Higher Percentage Of Residents Research Articles

Association of hospital and market characteristics with 30-day readmission rates from 2009 to 2015.

The US government implemented the Hospital Readmission Reduction Program on 1 October 2012 to reduce readmission rates through financial penalties to hospitals with excessive readmissions. We conducted a pooled cross-sectional analysis of US hospitals from 2009 to 2015 to determine the association of the Hospital Readmission Reduction Program with 30-day readmissions. We utilized multivariable linear regression with year and state fixed effects. The model was adjusted for hospital and market characteristics lagged by 1 year. Interaction effects of hospital and market characteristics with the Hospital Readmission Reduction Program indicator variable was also included to assess whether associations of Hospital Readmission Reduction Program with 30-day readmissions differed by these characteristics. In multivariable adjusted analysis, the main effect of the Hospital Readmission Reduction Program was a 3.80 percentage point (p < 0.001) decrease in readmission rates in 2013-2015 relative to 2009-2012. Hospitals with lower readmission rates overall included not-for-profit and government hospitals, medium and large hospitals, those in markets with a larger percentage of Hispanic residents, and population 65 years and older. Higher hospital readmission rates were observed among those with higher licensed practical nurse staffing ratio, larger Medicare and Medicaid share, and less competition. Statistically significant interaction effects between hospital/market characteristics and the Hospital Readmission Reduction Program on the outcome of 30-day readmission rates were present. Teaching hospitals, rural hospitals, and hospitals in markets with a higher percentage of residents who were Black experienced larger decreases in readmission rates. Hospitals with larger registered nurse staffing ratios and in markets with higher uninsured rate and percentage of residents with a high school education or greater experienced smaller decreases in readmission rates. Findings of the current study support the effectiveness of the Hospital Readmission Reduction Program but also point to the need to consider the ability of hospitals to respond to penalties and incentives based on their characteristics during policy development.

Abstract 15725: Access to Pacemaker Implantation Amongst Medicare Beneficiaries: Travel Distance and Time to Nearest Clinician

Background: Despite being an essential procedure with rising use in the United States, the availability and accessibility of procedural care for a permanent pacemaker are not known. We investigated access to pacemaker implantation among Medicare beneficiaries. Methods: US Medicare physician claims from 2020, and county population characteristic data from AHRQ were used to evaluate the density of providers and beneficiaries across states and counties. For each US zip code, we determined the closest pacemaker implantation center using the haversine formula, then assessed the travel duration for each route using the Google Maps API. Results: There was a median of 5 providers performing pacemaker placement per 100,000 individuals over 65 years across all states, with an IQR of 4.5 to 6. At the county level, only 20% of counties in the US had a center offering transvenous pacemaker implantation, and 4% had a center offering leadless pacemakers. Individuals in metropolitan counties drove a median 29 (IQR 18 - 47) minutes to reach a center for pacemaker implantation, while those in non-metropolitan counties drove a median of 72 (IQR 52 - 102) minutes. In counties where &gt;25% of the population is ≥65 years old, the median drive time to a pacemaker center is 86 (IQR 57 - 126) minutes. Residents of counties with a lower median household income (Spearman’s r = 0.45, p &lt; 0.001) and a higher percentage of residents using public insurance had longer drive time to a pacemaker center (r = 0.23, p &lt; 0.001). Out of the estimated 55,356,000 individuals ≥65 years old in the United States, 20,000,000 (36%) had to drive more than one hour, and 4,383,955 (8%) had to drive more than two hours to a site where a pacemaker implantation procedure is performed. Conclusion: Over one-third of the population in the United States has significant access issues to basic electrophysiologic care, highlighting the need for increased resources and improved accessibility.

Sociodemographic and regional determinants of rabies submission bias in North Carolina

AbstractWith North Carolina's human population and urban development rapidly expanding, spread of zoonotic disease is of concern to both wildlife managers and public health officials. Between 2008 and 2018, 300−1,000 wild terrestrial animals were submitted for rabies testing each year, however, only 30−46% of total submissions tested positive for rabies annually. Given the low percentage of positive tests and high number of submissions in some counties, we used one‐way ANOVAs to determine if a submission bias, that is, healthy wildlife being submitted for rabies testing for undetermined reasons (e.g., fear, lack of knowledge), may exist in some counties or throughout North Carolina. Using multiple regression analyses and data from all 100 counties, we investigated if income, age, education, gender, ethnicity, population density, housing density, and geographical region influenced total submissions and percent positive cases. Statewide, annual total submissions averaged 765 ± 56.0 (x̄ ± SE throughout) and the percent positive cases averaged 35% ± 1%, however variation existed among counties for both metrics (F98−99,947−1088 = 3.77−23.07 P &lt; 0.001) indicating submission bias. Counties that are in the Piedmont region and/or have lower percentages of Black residents (Std. β = −0.17) and counties with denser human populations, housing density, and/or more tourism income (β = 0.71) had the largest number of total submissions for rabies testing. Alternatively, counties that had higher percentages of residents who had attended some college submitted fewer animals for testing (Std. β = −0.18). Counties with a higher percent of Black residents also had a higher percentage of positive cases (Std. β = 0.33) and, as expected based on the ethnic composition of each region, there were lower percentages of positive cases in the Mountain region compared to the Piedmont and Coastal Plain regions. The percent of self‐reported Hispanic residents in a county also positively affected (Std. β = 0.30) the percentage of positive cases. This variable was negatively correlated with median age indicating counties with older residents have a lower percentage of positive cases. We suggest rabies education should be focused on the Mountain region, White residents, and older individuals in North Carolina since these groups of residents were more likely to request rabies testing on non‐rabid wildlife. Specifically, counties with higher populations of White individuals had higher annual total submissions, but fewer positive tests for rabies, indicating this demographic group had the most bias and they, as well as local and county animal control departments, should be the focus for targeted educational programs.

A Statistical Representation of the Inequities Encountered by African Americans Living in Atlanta During COVID: A Time for Action.

This research analyzes the statistically significant differences that exist between Blacks and Whites living in Atlanta via their social, economic, educational, and housing characteristics during COVID. Hypothesis tests confirmed what visual scatterplots and correlations inferred. The statistics overwhelmingly substantiate that all six of the important quality of life metrics viewed in this study are more favorable towards predominately White neighborhoods, as opposed to predominately Black neighborhoods. In particular, neighborhoods with a super majority of White residents tended to have higher life expectancies at the times of their births, sustained lower violent crime rates, held higher median household incomes, had a smaller percentage of its children living below the poverty level, had higher percentages of residents with at least a high school diploma, and maintained more occupied housing units, when compared to neighborhoods with a super majority of Black residents.

Healthcare service utilization for formerly homeless veterans in permanent supportive housing: Do neighborhoods matter?

Neighborhood characteristics are associated with residents' healthcare use. However, we understand less about these relationships among formerly homeless persons, who often have complex healthcare needs, including mental health and substance use disorders. Among formerly homeless Veterans, we examined: (a) how neighborhood characteristics are associated with Veteran Health Administration (VHA) healthcare use and, (b) if these relationships varied by Veterans' level of healthcare need. We obtained data on our cohort of 711 Veterans housed through VHA's permanent supportive housing program (HUD-VASH) in 2016-2017 from VHA's Homeless Registry, VHA's electronic health records, and the U.S. Census. We studied the relationships between neighborhood characteristics (% Veteran, % in poverty, % unemployed, % using public transportation, and % vacant properties) and VA healthcare use (primary care visits, outpatient mental health visits, and "high use" of emergency departments [> 4 visits]) using mixed-effects logistic and negative binomial regression models, controlling for patient demographics. We further examined moderation by patient healthcare need (calculated from cost and clinical data). We found that veterans in neighborhoods with higher percentages of residents who (a) were Veterans or (b) used public transportation were more likely to have high emergency department use. Those in neighborhoods with higher public transportation use had more primary care visits while those in neighborhoods with more property vacancies had more outpatient mental health visits. Among those with high healthcare needs, residents of areas with more Veterans had higher emergency department use. Promoting public transportation use and social engagement with other Veterans in residential neighborhoods may influence HUD-VASH Veterans' VA healthcare use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Relocation Patterns and Predictors of Relocation and Mortality in Swedish Sheltered Housing and Aging in Place

A reported objective of Swedish sheltered housing is to postpone care needs and relocation. The aim of this study was to describe migration patterns and explore predictors of relocation to nursing homes and mortality, in a sample of residents in sheltered housing and aging in place. To explore longitudinal differences between groups, study data were combined with registry data. The results showed that a higher percentage of residents in sheltered housing had relocated to a nursing home and deceased over a three-year time period, compared to aging in place, implying further interventions may be required to promote health in sheltered housing.

Social Connectedness among Long-Stay Nursing Home Residents with Alzheimer’s and Dementia: Exploring Individual and Facility-Level Variation

Introduction: This study sought to explore individual and facility-level variation in social connectedness among long-stay nursing home residents with Alzheimer’s or other dementias (ADRD). Methods: We identified 721,074 long-stay residents with ADRD using 2016 Minimum Data Set 3.0 data. Social connectedness was defined using the social connectedness index (SCI) (high: SCI = 5, lower: 0 < SCI ≤ 4). Adjusted odds ratios (aOR) provided estimates of the associations between resident-level and facility-level characteristics, and high SCI was derived from logistic models. Results: The SCI Cronbach’s alpha was 0.69; 78.6% had high SCI scores. Men were less likely than women to have higher SCI scores (aOR = 0.97; 95% CI: 0.97–0.98). Increasing age was associated with higher SCI scores (e.g., aOR [85–94 vs. 40–64 years]: 1.07; 95% CI: 1.06–1.07). Those with moderate cognitive impairment (aOR: 0.87) and severe cognitive impairment (aOR: 0.85) had reduced odds of SCI = 5 relative to those with mild/intact cognitive function. Residents living in homes with special care dementia units and with higher percentage of residents with dementia had decreased odds of high social connectedness. Discussion/Conclusion: Understanding resident- and nursing home-level variation in social connectedness may be important for targeting interventions that reduce isolation among residents with ADRD.

Availability of medical cannabis services by racial, social, and geographic characteristics of neighborhoods in New York: a cross-sectional study

BackgroundWithin the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services.MethodsIn this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban–rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor’s degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts’ characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression.ResultsOf 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25–0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92–0.99). For every 10% increase in the proportion of residents with bachelor’s degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21–1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor’s degrees or higher (43.7% vs. 34.1%, p < 0.005).ConclusionsIn New York, medical cannabis services are least available in neighborhoods with Black residents and most available in urban neighborhoods with highly educated residents. Benefits of legal cannabis must be shared by communities disproportionately harmed by illegal cannabis.

Predictors of US states’ adoption of naloxone access laws, 2001–2017

BackgroundThe opioid crisis has put an increasing strain on US states over the last two decades. In response, all states have passed legislation to implement a portfolio of policies to address the crisis. Although effects of some of these policies have been studied, research into factors associated with state policy adoption decisions has largely been lacking. We address this gap by focusing on factors associated with adoption of naloxone access laws (NAL), which aim to increase the accessibility and availability of naloxone in the community as a harm reduction strategy to reduce opioid-related morbidity and mortality. MethodsWe used event history analysis (EHA) to identify predictors of the diffusion of naloxone access laws (NAL) from 2001, when the first NAL was passed, to 2017, when all states had adopted NAL. A variety of state characteristics were included in the model as potential predictors of adoption. ResultsWe found that state adoption of NAL increased gradually, then more rapidly starting in 2013. Consistent with this S-shaped diffusion process, the strongest predictor of adoption was prior adoption by neighboring states. Having a more conservative political ideology and having a higher percentage of residents who identified as evangelical Protestants were associated with later adoption of NAL. ConclusionStates appear to be influenced by their neighbors in deciding whether and when to adopt NAL. Advocacy for harm reduction policies like NAL should take into account the political and religious culture of a state.

Extended Spaces of Environmental Injustice: Hydrocarbon Pipelines in the Age of Planetary Urbanization

Abstract Hydrocarbon pipelines have emerged as a highly contentious political issue in recent years. In this paper, I conduct spatial regression analyses at national and regional scales to determine whether the locations of hydrocarbon pipelines constitute a systemic environmental justice issue throughout the contiguous US transmission pipeline system. National-level analyses show that counties with higher percentages of non-White residents are associated with more kilometers of hydrocarbon pipeline, whereas counties with a higher percentage of residents with a four-year college degree are associated with fewer kilometers of hydrocarbon pipeline. Regional analyses reveal further complexity, showing only degrees of consistency with national-level results. Situating these results within the emergent literature on planetary urbanization, I develop a multiscalar environmental justice framework that I call extended spaces of environmental injustice. Extended spaces of environmental injustice describe the places through which infrastructures of extended urbanization, which are built across vast geographical distances and operate to meet the material needs of urban society, materialize as spatially variegated environmental justice issues at the local scale. I conclude by arguing that the extended spaces of environmental injustice framework can open new pathways for research related to environmental justice and scale, both in analyzing the geography of existing infrastructures of extended urbanization and the construction of future infrastructure as efforts to decarbonize the economy manifest spatially.

Assessing the impact of an orientation week on acclimation to radiology residency

PurposeAcclimating residents to radiology residency requires attention to new responsibilities, educational material, and social cohesion. To this end, we instituted a structured orientation week for incoming residents and assessed its impact. ProceduresDuring the first weeks of July 2016 and 2017, first year residents attended a five day orientation free of clinical duties, consisting of didactics, hands-on training sessions, and social events. After two orientation cohorts, residents who completed orientation week, and two cohorts who had not, were given a voluntary, anonymous survey using Likert scale questions (1 [worst] to 5 [best]) regarding preparedness for responsibilities, learning, and social cohesion. Residents were asked which components were or would have been helpful. Independent samples t-tests were performed to evaluate differences between the two groups (two-tailed p < 0.05). Findings21/37 (57%) residents participated. Higher percentages of residents who participated in the orientation week gave scores ≥4 when asked about preparedness for rotations (70% vs. 36%), learning new material (80% vs. 36%), and class cohesiveness (90% vs. 70%). Mean scores on these questions were also higher for these residents with regards to: preparedness for new responsibilities (3.7 vs. 2.9), learning new material (3.8 vs. 2.9), and class cohesiveness (4.5 vs. 3.8), with differences approaching significance (p = 0.09–0.15). Individual components receiving most votes of ≥4 were social outings, resident lunches, didactic lectures, and PACS training. ConclusionA weeklong orientation program free of clinical duties was valued by residents and contributed to acclimation to new responsibilities, education, and social cohesion.

What school did you go to? Education and status in Edinburgh

The question ‘Which school did you go to?’ is an attempt to ‘place’ respondents in Edinburgh in terms of social status. This article examines the social and educational origins of fee-paying schools in a city with a significantly higher proportion of secondary pupils in such schools than elsewhere in Scotland. It asks what the perceived ‘pay-off’ is as regards social and educational mobility in the context of a significant decline since the 1960s in the numbers attending their ‘local’ university, and in a city with a much higher percentage of residents born furth of Scotland. The key question is to what extent being educated privately still makes a difference.

Naloxone Availability in Retail Pharmacies and Neighborhood Inequities in Access

This study examines the implementation of North Carolina's statewide naloxone standing order and identifies community characteristics associated with pharmacy stocking and willingness to sell naloxone under the standing order. In April-June 2019, a mystery caller protocol was completed to assess if (1) North Carolina pharmacies had naloxone available and were willing to dispense it without a prescription, (2) pharmacy characteristics associated with availability, and (3) there were neighborhood differences (e.g., Census tract population size, density, racial composition, SES, rates of opioid overdoses, and rates of opioid prescriptions dispensed) in availability. Using random sampling stratified by inclusion on North Carolina's public list of pharmacies participating in the standing order, chain, independent, and health department pharmacies in North Carolina were sampled (n=161 of 2,044). In June 2019, the data were analyzed. Survey weights were utilized to calculate the prevalence of availability, and regression models were conducted to examine associations. An estimated 61.7% (95% CI=54.3, 68.5) of North Carolina retail pharmacies have naloxone available without a prescription. The odds of naloxone availability were lower for independent pharmacies than chains (OR=0.12, 95% CI=0.06, 0.25). Inclusion on North Carolina's public list of pharmacies had greater odds of naloxone availability (OR=2.32, 95% CI=1.22, 4.43). Naloxone availability was lower in communities with higher percentages of residents with public health insurance (OR=0.97, 95% CI=0.95, 0.999). Though more than half of the pharmacies in North Carolina participate in the standing order for naloxone, efforts to identify the best practices for ensuring widespread implementation of statewide standing orders for naloxone are warranted.

ASSESSMENT AND INFLUENCE OF A FAMILY PHYSICIAN ON THE HEALTH STATUS OF THE POPULATION OF AMALGAMATED TERRITORIAL COMMUNITIES

Introduction: Primary health care is the most important part of the health system. Family physicians, as representatives of this link, are key figures who are assigned a number of responsibilities for the prevention, diagnosis, and treatment of both adults and children. An indicator of the effectiveness of their work is the level of satisfaction of citizens with the quality of service. To understand the effectiveness of reform implementation, the authors evaluated the activities of the family physician and its influence on the health of citizens living on the entrusted territory. The aim of the study is an empirical analysis of the selection criteria, frequency and reasons for the citizens' visits to a family physician in the amalgamated territorial communities of the Sumy region. Materials and methods: During the research, methods of a systematic approach and comparative analysis were used. The study was conducted in the form of a survey. Calculations and processing of statistical information were carried out using the "OSA" application. Study results and discussion: The paper shows the condition of primary care as a result of the health system reform. The sociological survey on the work of family physicians in the amalgamated territorial communities concerned the criteria for choosing a family physician, the frequency of requests for medical care, and the reasons for requests, in particular for preventive purposes. The analysis showed that the percentage of signing declarations is relatively high. However, a certain formality of this process was observed, since a significant percentage of citizens who signed the declaration have never met their family physician. The result indicates that citizens often do not seek medical care in outpatient clinics on the territory of the amalgamated territorial community, and they rarely visit the physician for preventive purposes. According to respondents, the reason for not seeking prevention is the lack of need. Conclusion: A high percentage of residents of the amalgamated territorial communities signed declarations with family physicians. However, having analyzed the survey data, we can note a rather formal attitude to this procedure, since many residents seek medical services in other medical institutions. It is a consequence of the insufficient effectiveness of the reform of primary health care and insufficient attention on the part of local authorities to provide outpatient clinics with qualified specialists. There is a need to raise awareness about the importance of preventive measures. Keywords family medicine, family physician, preventive work, declaration, communication.

Abstract 1202: Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression

Abstract Literature on spatial variation of cancer outcomes in the US remains scarce. Studies have not assessed how late-stage OPC diagnosis varies across geography nor the effect of spatially different socioeconomic factors. Identifying risk factors that have higher impact on certain localities can help inform clinicians and policy-makers. Our study aimed to evaluate spatial differences in stage of diagnosis of oropharyngeal cancer (OPC) in Florida using hierarchical and geographically-weighted regression (GWR) models. We used the Florida Cancer Data System to derive a cohort of 57,082 patients diagnosed with OPC during 1990-2010. The individual-level covariates that informed our models consisted of age at diagnosis, gender, race, married status, health insurance payer, history of cigarette smoking, and year of diagnosis. Patients' addresses were geocoded to obtain a point feature used to map the spatial distribution of individuals using ArcGIS. A hot-spot analysis (Getis-or-Gi) revealed areas of high clustering of patients with late-stage diagnosis. To evaluate spatially-relevant factors for such variation, we fitted a mixed logistic regression model using PROC GLIMMIX in SAS with the individual-level variables in addition to county and census tract-level covariates. We used US Census data to extract records on the percent of residents unemployed, living in poverty, and foreign-born. Variables for the county level extracted from the Area Health Resource File and the Behavioral Risk Factor Data included the percent of residents engaging in heavy drinking, who couldn't visit a dentist due to cost, and who were smokers, a flag for Health Professional Shortage Areas for primary care doctors and dentists, presence of a hospital with oncology services, and a flag for rural designation. The model showed significant higher odds for late-stage OPC diagnosis for non-White patients (OR 1.63, 95%CI 1.48-1.79 for Black and 1.29, 95%CI 1.03-1.62 for other-race), current smoker status (OR 1.45, 95%CI 1.36-1.54), former smoker status (OR 1.36, 95%CI 1.27-1.45), patients without health insurance (OR 1.60, 95%CI 1.41-1.82), patients covered by Medicaid (OR 1.73, 95%CI 1.5-1.97), patients diagnosed with cancer in pharyngeal sites (OR 4.74, 95%CI 4.53-4.95), and higher percentage of residents in census tract living in poverty (OR 1.01, 95%CI 1.00-1.011). The GWR conducted at the county-level revealed areas where coefficients associated with various risk-factors contributed to a higher proportion of late-stage OPC diagnosis. For easier communication of findings, we created density maps that will be presented. Our study empirically showed variation of late-stage OPC diagnosis across Florida and differential effects of spatial socioeconomic factors. Future public health initiatives can use a targeted approach to focus resources in these specific areas more likely to be impacted. Citation Format: Juan M. Hincapie-Castillo, Yi Guo, Natalie L. Silver, Hong Xiao. Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1202.

Public information seeking, place-based risk messaging and wildfire preparedness in southern California

Southern California is a challenging environment for managing and adapting to wildland–urban interface fires. Previous research shows risk perception and information seeking are related and that public information dissemination influences locally specific risk perception and preparedness actions. Here, we examine relationships between residents’ wildfire knowledge and experience, readiness actions and media choice to determine how to integrate preparedness information and the recently developed Santa Ana Wildfire Threat Index into public information. Based on frequencies, means tests and correlations, we find television most frequently used for both daily news and wildfire information and that most people intend to seek information from the same sources in future fires. Wildfire knowledge, experience and past preparedness actions influence the number of sources from which respondents report seeking information. We note significant geographic differences in information sources used before and during wildfire, with higher percentages of residents in more rural areas relying on television, radio, Reverse 911, and friends and family for information during a wildfire. Findings support previous research results indicating sources considered trustworthy are not always considered the most up-to-date. Our findings support other empirical research recommending a multimedia, two-way communication model for event-based and readiness information supplemented with one-way sources like television.

The impact of neighborhood on physical activity in the Jackson Heart Study

Physical inactivity is an independent risk factor for many diseases. Most research has focused on individual-level factors for physical activity (PA), but evidence suggests that neighborhood is also important. We examined baseline data collected between 2000 and 2004 from 5236 participants in the Jackson Heart Study to determine the effects of neighborhood on 2 types of PA: Active Living (AL), and Sports and Exercise (Sport) in an all-African American cohort. Participants were georeferenced and data from individual baseline questionnaires and US Census were analyzed using descriptive, bivariate, and multilevel models. In both types of PA, neighborhood factors had an independent and additive effect on AL and Sport. Living in an urban (p=0.003) or neighborhood with a higher percentage of residents with less than a high school education (p<0.001) was inversely associated with AL. There was an inverse interaction effect between individual and lower neighborhood education (p=0.01), as well as between age and urban neighborhoods (p=0.02) on AL. Individual level education (OR=1.30) and per capita income (OR=1.07) increased the odds of moderate-to-high sports. Future studies should focus on what contextual aspects of urban or less educated neighborhoods are influential in determining PA, as well as longitudinal multilevel analyses of neighborhood effects on PA.

Evaluation of the effectiveness of Gold STAMP intervention on pressure ulcer reductions

Introduction: This prospective cohort study is to evaluate the effectiveness of the Gold STAMP (Success Through Assessment, Management and Prevention) intervention on reducing pressure ulcer (PU) incidence rates among nursing home residents in New York State. Methods: Nursing home residents (n = 2,480) who did not have PU at baseline were followed to calculate PU incidence. Gold STAMP educational intervention included care assessment, care practice, communication, and collaboration. Covariates included socio-demographics, selected health conditions, and functional status. Kaplan Meier survival analyses were conducted after propensity score matching (PSM) to assess the impact of the Gold STAMP intervention on PU incidence rate reduction. Results: Prevalent conditions were urinary incontinence (83%), bowel incontinence (73%), and arthritis (37%). The Kaplan-Meier survival analyses indicated that the case group had a higher percentage of residents with no PUs after 6 months of follow-up compared to the control group (94% vs. 85%; p = .06). Conclusions: The 9% PU incidence rate reduction is both clinically and financially meaningful. We suggest a longer study period to monitor the long-term effects of the Gold STAMP intervention in reducing PU incidence.

Correlates of Preincarceration Health Care Use Among Women and Men in Jail.

Although women and men in jails bear a burden of health problems, little is known about factors associated with their health care use. We conducted a cross-sectional survey of preincarceration health care use with 596 jail inmates. Descriptive statistics and correlates of participants' health care use were assessed. A year before incarceration, 54% of participants used an emergency room, 24% were hospitalized, and 39% used primary care. Correlates of health care use included gender, health insurance status, and drug dependence. For participants without mental health problems, use was associated with living in neighborhoods where a higher percentage of residents did not complete high school. Findings suggest individual and community factors that can be targeted by reentry programs to improve health care use after jail.

Occurrence of severe dengue in Rio de Janeiro: an ecological study.

This study aimed to analyze the relationship between the incidence of severe dengue during the 2008 epidemic in Rio de Janeiro, Brazil, and socioeconomic indicators, as well as indicators of health service availability and previous circulation of the dengue virus serotype-3 (DENV-3). In this ecological study, the units of analysis were the districts of Rio de Janeiro. The data were incorporated into generalized linear models, and the incidence of severe dengue in each district was the outcome variable. The districts with more cases of dengue fever in the 2001 epidemic and a higher percentage of residents who declared their skin color or race as black had higher incidence rates of severe dengue in the 2008 epidemic [incidence rate ratio (IRR)= 1.21; 95% confidence interval (95%CI)= 1.05-1.40 and IRR= 1.34; 95%CI= 1.16-1.54, respectively]. In contrast, the districts with Family Health Strategy (FHS) clinics were more likely to have lower incidence rates of severe dengue in the 2008 epidemic (IRR= 0.81; 95%CI= 0.70-0.93). At the ecological level, our findings suggest the persistence of health inequalities in this region of Brazil that are possibly due to greater social vulnerability among the self-declared black population. Additionally, the protective effect of FHS clinics may be due to the ease of access to other levels of care in the health system or to a reduced vulnerability to dengue transmission that is afforded by local practices to promote health.