October 2019 - February 2022, 801 patients (19.5%) with 976 supportive or practical needs alerts were triggered to social workers where only 68.4% of the alerts were acted upon within a 72-hour window. For patients identified by MWC as having financial toxicity, Social Workers identified available resources to assist with patients’ out-of-pocket costs. Methods: In July 2022, the CCC launched a patient financial assistance program which included screening of all patients receiving systemic therapy administered at infusion centers. A third-party partner was contracted to provide patient advocates and technology augmenting the EHR. Patient Advocates identified eligible patients and enrolled them into financial assistance programs. Results: A retrospective analysis was performed for the period of May 2022 - December 2023, comparing patients receiving philanthropic medical financial assistance consisting of copay assistance and grants sponsored by drug manufacturers and diagnosis based non-profit foundations with infusion center patient population demographic data. The cohort participating in patient assistance programs included a higher percentage of female, Hispanic, age 27-64, commercially insured, and patients that reside in high and medium-high Social Vulnerability Index (SVI) counties. Conclusions: A proactive patient financial assistance program can help reduce financial distress for patients with cancer, especially those residing in high and medium high SVI counties. Leveraging the expertise of a third party helps mitigate financial toxicity in the short term and can help drive more equitable cancer outcomes.

Proteomic profiling reveals higher presence of glycolytic enzymes in vulnerable atherosclerotic lesions

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Leducq PlaqOmics Background Our definition of vulnerable plaques is predominantly driven by histological analysis. The molecular mechanisms behind the vulnerable histological characteristics are not fully understood. Here we use mass spectrometry-based proteomics data, to identify molecular mechanisms linked to vulnerable plaques. Methods Atherosclerotic lesions from two hundred patients undergoing endarterectomy surgery were collected (149 male and 51 female plaques). From a total of two hundred plaque samples, extracellular matrix proteins were extracted and processed for untargeted proteomics analysis. The resulting protein levels were linked to existing histological characteristics, transcriptomic, and clinical data. Results We detected 1499 proteins in atherosclerotic lesions, which were mostly affiliated with biological processes including extracellular matrix organization, coagulation, and peptidase activity. Linear regression identified 240 proteins associated with plaque vulnerability index (a semi-quantitative score summarizing the presence of SMC cells, macrophages, plaque hemorrhage, and fat in the plaque). Among the proteins associated with high plaque vulnerability index we identified an overrepresentation of enzymes involved in glycolysis – including the rate limiting enzymes HK3 (beta =0.40 p =0.003) and PKM (beta =0.19 p =0.009). This was driven by macrophage numbers and fat content in the plaque. Furthermore, data from a validation cohort of 120 patients from the Medical University of Vienna, Austria, revealed that HK3 and PKM were associated with plaque progression (p =&amp;lt;0.001, p =0.017) and clinical symptoms (p = &amp;lt;0.001, p = &amp;lt;0.001). Conclusion Enzymes involved in the glycolysis process show higher presence in vulnerable plaques. This suggests an important role for energy metabolism in plaque vulnerability.

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

The National Health Service Corps (NHSC) Loan Repayment Program (LRP) expansion in fiscal year (FY) 2019 intended to improve access to medication for opioid use disorder (MOUD) by adding more clinicians who could prescribe buprenorphine. However, some clinicians still face barriers to prescribing, which may vary between rural and nonrural areas. To examine the growth in buprenorphine prescribing by NHSC clinicians for Medicaid beneficiaries during the NHSC LRP expansion and describe the challenges to prescribing that persist in rural and nonrural areas. This cross-sectional study analyzed preexpansion and postexpansion Medicaid claims data to evaluate the percentage of prescriptions of buprenorphine filled during FY 2017 through 2021. This study also analyzed challenges and barriers to prescribing MOUD between rural and urban areas, using results from annual surveys conducted with NHSC clinicians and sites from FY 2019 through FY 2021. Prescribing of buprenorphine by NHSC clinicians. The main outcomes were the percentage and number of Medicaid beneficiaries with opioid use disorder (OUD) who filled a prescription for buprenorphine before and after the LRP expansion and the challenges NHSC clinicians and sites faced in providing substance use disorder and OUD services. Survey results were analyzed using descriptive statistics. During FYs 2017 through 2021, 7828 NHSC clinicians prescribed buprenorphine (standard LRP: mean [SD] age, 38.1 [8.4] years and 4807 females [78.9%]; expansion LRPs: mean [SD] age, 39.4 [8.1] years and 1307 females [75.0%]). A total of 3297 NHSC clinicians and 4732 NHSC sites responded to at least 1 survey question to the 3 surveys. The overall percentage of Medicaid beneficiaries with OUD who filled a prescription for buprenorphine during the first 2.5 years post expansion increased significantly from 18.9% before to 43.7% after expansion (an increase of 123 422 beneficiaries; P < .001). The percentage more than doubled among beneficiaries living in areas with a high Social Vulnerability Index score (from 17.0% to 36.7%; an increase of 31 964) and among beneficiaries living in rural areas (from 20.8% to 55.7%; an increase of 45 523). However, 773 of 2140 clinicians (36.1%; 95% CI, 33.6%-38.6%) reported a lack of mental health services to complement medication for OUD treatment, and 290 of 1032 clinicians (28.1%; 95% CI, 24.7%-31.7%) reported that they did not prescribe buprenorphine due to a lack of supervision, mentorship, or peer consultation. These findings suggest that although the X-waiver requirement has been removed and Substance Abuse and Mental Health Services Administration guidelines encourage all eligible clinicians to screen and offer patients with OUD buprenorphine, as permissible by state law, more trained health care workers and improved care coordination for counseling and referral services are needed to support comprehensive OUD treatment.

Social Factors Associated With Congenital Syphilis in Missouri.

Congenital syphilis disproportionately affects individuals impacted by adverse social determinants of health. Understanding these determinants may help facilitate holistic care. We performed a retrospective review of mother-infant dyads with potential congenital syphilis in a Missouri hospital system. Cases were classified per Centers for Disease Control and Prevention clinical scenarios. Information was collected regarding demographics, prenatal care, substance use, and other social factors. Dyads with confirmed/highly probable or possible congenital syphilis ("congenital syphilis outcomes") were compared to those with less likely/unlikely congenital syphilis ("noncongenital syphilis outcomes") using descriptive statistics. We identified 131 dyads with infant dates of birth from 2015 to 2022: 74 (56%) with congenital syphilis outcomes and 56 (43%) with noncongenital syphilis outcomes. Most mothers were Black/African American (n = 84 [65%]) and lived in areas with a high Social Vulnerability Index. Many had inadequate prenatal care (n = 61 [47%]) and/or had substance use histories (n = 55 [42%]). Significant associations (odds ratio [95% confidence interval]) with congenital syphilis outcomes included limited prenatal care (3.01 [1.38-6.56]), no prenatal care (16.08 [1.96-132.11]), substance use (3.42 [1.61-7.25]), housing instability (3.42 [1.39-8.38]), and justice system interactions (2.29 [1.00-5.24]). Substance use correlated with prenatal care adequacy (P < .001). One-third of infants with congenital syphilis outcomes were taken into protective custody. Adverse social determinants of health are common in dyads impacted by congenital syphilis. Health systems should consider interdisciplinary programming to improve testing and linkage to care. Future studies should evaluate social support for congenital syphilis prevention and management.

Association of county-level provider density and social vulnerability with colorectal cancer-related mortality

BackgroundHealth care providers play a crucial role in increasing overall awareness, screening, and treatment of cancer, leading to reduced cancer mortality. We sought to characterize the impact of provider density on colorectal cancer population-level mortality. MethodsCounty-level provider data, obtained from the Area Health Resource File between 2016 and 2018, were used to calculate provider density per county. These data were merged with county-level colorectal cancer mortality 2016–2020 data from the Centers for Disease Control and Prevention. Multivariable regression was performed to define the association between provider density and colorectal cancer mortality. ResultsAmong 2,863 counties included in the analytic cohort, 1,132 (39.5%) and 1,731 (60.5%) counties were categorized as urban and rural, respectively. The colorectal cancer-related crude mortality rate was higher in counties with low provider density versus counties with moderate or high provider density (low = 22.9, moderate = 21.6, high = 19.3 per 100,000 individuals; P < .001). On multivariable analysis, the odds of colorectal cancer mortality were lower in counties with moderate and high provider density versus counties with low provider density (moderate odds ratio 0.97, 95% confidence interval 0.94–0.99; high odds ratio 0.88, 95% confidence interval 0.86–0.91). High provider density remained associated with a lower likelihood of colorectal cancer mortality independent of social vulnerability index (low social vulnerability index and high provider density: odds ratio 0.85, 95% confidence interval 0.81–0.89; high social vulnerability index and high provider density: odds ratio 0.93, 95% confidence interval 0.89–0.98). ConclusionRegardless of social vulnerability index, high county-level provider density was associated with lower colorectal cancer-related mortality. Efforts to increase access to health care providers may improve health care equity, as well as long-term cancer outcomes.

Earthquake Disaster Risk Assessment in Purworejo District, Central Java Province, Indonesia

&lt;p class="Abstract"&gt;Purworejo Regency is directly adjacent to the Indian Ocean and is close to the Java subduction, so it is estimated to have a high earthquake risk index. This study aims to analyze the earthquake disaster risk in Purworejo District, Central Java Province, Indonesia. Earthquake risk analysis methods follow Perka BNPB No 02 of 2012, including hazard, vulnerability, and capacity analysis. The disaster risk index combines the disaster, vulnerability, and capacity indexes. The findings of this study reveal the following: (1) 295 villages within Purworejo Regency fall into the high earthquake hazard category, primarily located in the southern region of Purworejo or near the Java subduction zone. (2) The high vulnerability to earthquakes is widespread across almost all villages in Purworejo Regency. The highest concentration of villages with a high vulnerability index is found in Ngombol District (57 villages), Butuh District (41 villages), and Purwodadi District (40 villages). (3) Purworejo Regency exhibits a capacity to cope with earthquakes that are not categorized as low. The majority, comprising 464 villages (93.92%), falls within the middle class, while 30 villages (6.08%) are classified as having a high capacity. (4) Within Purworejo Regency, 117 villages (23.7%) are at a high risk of earthquakes, and 376 villages face a moderate risk. Only one village has a low disaster risk index.&lt;/p&gt;

Vulnerability Index Assessment for Mapping Ground Movements Using the Microtremor Method as Geological Hazard Mitigation

Various geological disasters, such as landslides and ground movements, occur annually in Srimulyo Village, Malang District, with varying levels of damage. Ground movements can affect structures built above, causing sinking, cracking, and collapse. Research into landslides and ground movements triggered by vibrations is generally conducted using the microtremor method, which has proven effective. This study uses the microtremor method to map the soil condition that is potentially prone to movement or landslides based on the observed soil vulnerability index. Data was collected using a TDL 303s Digital Portable Seismograph instrument; the measurement points were established in the form of a grid distributed across the research area, with a recording duration of approximately 45 minutes at each point. The analysis technique utilizes the Horizontal Vertical Spectrum Ratio (HVSR) based on the Fast Fourier Transform (FFT) principle. The study’s results found that the research location’s seismic vulnerability index varies between 6.5 and 16.5. Areas with high seismic vulnerability index values, specifically those with Kg&gt;11.5, are scattered on the west, south, and southeast sides of the research location. Based on field observations, these areas are dominated by relatively thick sediment layers, leading to lower dominant frequency values and higher amplification values; consequently, the seismic vulnerability index in the southern region is also high. Doi: 10.28991/CEJ-2024-010-05-017 Full Text: PDF

Epidemiological, clinical, and geographical characterization of Leprosy in the County of Santarém-Pará: Insights for effective control and targeted intervention.

Leprosy is an infectious disease characterized by slow and chronic evolution, caused by Mycobacterium leprae and or Mycobacterium lepromatosis, an intracellular alcohol-acid-resistant (BAAR) bacillus. The objective of this study was to provide an epidemiological, clinical, and geographic characterization of leprosy in the city of Santarém-Pará during the period 2011-2020. A cross-sectional, descriptive, and quantitative approach was used, employing maps and tables to illustrate clinical and epidemiological variables, including: sex, age, race, area of residence, operational classification, clinical form, number of skin lesions, number of affected nerves, and health units. During the analyzed period, 581 cases of leprosy were diagnosed, resulting in the following cumulative incidence rates: male (60%); age over 15 years (94%); urban area (73%); multibacillary (74%); borderline form (46%); skin lesions greater than 5 (34%); and no nerves affected (68%). In the urban perimeter, a higher cumulative incidence of cases was observed in the central area with 133 cases. However, the health unit reporting the largest number of cases belonged to the southern area, specifically the Basic Health Unit of Nova República, with 48 cases. This study highlights the need to characterize the nuances of leprosy and its variability within the urban environment, according to different areas. Further research is essential to inform the implementation of public policies aimed at addressing the population with the highest vulnerability index, thereby reducing leprosy rates in Santarém.

Pivoting COVID-19 Resources for an Equitable Mpox Vaccine Response in Louisiana

IntroductionThe first case of mpox in Louisiana was identified two months ahead of Southern Decadence Festival in New Orleans, the largest LGBTQ+ Pride festival in the South. With mpox case numbers reflecting racial disparities, the objective was to mount an equitable vaccination response. MethodsThe Louisiana Department of Health (LDH) rapidly pivoted its Covid-19 resources and strategies – specifically, using vaccine strike teams and mobile events, in-state vaccine redistribution through centralized warehousing and shipping support, and community partnerships – to now control mpox transmission. Here we have evaluated State-based Immunization Information System data to examine whether the vaccination response was geographically and racially equitable. Geographic equity was measured by taking into account vaccine availability as well as uptake in areas with high Social Vulnerability Index (SVI). Results113 providers were enrolled in the vaccination program, and 96 mobile vaccination events were held in locations frequented by at-risk populations. Racial disparities among vaccine recipients decreased over time, and vaccine availability and uptake was equitable in high SVI areas. However, Black, female and Hispanic/Latinx patients had significantly higher risk of not completing the two-dose series relative to their counterparts. ConclusionThe mpox vaccination response in Louisiana was geographically equitable, though some disparities remained.

Association of social vulnerability index and masking adherence among children enrolled in COVID-19 community research partnership study

BackgroundIndividuals with high social vulnerability index (SVI) have poorer outcomes with COVID-19. Masking reduces transmission of COVID-19 among children, but how SVI plays a role in masking behavior is unknown. We aimed to measure the association of SVI with masking adherence among children during the COVID-19 pandemic.MethodsWe conducted a multi-site, prospective syndromic surveillance study among children aged 2 – 17 years in the Southeastern United States by daily electronic surveys which solicited symptoms of COVID-19-like illness, infection with or exposure to SARS-CoV-2, masking habits, and any receipt of COVID-19 vaccines. Parents/guardians submitted surveys for their children; adolescents 13 years and older could opt to submit their own surveys. Multivariable and univariate linear models were used to measure the associations of different predictors such as SVI with masking adherence.ResultsOne thousand four hundred sixty-one children from 6 states and 55 counties predominately from North and South Carolina were included in the analysis. Most children in the cohort were 5 – 11 years old, non-Hispanic White, from urban counties, and with low-moderate SVI. Overall masking adherence decreased over time, and older children had higher masking adherence throughout the study period compared with younger children. Children who resided in urban counties had greater masking adherence throughout the study period than those who resided in suburban or rural counties. Masking adherence was higher among children with both low and medium SVI than those with high SVI.ConclusionsDespite being at risk for more severe outcomes with COVID-19, children with high SVI had lower levels of masking adherence compared to those with low SVI. Our findings highlight opportunities for improved and targeted messaging in these vulnerable communities.

Distribution of Mosaic Disease in Ridge Gourd (Luffa acutangula (L.) Roxb.), Characterization of Associated Virus and Screening for Virus Resistance

Aims: A survey was conducted in the ridge gourd growing areas of Kasaragod, Kannur and Kozhikkode district, India, to assess the prevalence of virus diseases. Molecular detection and characterization indicated the presence of mixed infection of Tomato leaf curl New Delhi virus (ToLCNDV) and Cucumber mosaic virus (CMV) in infected samples of ridge gourd collected from surveyed locations. Additionally, a screening of popular varieties/hybrids was undertaken to identify resistance sources against the Begomovirus in Ridge gourd.&#x0D; Study Design: CRD design for screening for resistance genotype.&#x0D; Place and Duration of Study: Department of Plant Pathology, College of Agriculture, Padannakkad. November 2022 - 2023.&#x0D; Methodology: Twenty-five ridge gourd plants were selected from a field and scored during survey. Major weeds and insects in and around the location were collected and identified. Screening for resistance was carried out in vitro by grafting infected scion on to healthy ridge gourd plants. Begomovirus infections were confirmed by polymerase chain reaction (PCR) using specific coat protein primers. Presence of CMV was detected using specific primers.&#x0D; Results: Disease incidence (DI) of surveyed locations ranged from 5.3-100 per cent and vulnerability index (VI) from 26.57-84.08. Kunjathur, Thalangady, and Hosabettu areas of Kasaragod district recorded the highest incidence (100%). The highest VI (84.08) was recorded in Thalangady (Kasaragod). Bemisia tabaci and Aphis gossypii were the associated insects and Synedrella sp., Ageratum conizoides and Alternanthera sp. were the associated weeds.&#x0D; Screening of varieties indicated moderately susceptible reactions of RG7 and RG10 after 60 days of grafting. PCR based molecular detection of ToLCNDV using coat protein specific primers yielded amplicons of approximately 575 bp. All the isolated sequences were found to be related to ToLCNDV on sequencing and blast analysis. Phylogenetic studies revealed that isolates from Thrikaripur, Mavichery, and Poolacode were closely related to each other. Cucumber mosaic virus, a RNA virus was also detected from isolated samples using specific primers of CMV with an amplicon size of 400 bp.&#x0D; Conclusion: The study revealed that the ridge gourd cultivated in areas of Kasaragod, Kannur and Kozhikode were infected with ToLCNDV and CMV; RG7 and RG10 were moderately susceptible among the varieties and hybrids screened. The presence of the begomovirus was detected in weeds indicating its role in perpetuation and spread of the virus disease in the field.

Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment and survival in Arizona.

Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease-free survival (DFS), and overall survival (OS). Arizona Cancer Registry (2009-2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox-regression hazard models were used to test DFS and OS. Hispanic and AI patients with T1 tumors had a longer time to surgery than non-Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02-2.31) and cT2 (OR 2.32, 95% CI: 1.13-4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99-3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17-1.99) and OS (HR 1.63, 95% CI: 1.26-2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07-2.57). High social vulnerability was associated with increased time to surgery and poor survival after surgery.