Large County Research Articles

Mental Disorders, Substance Use Disorders, and Psychotropic Medication Use Among Sudden-Death Victims.

The authors sought to estimate the prevalence of mental and substance use disorders and psychotropic medication prescriptions among working-age sudden-death victims. Using a written protocol, the authors screened for sudden deaths attended by emergency medical services (EMS) in a large metropolitan county in North Carolina from March 1, 2013, to February 28, 2015. Sudden-death cases were adjudicated by three cardiologists. Mental health and chronic disease diagnoses and treatments were abstracted from EMS, medical examiner, toxicology, and autopsy reports and from clinical records for the past 5 years before death. Sudden death was identified for 399 adults ages 18-64 years, 270 of whom had available medical records. Most sudden-death victims were White (63%) and male (65%), had a comorbid condition such as hypertension or respiratory disease, and had a mean±SD age of death of 53.6±8.8 years. Most victims (59%) had at least one mental health or substance use disorder documented in a recent medical record; 76%-78% of victims with a mental disorder had a documented psychotropic medication prescription. However, fewer than one-half (41%) had a documented referral to a mental health professional. The most common diagnostic categories were depressive, anxiety, and alcohol-related disorders. Almost one-half (46%) of the victims had a recent psychotropic prescription, most commonly antidepressants (29%) and benzodiazepines (19%). Mental illness, substance use disorders, and psychotropic medication prescriptions were prevalent among sudden-death victims. The health care needs of these individuals may be better addressed by collaborative care for general medical and mental disorders.

Does Increasing Access to Prenatal Care Reduce Racial Disparities in Birth Outcomes?

PurposeTo examine the effectiveness of early and adequate prenatal care (PNC) in reducing racial disparities in pre-term birth (PTB) among low-income women. Design and methodsThis retrospective study examined birth records for 14,950 low-income Black and White women. The primary outcome of interest was racial disparities in PTB. Exposures of interest were first trimester entry into, and adequacy of, PNC. Maternal residential proximity to nearest PNC provider was calculated. Bivariate analyses were performed for PTB by race. Binary logistic regression was performed, controlling for maternal age, smoking status and racial segregation. Attributable risk of PTB for no or late entry into PNC, and percent difference by race was calculated. ResultsWe find that early and adequate PNC significantly decreases the risk of preterm birth, however, we find no evidence that this reduces racial disparities. Low income black females in a large metropolitan county have greater geographic access to and utilization of PNC than low-income white females, yet racial disparities in preterm birth remain. Attributable risk of PTB for no or late entry into PNC was lower for Black women (32.2%) than White women (39.4%). ConclusionsOur findings suggest that adequate PNC alone does not reduce the marked racial disparities in preterm birth. Practice implicationsPublic health agencies and health care providers need to look beyond access to care, to achieve racial equity in birth outcomes. Expansion of evidence-based, comprehensive nursing interventions shown to reduce preterm birth, such as the Nurse Family Partnership home visiting program, could contribute to these efforts.

Estimated seroprevalence of SARS-CoV-2 antibodies among adults in Orange County, California

Clinic-based estimates of SARS-CoV-2 may considerably underestimate the total number of infections. Access to testing in the US has been heterogeneous and symptoms vary widely in infected persons. Public health surveillance efforts and metrics are therefore hampered by underreporting. We set out to provide a minimally biased estimate of SARS-CoV-2 seroprevalence among adults for a large and diverse county (Orange County, CA, population 3.2 million). We implemented a surveillance study that minimizes response bias by recruiting adults to answer a survey without knowledge of later being offered SARS-CoV-2 test. Several methodologies were used to retrieve a population-representative sample. Participants (n = 2979) visited one of 11 drive-thru test sites from July 10th to August 16th, 2020 (or received an in-home visit) to provide a finger pin-prick sample. We applied a robust SARS-CoV-2 Antigen Microarray technology, which has superior measurement validity relative to FDA-approved tests. Participants include a broad age, gender, racial/ethnic, and income representation. Adjusted seroprevalence of SARS-CoV-2 infection was 11.5% (95% CI: 10.5–12.4%). Formal bias analyses produced similar results. Prevalence was elevated among Hispanics (vs. other non-Hispanic: prevalence ratio [PR] = 1.47, 95% CI 1.22–1.78) and household income < $50,000 (vs. > $100,000: PR = 1.42, 95% CI: 1.14 to 1.79). Results from a diverse population using a highly specific and sensitive microarray indicate a SARS-CoV-2 seroprevalence of ~ 12 percent. This population-based seroprevalence is seven-fold greater than that using official County statistics. In this region, SARS-CoV-2 also disproportionately affects Hispanic and low-income adults.

722 Perinatal outcomes among women living in at-risk areas identified by a community health needs assessment

As a recent Community Health Needs Assessment (CHNA) identified geographic areas within our county with substantial health disparities, the aim of this study was to evaluate maternal and infant outcomes within the region. We hypothesized that perinatal outcomes would differ for women living in areas with the higher social needs compared to those living in other regions of the county. This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital, which serves as the safety net hospital for the county. Perinatal outcomes were analyzed for women living within a target region of ten zip codes, identified during a recent CHNA, and compared to those women living outside the target region. Statistical analysis included student’s t-test, chi square, and logistic regression to adjust for demographics. Between January 2015 and July 2020, 66,936 women delivered at the county hospital. Of these, a total of 7,585 (11%) resided in the CHNA target region. The women living in the target region were younger (26.8 + 6.5 vs 27.9 + 6.4 years, p<.001), more likely to be black (37% vs 13%, p<.001), and had a higher BMI (33.3 + 7.0 vs 32.6 + 6.4 kg/m2,p <.001). The rates of preeclampsia and abruption were higher in the target region (Table). Adverse infant outcomes were also more common including preterm birth, neonatal ICU admission, and neonatal death. Increased risk for all maternal and neonatal adverse outcomes persisted after adjustment for age, race, and BMI (figure). Women living in areas with higher health disparity and more social needs identified in a recent CHNA are at greater risk of adverse perinatal outcomes. Efforts to improve obstetric outcomes in this at-risk area should focus on achieving health equity by eliminating social disparities through targeted education and outreach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

843 A comparison of acute pain management strategies after cesarean delivery

To determine if a multimodal pain management regimen after cesarean delivery reduces the number of morphine milligram equivalents (MME) compared to traditional patient controlled opioid analgesia (PCA) while adequately controlling postoperative pain. This was a prospective inception cohort analysis of postoperative pain management for women undergoing cesarean delivery at a large county hospital during a transition from a traditional morphine PCA to a multimodal regimen that included scheduled NSAIDs and acetaminophen, with opioids as needed. Data was collected for a 6 week period before and after the transition. The primary outcome was postoperative opioid use defined as MME in the first 48 hours. Secondary outcomes included serial pain scores, time to discharge, and exclusive breastfeeding rates. Women who required general anesthesia, had a history of substance abuse disorder or who delivered in the first 4 weeks after the transition were excluded. Statistical analysis included Student’s t test, Wilcoxon rank sum and Hodges-Lehman shift. During the study period 878 women underwent cesarean delivery and 775 met inclusion criteria: 376 received the traditional PCA and 399 received the multimodal regimen. Implementation of a multimodal regimen resulted in a significant reduction in MME use in the first 48 hours (30 [16,45] MME vs 135 [88,177] MME, p<0.001, Figure). Compared to the traditional group, more women in the multimodal group reported a pain score ≤ 4 by 48 hours (88% vs 77%, p<0.001). There was no difference in time to discharge. Of women who planned to exclusively breastfeed, fewer used formula prior to discharge in the multimodal group as compared to the traditional group (9% vs 12%, p<0.001). Transition to a multimodal pain management regimen for women undergoing cesarean delivery resulted in decreased opioid use while adequately controlling postoperative pain. A multimodal regimen was associated with early successful exclusive breastfeeding.

Emergency department visits among patients transported by law enforcement officers.

Law enforcement officers frequently encounter people with health conditions. We sought to estimate the rates, diagnoses, and characteristics of emergency department (ED) visits among patients transported directly by law enforcement. We analyzed statewide North Carolina Emergency Department data for adults, aged 18+ years, from 2009 to 2016. We estimated transport rates using census data; categorized primary ED diagnoses into 13 major and 8 substituent categories; compared county transport rates by rurality; and examined patient characteristics. There were 136,240 patients transported by law enforcement; annual rates increased from 186.9 (per 100,000 adult residents) in 2009 to 279.2 in 2016. Among visits, 67.7% were among men, the median age was 37 years, and 20.4% resulted in a hospital admission. Most common primary diagnoses were Mental Health Diagnoses (43.1%)-including Schizophrenia and other Psychotic Disorders (7.6%), Mood Disorders (9.7%), and Alcohol and Substance Use (10.7%)-followed by Injury and Poisoning (12.4%) and Circulatory conditions (4.1%). Involuntary commitments constituted 22% of all visits. The median transport rate in rural counties, 291.1, was 2 times that of large metro counties, 145.1. The visit rate increased by nearly 50% during the study period, with the highest rates in rural counties. Many transports were for Mental Illness and involuntary commitments. The relatively common occurrence of law enforcement transports suggests the need for greater research to understand factors influencing law enforcement transport decisions, the impact of these transports on patient health and safety, and the repercussions on patient care of a growing officer presence in EDs.

Local measures enable COVID-19 containment with fewer restrictions due to cooperative effects.

BackgroundMany countries worldwide are faced with the choice between the (re)surgence of COVID-19 and endangering the economic and mental well-being of their citizens. While infection numbers are monitored and measures adjusted, a systematic strategy for balancing contact restrictions and socioeconomic life in the absence of a vaccine is currently lacking.MethodsIn a mathematical model, we determine the efficacy of regional containment strategies, where contact restrictions are triggered locally in individual regions upon crossing critical infection number thresholds. Our stochastic meta-population model distinguishes between contacts within a region and cross-regional contacts. We use current data on the spread of COVID-19 in Germany, Italy, England, New York State and Florida, including the effects of their individual national lockdowns, and county population sizes obtained from census data to define individual regions. As a performance measure, we determine the number of days citizens will experience contact restrictions over the next 5 years (‘restriction time’) and compare it to an equivalent national lockdown strategy. To extract crucial parameters, we vary the proportion of cross-regional contacts (between 0% and 100%), the thresholds for initiating local measures (between 5 and 20 active infections per 100,000 inhabitants) as well as their duration after infection numbers have returned below the threshold (between 7 and 28 days). We compare performance across the five different countries and test how further subdivision of large counties into independently controlled regions of up to 100,000 or 200,000 inhabitants affects the results.FindingsOur numerical simulations show a substantially reduced restriction time for regional containment, if the effective reproduction number of SARS-CoV-2 without restrictions, R0, is only slightly larger than 1 and the proportion of cross-regional contacts (the so-called leakiness) is low. In Germany, specifically, for R0=1.14, a leakiness of 1% is sufficiently low to reduce the mean restriction time from 468 days (s.d. 3 days) for the national containment strategy to 43 days (s.d. 3 days across simulations) for the regional strategy, when local measures are initiated at 10 infections per 100,000 inhabitants in the past 7 days. For R0=1.28, the allowed leakiness for minimal restriction time reduces to approximately 0.3%. The dependence of the restriction time on the leakiness is threshold-like only for regional containment, due to cooperative effects. It rises to levels similar to the national containment strategy for a leakiness > 10% (517 days national vs. 486 days regional for leakiness 32% and R0=1.14). We find a strong correlation between the population size of each region and the experienced restriction time. For countries with large counties, this can result in only a mild reduction in restriction time for regional containment, which can only be partly compensated by lower thresholds for initiating local measures and increasing their duration. In contrast, further subdividing large counties into smaller units can ensure a strong reduction of the restriction time for the regional strategy.InterpretationThe leakiness, i.e. the proportion of cross-regional contacts, and the regional structure itself were crucial parameters for the performance of the regional strategy. Therefore, regional strategies could offer an adaptive way to contain the epidemic with fewer overall restrictions, if cross-regional infections can be kept below the critical level, which could be achieved without affecting local socioeconomic freedom. Maintaining general hygiene and contact tracing, testing should be intensified to ensure regional measures can be initiated at low infection thresholds, preventing the spread of the disease to other regions before local elimination. While such tight control could lead to more restrictions in the short run, restrictions necessary for long-term containment could be reduced by up to a factor of 10. Our open-source simulation code is freely available and can be readily adapted to other countries.FundingThis work was supported by the Max Planck Society.

Effects of US state preemption laws on infant mortality

Studies show that raising the minimum wage in a US state above the federal minimum wage can reduce infant mortality rates in those states. Some states have raised their minimum wage in recent decades, while many others did not, and have prohibited local authorities from doing so by enacting preemption laws. This study investigates how the recent emergence of state preemption laws that remove local authority to raise the minimum wage has affected infant mortality rates. Using county- and state- level data spanning 2001 through 2018, this study models infant mortality rates as a function of minimum wage levels, controlling for confounders. The estimated model, combined with information on the timing, location, and level of preempted minimum wages, is then used to estimate the number of infant deaths that occurred in 2018 that could be attributed to state preemption of local minimum wage increases. In the 9 largest (pop. > 250,000) metro counties most directly affected by state preemption, we estimate that in 2018, 25 infant deaths were attributable to preemption. This equates to a 5.4% reduction in these counties' infant mortality rate. When considering all large metro counties in preemption states, as many as 605 infant deaths could be attributed to preemption. State preemption laws that remove local authority to enact health-promoting legislation, such as minimum wage increases, are a significant threat to population health. The growing tide of these laws, particularly since 2010, may be contributing to recent troubling trends in US life expectancy.

COVID-19 Attributed Cases and Deaths are Statistically Higher in States and Counties with 5th Generation Millimeter Wave Wireless Telecommunications in the United States.

COVID-19-attributed case and death rates for the U.S.A. were analyzed through May 2020 in three ways – for all 50 states, the country’s largest counties, and the largest counties in California – and found to be statistically significantly higher for states and counties with compared to those without 5G millimeter wave (mmW) technology. 5G mmW index was a statistically significant factor for the higher case and rates in all three analyses, while population density, air quality and latitude were significant for only one or two of the analyses. For state averages, cases per million were 79% higher (p = 0.012), deaths per million were 94% higher (p = 0.049), cases per test were 68% higher (p = 0.003) and deaths per test were 81% higher (p = 0.025) for states with vs. without mmW. For county averages, cases per million were 87% higher (p = 0.005) and deaths per million were 165% higher (p = 0.012) for counties with vs. without mmW. While higher population density contributed to the higher mean case and death rates in the mmW states and counties, exposure to mmW had about the same impact as higher density of mmW states on mean case and death rates and about three times as much impact as higher density for mmW counties on mean case and death rates. Based on multiple linear regression, if there was no mmW exposure, case and death rates would be 18-30% lower for 5G mmW states and 39-57% lower for 5G mmW counties. This assessment clearly shows exposure to 5G mmW technology is statistically significantly associated with higher COVID-19 case and death rates in the U.S.A. The mechanism–should this be a causal relationship–may relate to changes in blood chemistry, oxidative stress, an impaired immune response, an altered cardiovascular and/or neurological response.

The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data

This paper estimates effects of e-cigarette taxes enacted in eight states and two large counties on e-cigarette prices, e-cigarette sales, and sales of other tobacco products. We use NielsenIQ Retail Scanner data from 2011 to 2017, comprising approximately 35,000 retailers nationally, and develop a method to standardize e-cigarette taxes since adopting localities have taxed these products in heterogeneous ways. We estimate a tax-to-price pass-through rate of 1.44 and a Herfindahl–Hirschman Index of 0.246 for e-cigarette retail purchases, indicating a moderately to highly concentrated market structure theoretically linked to tax over-shifting. We then calculate an e-cigarette own-price elasticity of -1.30 and positive cross-price elasticities of demand between e-cigarettes and cigarettes, suggesting they are economic substitutes. Other analyses explore heterogeneity in tax and price responses across flavored and non-flavored e-cigarettes and cigarettes.

Understanding Michigan's Electoral Competitiveness: Swing Counties 1976-2018

ABSTRACT Considerable media attention was given to the so-called “pivot counties” in the U.S. and in Michigan that flipped from supporting Barack Obama twice to voting for Donald Trump in 2016. We first summarize theories of voting behavior and speculate about why Michigan has been consistently competitive over the years. We explore 40 years' worth of county-level presidential and gubernatorial election results in Michigan to determine how frequently counties have flipped across a large number of elections. We find that a number of Michigan counties frequently flip between elections, but the number of competitive Michigan counties has substantially declined in recent decades. Turnout in larger counties can affect election outcomes, and large counties that swing have been key bellwethers in past elections, and should be a major focus of research on future elections in Michigan.

Measuring Hazards of Undetectable Viral Load among Hepatitis C Antibody Positive Residents of a Large Southern California County.

Background Hepatitis C virus (HCV) infection is the most common bloodborne infection in the U.S. However, only a small proportion of persons are treated and cured. Previous research has not characterized sociodemographic characteristics of who receives treatment. We examined predictors of undetectable for HCV in Orange County, the sixth largest county in the United States, where HCV is the most commonly reported infection. Methods: From 2014 to 2020, we acquired public health surveillance data from 91,165 HCV antibody-positive care encounters from the California Reportable Disease Information Exchange (CalREDIE). We used a time-to-event proportional hazards framework to estimate individual and area-level correlates of time-to-HCV undetectable viral load among HCV + individuals. Results: Older adults (>65 years) showed an increased hazard of undetectable viral load relative to younger adults (HR = 2.00). In addition, residents of census tracts with greater enrollment in health insurance showed a greater likelihood of undetectable viral load (HR = 1.36). The moderating effect of higher tract median household income and higher tract levels of health insurance were more likely to have undetectable viral load and was statistically significant. Conclusion: In a large urban county, HCV antibody-positive older adults appear much more likely to show undetectable viral load compared to younger adults. Residents in areas with higher quartiles of health insurance enrollment have an increased likelihood of undetectable viral load. The extent to which constraints impede HCV care requires further investigation, including follow-up studies on health insurance type to test the relationship of health insurance type to undetectable viral load.

Biophysical and Socioeconomic Factors Associated to Deforestation and Forest Recovery in Brazilian Tropical Dry Forests

The determination of land cover changes (LCCs) and their association to biophysical and socioeconomic factors is vital to support government policies toward the sustainable use of natural resources. The present study aimed to quantify deforestation, forest recovery and net cover change in tropical dry forests (TDFs) in Brazil from 2007 to 2016, and investigate how they are associated to biophysical and socioeconomic factors. We also assessed the effects of LCC variables in human welfare indicators. For this purpose, we used MODIS imagery to calculate TDF gross loss (deforestation), gross gain (forest recovery) and net cover change (the balance between deforestation and forest recovery) for 294 counties in three Brazilian states (Minas Gerais, Bahia, and Piauí). We obtained seven factors potentially associated to LCC at the county level: total county area, road density, humidity index, slope, elevation, and % change in human population and in cattle density. From 2007 to 2016, TDF cover increased from 76,693 to 80,964 km2 (+5.6%). This positive net change resulted from a remarkable forest recovery of 19,018 km2 (24.8%), offsetting a large deforested area (14,748 km2; 19.2%). Practically all these cover changes were a consequence of transitions from TDF to pastures and vice-versa, highlighting the importance of developing sustainable policies for cattle raising in TDF regions. Each LCC variable was associated to different set of factors, but two biophysical variables were significantly associated both to TDF area gained and lost per county: county area (positively) and slope (negatively), indicating that large and flat counties have very dynamic LCCs. The TDF net area change was only associated (negatively) to the humidity index, reflecting an increase in TDF cover in more arid counties. The net increase in Brazilian TDF area is likely a result from an interplay of biophysical and socioeconomic factors that reduced deforestation and caused pasture abandonment. Although the ecological integrity and permanence of secondary TDFs need further investigation, the recovery of this semi-arid ecosystem must be valued and accounted for in the national forest restoration programs, as it would significantly help achieving the goals established in the Bonn agreement and the Atlantic Rain Forest pact.

Abstract PR04: Low-income minorities and immigrants are priority targets in late stage hepatocellular carcinoma hotspots

Abstract Background: Survival for hepatocellular carcinoma (HCC) is highly contingent on stage at diagnosis. Identifying high-risk population groups is crucial for efficient delivery of limited resources. We present a population-based geospatial approach to identifying priority targets for early detection interventions in a defined area with high rates of late stage HCC. Methods: We utilized a high-quality population-based cancer registry for cohort identification. Inclusion criteria were: 1) incident HCC (C22.0, 8170-8175), 2) diagnosis between 2008-2017, and 3) residence within boundaries of a single large metropolitan county (Los Angeles). Late stage included AJCC 7th Edition stages III-VI and unstaged cases. We mapped “hotspots” or areas with high density of late stage disease using address coordinates and kernel density estimation in ArcMap 10.3.1. We selected a hotspot density threshold that best optimized number of hotspots, number of cases, and proportion of late stage cases within hotspots. Individual-level factors associated with residence in a hotspot were identified with univariate logistic regression. Age-adjusted incidence rate (AAIR) and population attributable risk (PAR) of late stage disease if residence in a hotspot were calculated. Results: In Los Angeles County, 3894 (51.8%) of 7519 incident cases of HCC were late stage. We identified 23 discrete hotspots that encompassed 26.7% of all cases and 30.0% of late stage cases. Hotspots had 10% more late stage disease (59.1% within vs 49.1% outside hotspots, p&amp;lt;0.01). The composition of hotspots heavily favored racial/ethnic minorities (86.3% vs 69.5%, p&amp;lt;0.01) and nearly half of hotspot residents were foreign-born (48.6% vs 36.9%, p&amp;lt;0.01; &amp;gt;25% with unknown birthplace). 45.4% of residents within hotspots were in the lowest socioeconomic status (SES) quintile compared to only 19.1% outside hotspots. Factors associated with residence in a hotspot included non-White race/ethnicity (OR 2.6, 2.7, and 3.1 for Black, Hispanic, and Asian, respectively, compared to White), foreign-born (OR 1.3 vs US-born), and Medicaid insurance (OR 1.7 vs non-Medicaid) (all p&amp;lt;0.05). Likelihood of residence in a hotspot sequentially increased with each quintile decrease in SES (OR 3.3 for highest-middle to OR 33.2 for lowest vs highest quintile, p&amp;lt;0.01). The AAIR of late stage HCC was twice as high within compared to outside hotspots (6.85 vs 3.38) and 43% of late stage HCC at diagnosis was attributable to residence in a hotspot (PAR=0.43). Conclusion: Late stage HCC hotspots in Los Angeles County are disproportionately comprised of low-income minority and immigrant populations. Early detection interventions that modify risk in these priority groups have potential to reduce late stage burden by nearly 40%. Our strategy can be replicated in any population-based cancer registry for individualized area-specific targets. Citation Format: Kali Zhou, Laura Thompson, Norah A. Terrault, Myles G. Cockburn. Low-income minorities and immigrants are priority targets in late stage hepatocellular carcinoma hotspots [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR04.

Magnetic Resonance Imaging of Diabetic Foot Osteomyelitis: Imaging Accuracy in Biopsy-Proven Disease

Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO). The gold standard to diagnose osteomyelitis is bone biopsy with a positive culture and/or histopathology finding consistent with osteomyelitis. The purpose of this study is to assess the accuracy of MRI readings in biopsy-proven diabetic foot osteomyelitis with a second read done by a blinded, expert musculoskeletal radiologist. A retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large county hospital between 2010 and 2014. A second, blinded musculoskeletal radiologist reviewed the images for accuracy, once the official reading was recorded. Imaging results were correlated with the final diagnosis of osteomyelitis determined by bone biopsy. In 17 of 58 patients (29.3%), the diagnosis of DFO by MRI was not confirmed by bone biopsy. There were 12 false positives and 5 false negatives. After the second expert read, there were 5 false positives and 4 false negatives. The overall accuracy was 84% for the second read. Our study demonstrated results comparable to the previously reported meta-analysis findings. There is a clear variation on the read of MRI that could lead to an incorrect diagnosis of DFO. An integrated approach with evaluation of clinical findings, communication with radiologist about the MRI results when indicated, and bone biopsy is warranted for accurate diagnosis management of DFO.

Reopening libraries in COVID 19 pandemic: challenges and recommendations

Reopening libraries in COVID 19 pandemic: challenges and recommendations - IJLSIT- Print ISSN No: - 2582-1555 Online ISSN No:- 2456-9623 Article DOI No:- 10.18231/j.ijlsit.2020.004, IP Indian Journal of Library Science and Information Technology-IP Indian J Libr Sci Inf Technol

Persistence and convergence: The end of kindergarten outcomes of pre-K graduates and their nonattending peers.

The present investigation examined the benefits of pre-K through the end of kindergarten for children from low-income homes who lived in a large and diverse county (n = 2,581) as well as factors associated with a reduction in benefits during the kindergarten year. Results revealed that pre-K graduates outperformed nonattenders in the areas of achievement and executive functioning skills at the end of kindergarten, and also that the benefits of pre-K at the start of the year diminished by a little more than half. This convergence between groups' performance was largest for more constrained skills, such as letter-word identification, and was attributed to the fact that nonattenders made greater gains in kindergarten as compared with graduates of pre-K. Importantly, convergence in the groups' performance in kindergarten was not attributed to pre-K children's classroom experiences in kindergarten. Convergence was, however, attributable to preexisting individual differences, and there was support for the notion that even though children's skills are susceptible to improvement as a result of pre-K, their longer-term outcomes are likely to be impacted by factors that are outside the scope of early schooling. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Road Traffic Accidents and Disparities in Child Mortality.

Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.

Clinical Implications of Violence Risk After Civil Commitment in Florida.

In their article, Swanson and colleagues examine the long-term risk of firearm-related and other violent crime in a large population of adults with serious mental illnesses following a gun-disqualifying involuntary civil commitment, compared with similar individuals who were evaluated for commitment but released or voluntarily admitted and with a third group with no holds or commitments. They build on prior research from a sample of individuals from public behavioral health systems of two large counties in Florida. This commentary provides further context for their research by highlighting additional factors related to mental health in the state of Florida. Understanding recent legislation regarding the medical privacy of firearm owners, mental health spending, trends in involuntary examinations, and related firearm laws in Florida will contribute to describing the backdrop of the current study. While Swanson's research proposes greater policy implications, this commentary will examine the direct impact on the practice of clinical psychiatrists.

The Incidence, Characteristics, and Outcomes of Community and Hospital-Associated S. aureus Disease in Fulton County, Georgia

Background: Due to reliance on hospital discharge data for case identification, the burden of noninvasive and community-acquired S. aureus disease is often underestimated. To determine the full burden of S. aureus infections, we utilized population-based surveillance in a large urban county. Methods: The Georgia Emerging Infections Program (GA EIP) conducted CDC-funded, population-based surveillance by finding cases of S. aureus infections in 8 counties around Atlanta in 2017. Cases were residents with S. aureus isolated from either a normally sterile site in a 30-day period (invasive cases) or another site in a 14-day period (noninvasive cases). Medical records (all invasive and 1:4 sample of noninvasive cases) among Fulton County residents were abstracted for clinical, treatment, and outcome data. Cases treated were mapped to standard therapeutic site codes. Noninvasive specimens were reviewed and attributed to an invasive case if both occurred within 2 weeks. Incidence rates were calculated using 2017 census population and using a weight-adjusted cohort to account for sampling. Results: In total, 1,186 noninvasive (1:4 sample) and 529 invasive cases of S. aureus in Fulton county were reviewed. Only 35 of 1,186 (2.9%) noninvasive cases were temporally linked to invasive cases, resulting in 5,133 cases after extrapolation (529 invasive, 4,604 noninvasive). All invasive cases and 3,776 of 4,604 noninvasive cases (82%) were treated (4,305 total). Treatment was highest in skin (90%) and abscess (97%), lowest in urine (62%) and sputum (60%), and consisted of antibacterial agents alone (65%) or in addition to drainage procedures (35%). Overall, 41% of all cases were hospitalized, 12% required ICU admission, and 2.7% died, almost exclusively with bloodstream and pulmonary infections. Attribution of noninvasive infection was most often outside healthcare settings (87%); only 341 (7.9%) were hospital-onset cases; however, 34% of cases had had healthcare exposure in the preceding year, most often inpatient hospitalization (75%) or recent surgery (35%). Estimated countywide incidence was 414 per 100,000 (130 for MRSA and 284 for MSSA), invasive infection was 50 per 100,000. Among treated cases, 57% were SSTI, and the proportion of cases caused by MRSA was ~33% but varied slightly by therapeutic site (Fig. 1). Conclusions: The incidence of treated S. aureus infection in our large urban county is estimated to be 414 per 100,000 persons, which exceeds previously estimated rates based on hospital discharge data. Only 12% of treated infections were invasive, and &lt;1 in 10 were hospital onset. Also, two-thirds of treated disease cases were MSSA; most were SSTIs.Funding: Proprietary Organization: Pfizer.Disclosures: Scott Fridkin, consulting fee - vaccine industry (spouse).