Mailing Address Research Articles

Neighborhood greenness and long-term physical and psychosocial quality of life among prostate cancer survivors in the Health Professionals Follow-up Study

IntroductionNeighborhood greenness may benefit long-term prostate cancer survivorship by promoting physical activity and social integration, and reducing stress and exposure to air pollution, noise, and extreme temperatures. We examined associations of neighborhood greenness and long-term physical and psychosocial quality of life in prostate cancer survivors in the Health Professionals Follow-up Study. MethodsWe included 1437 individuals diagnosed with non-metastatic prostate cancer between 2008 and 2016 across the United States. Neighborhood greenness within a 1230m buffer of each individual's mailing address was measured using the Landsat satellite image-based Normalized Difference Vegetation Index (NDVI). We fit generalized linear mixed effect models to assess associations of greenness (in quintiles) with longitudinal patient reported outcome measures on prostate cancer-specific physical and psychosocial quality of life, adjusting for time-varying individual- and neighborhood-level demographic factors and clinical factors. ResultsThe greatest symptom burden was in the sexual domain. More than half of survivors reported good memory function and the lack of depressive signs at diagnosis. In fully adjusted models, cumulative average greenness since diagnosis was associated with fewer vitality/hormonal symptoms (highest quintile, Q5, vs lowest quintile, Q1: mean difference: 0.46, 95% confidence interval [CI]: 0.81, −0.12). Other domains of physical quality of life (bowel symptoms, urinary incontinence, urinary irritation, and sexual symptoms) did not differ by greenness overall. Psychosocial quality of life did not differ by greenness overall (Q5 vs Q1, odds ratio [95% CI]: memory function: 1.01 [0.61, 1.73]; lack of depressive signs: 1.10 [0.63, 1.95]; and wellbeing: 1.17 [0.71, 1.91]). ConclusionDuring long-term prostate cancer survivorship, cumulative average 1230m greenness since diagnosis was associated with fewer vitality/hormonal symptoms. Other domains of physical quality of life and psychosocial quality of life did not differ by greenness overall. Limitations included potential non-differential exposure measurement error and NDVI's lack of time-activity pattern.

Clinician-created video education for patients with atrial fibrillation: a randomised clinical trial

Abstract Background Improved health literacy is associated with better health outcomes.(1) Atrial fibrillation (AF) is a complex condition and patient understanding of AF is poor.(2) There is little time during routine care to provide education on AF. Clinic waiting time provides an opportunity to deliver education that improves AF knowledge and engagement with clinical care. Purpose Assess the efficacy and feasibility of remotely-delivered clinician-created education for patients with AF. Methods Single-centre randomised clinical trial (ANZCTRN 12620000729921, registered 13/07/2020) conducted in adults over 18 years of age awaiting outpatient cardiac clinic appointments with electrocardiogram-confirmed AF, CHA²DS²VASc > 0 and an active electronic mailing address or mobile phone. Those with insufficient English proficiency to comprehend video content were excluded. Eligible participants were recruited remotely and randomised 1:1 to an internet-based intervention of 4 animated videos narrated by treating cardiologists totalling 15 minutes with the option to review videos weekly, or usual care. Recruiting staff, outcome assessors and those responsible for statistical analysis were blinded to treatment allocation. The primary outcome was Jessa AF Knowledge Questionnaire (JAKQ) score (a 16-item validated questionnaire consisting of general AF and anticoagulation-specific questions(2)) at 90 days post recruitment adjusted for baseline performance, AF diagnosis, educational level, age and sex. A sample size of 200, allowing for 15% attrition and a standard deviation of 18 described previously(2) was prospectively calculated to have 90% power (2-sided, type 1 error of 5%) to detect an 8.95% difference in 90-day AF knowledge. Results Between November 2020 and July 2022, 208 patients were randomised (104 intervention, 104 control). Mean (standard deviation) age was 65.0 (12) years, and 65.2% were male. Most (56.2%) had paroxysmal AF and 6.4% had first episode AF. Intervention participants were more likely to correctly answer JAKQ questions at 90 days (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01, 1.49]). Highly engaged participants were more likely to have higher JAKQ scores (OR 1.46 [95% CI 1.14, 1.88] among those who watched videos on 3 or more weeks compared to control). Video satisfaction was high (figure 2). There was no significant difference in satisfaction with care or education provided in clinic OR 1.32 [95% CI 0.71, 2.44]). Conclusions A clinician-created, low-cost, remotely-delivered educational intervention among patients with AF awaiting cardiac clinic appointments was highly acceptable and improved AF knowledge at 90 days. Increased intervention exposure correlated with higher knowledge scores. Future delivery of this intervention could investigate impact on medication adherence, AF burden, and patient-reported quality of life outcomes.Figure 1Figure 2

Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022.

Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.

Labeling compliance and online claims for Ayurvedic herbal supplements on the U.S. market associated with the purported treatment of COVID-19.

During the COVID-19 pandemic, many consumers increased their use of supplements that claimed to support immune health, including Ayurvedic preparations. The goal of this study was to analyze labeling compliance and online claims for Ayurvedic herbal supplements associated with the purported treatment of COVID-19. The physical product labels for 51 herbal supplements labeled as ginger, tulsi/holy basil, amla, vacha/calamus root, guduchi/giloy, cinnamon, ashwagandha, tribulus, or turmeric were assessed for U.S. regulatory compliance. Disease claims, structure/function claims, and general well-being claims were also examined. The online listings for products purchased online (n=42) were examined for claims and for the presence of the required legal disclaimer. Collectively, 61% of products had at least one instance of noncompliance on the physical label. The most common violations included missing/noncompliant disclaimer (33%), noncompliant "Supplement Facts" label (29%), noncompliant statement of identity (27%) and noncompliant domestic mailing address or phone number (25%). Structure/function claims occurred more frequently in the online product listings (average of 5 claims per product) compared to the physical labels (average of 2 claims per product). Disease claims were observed for 38% of online product listings and on 8% of physical labels. The use of disease claims on herbal supplements is a significant concern for public health because it may lead consumers to delay seeking professional treatment for life-threatening diseases. Overall, this study revealed a lack of labeling compliance among Ayurvedic herbal supplements and a need for greater scrutiny and monitoring of online product listings.

A Study of Arizona Physician Relocation Patterns by Rurality and Primary Care Status.

Physician location is an important element of health care access. However, physician shortages and disparities in geographic distribution exist. This study examines physician locations, relocation patterns, and factors associated with relocating. We used Arizona licensure data and rural-urban commuting area (RUCA) codes to identify Arizona physicians and their office or mailing address locations. Our sample included Arizona physicians estimated to be younger than 70 years of age who had an active license between in 2014 and 2019. We used multivariable logistic regression to assess physicians' adjusted odds of relocating in Arizona by RUCA code, primary care status, age, gender, and medical education location. We identified 11,202 Arizona physicians in our sample, 33% of whom changed practice addresses within Arizona between 2014 and 2019. Primary care physicians (PCPs) in large rural areas had lower odds of relocating in Arizona (0.62, 95% CI 0.43-0.90) than PCPs in urban areas. Compared to 64-69-year-old physicians, those less than 34 and 34-43 years old had statistically higher odds of relocating within Arizona. Primary care status and rurality are important factors consider to understand physician relocation patterns. We found that a substantial number of Arizona physicians relocated within Arizona between 2014 and 2019, and few of those who relocated (2%) moved to a more rural area.

Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates

Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%. To determine whether an electronic primer message delivered through the patient portal increases the completion rate of CRC screening in a mailed fecal immunochemical test (FIT) outreach program. In this randomized clinical quality improvement trial at the University of California, Los Angeles Health of 2339 patients enrolled in a FIT mailing program from August 28, 2019, to September 20, 2020, patients were randomly assigned to either the control or intervention group, and the screening completion rate was measured at 6 months. Participants were average-risk managed care patients aged 50 to 75 years, with a valid mailing address, no mailed CRC outreach in the previous 6 months, and an active electronic health record (EHR) patient portal who were due for CRC screening. Data were analyzed on an intention-to-treat basis. Eligible patients were randomly assigned to receive either (1) the standard FIT mailed outreach (control group) or (2) the standard FIT mailed outreach plus an automated primer to notify patients of the upcoming mailed FIT sent through the electronic patient portal (intervention group). The primary outcome was the screening completion rate (ie, returning the FIT). Secondary outcomes were (1) were the time to CRC screening from the FIT mailing date, (2) screening modality completed, and (3) the effect of opening the electronic primer on screening completion rate. The study included 2339 patients (1346 women [57.5%]; mean [SD] age, 58.9 [7.5] years). The screening completion rate was higher in the intervention group than in the control group (37.6% [445 of 1182] vs 32.1% [371 of 1157]; P = .005). The time to screening was shorter in the intervention group than in the control group (adjusted hazard ratio, 1.24; 95% CI, 1.08-1.42; P = .003). The proportion of each screening test modality completed was similar in both groups. In a subanalysis of the 900 of 1182 patients (76.1%) in the intervention group who opened the patient portal primer message, there was a 7.3-percentage point (95% CI, 2.3-12.4 percentage points) increase in CRC screening (local mean treatment effect; P = .004). Implementation of an electronic patient portal primer message in a mailed FIT outreach program led to a significant increase in CRC screening and improvement in the time to screening completion. The findings provide an evidence base for additional refinements to mailed FIT outreach quality improvement programs in large health systems. ClinicalTrials.gov Identifier: NCT05115916.

Not in my neighborhood: the effects of single-family rentals on home values

Since the Great Recession, single-family rentals have increased as a share of the housing units within America's neighborhoods. Homeowners are concerned that this shift in housing tenure will lower their neighborhood's quality and have an adverse effect on their property values. However, no current evidence exists on whether these concerns have any validity. In this paper, we utilize a six-year balanced panel of neighborhoods from the state of Florida's metropolitan areas to study the impacts that single-family rentals have on the values of single-family homes. Our case for causality is buttressed by estimating house value models that include time and neighborhood fixed effects, treat the rentals as endogenous variables, and control for sample selection and changes in neighborhood demographics and land uses. Our results show that share increases in single-family rentals lower house values, but the effects vary between central cities and suburbs, across neighborhoods of different income levels and density, by the price of the rental unit, and whether the owner has a mailing address outside the state of Florida.

Outreach to new mothers through direct mail and email: recruitment in the Early Check research study

Meeting recruitment targets for clinical trials and health research studies is a notable challenge. Unsuccessful efforts to recruit participants from traditionally underserved populations can limit who benefits from scientific discovery, thus perpetuating inequities in health outcomes and access to care. In this study, we evaluated direct mail and email outreach campaigns designed to recruit women who gave birth in North Carolina for a statewide research study offering expanded newborn screening for a panel of rare health conditions. Of the 54,887 women who gave birth in North Carolina from September 28, 2018, through March 19, 2019, and were eligible to be included on the study’s contact lists, we had access to a mailing address for 97.9% and an email address for 6.3%. Rural women were less likely to have sufficient contact information available, but this amounted to less than a one percentage point difference by urbanicity. Native American women were less likely to have an email address on record; however, we did not find a similar disparity when recruitment using direct‐mail letters and postcards was concerned. Although we sent letters and emails in roughly equal proportion by urbanicity and race/ethnicity, we found significant differences in enrollment across demographic subgroups. Controlling for race/ethnicity and urbanicity, we found that direct‐mail letters and emails were effective recruitment methods. The enrollment rate among women who were sent a recruitment letter was 4.1%, and this rate increased to 5.0% among women who were also sent an email invitation. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Under‐representation by traditionally underserved populations in clinical trials and health research is a challenge that may in part reflect inequitable opportunities to participate. WHAT QUESTION DID THIS STUDY ADDRESS? Are direct‐mail and email outreach strategies effective for reaching and recruiting women from traditionally underserved and rural populations to participate in large‐scale, population‐based research? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Despite sending recruitment letters and email invitations in roughly equal proportion by urbanicity and race/ethnicity, women living in rural areas were less likely to enroll (2.8%) than women from urban areas (4.2%). Additionally, enrollment rates decreased as the probability that women were members of a racial or ethnic minority group increased. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? Results from this study might encourage researchers to take a holistic and participant‐centered view of barriers to study enrollment that may disproportionately affect underserved communities, including differences in willingness to participate, trust, and access to resources needed for uptake.

Andy Warhol's Pantry Tokens

This essay announces the creation of the Warhol's Pantry Tokens collection of NFTs. This collection of 60 NFTs corresponds to 60 works of art I created. Ownership of one of the NFTs in this collection constitutes ownership of the unique copy of the work to which it corresponds. The unique copies are stored in the Brian L. Frye Shoebox Art Freehold at an undisclosed location. The owner of an NFT can redeem the NFT for the copy at any time, by burning the NFT and sending me their mailing address. Each work consists of an image drawn by Andy Warhol and printed in Amy Vanderbilt's Complete Cookbook (1961), which I cut out of a copy of the cookbook and glued to a card. I created a PDF scan of each work for the purpose of illustrating the sale of the NFT to which it corresponds. Ownership of an NFT from this collection does not constitute ownership of copyright in the drawing represented in the work corresponding to the NFT. This essay reflects on the copyright problems presented by the creation and sale of these NFTs. For better or worse, I believe no infringement has occurred. Do you agree?

Bovine Liver Supplement Labeling Practices and Compliance With U.S. Regulations

Bovine liver supplements are sought after by consumers due to their nutrient-dense profile and high protein content. However, there is a lack of information regarding bovine liver supplement labeling practices. The objective of this study was to assess labeling practices and compliance with U.S. regulatory standards among commercially sold bovine liver supplements. The product labels for 49 bovine liver supplements were examined for required information, including a statement of identity; net quantity of contents; “Supplement Facts” label; ingredient statement; and name and place of business of manufacturer, packer, or distributor with domestic address or telephone number. Any claims made on the supplement labels were also reviewed for compliance. Overall, 59% of the products had at least one instance of noncompliance with U.S. labeling regulations. The main categories of noncompliance were missing a domestic mailing address or phone number (39% of products), noncompliant nutrient content claim (31% of products), and missing/noncompliant disclaimer for a nutritional support statement (6% of products). The lack of a mailing address or phone number is problematic because it prevents consumers from being able to report serious adverse events to the manufacturer. The majority (85%) of the nutrient content observed on product labels was found to be noncompliant. Noncompliant nutrient content claims are a major concern for consumers who rely on these claims to assess the nutritional benefits of a product. Overall, the results of this study revealed a lack of labeling compliance in bovine liver supplements, indicating a need for increased awareness and monitoring.

Patient Satisfaction with Quality of Care of a New Multidisciplinary Thrombosis Service

INTRODUCTION As patient centered healthcare is becoming increasingly popular, it is important to assess patient satisfaction with this approach. We started a new multidisciplinary Adult Outpatient Thrombosis Service (TS) in October 2017 in a Canadian health authority servicing over 300 000 people. The TS is a comprehensive thrombosis and anticoagulation management program with unique, interrelated clinics providing the spectrum of care required for this patient group. The TS includes an Emergency Thrombosis Clinic for care after an acute episode of venous thromboembolism; Thrombosis Clinics addressing non-urgent thrombosis questions and follow up; Anticoagulation Management Clinics for patients on extended duration anticoagulation; and a Perioperative Anticoagulation Management Clinic for patients on anticoagulation requiring surgery or procedures. The TS is staffed by Pharmacists, a Thrombosis Physician/Hematologist, and Clerical staff. The objective of this study was to assess patient satisfaction with the TS. METHODS We conducted a cross sectional survey of patients attending at least one appointment at the TS between October 2017 and May 2019 and who had a valid mailing address available in the hospital records. Eligible patients (n=1058) were mailed an anonymous survey with a cover letter and self-addressed, return stamped envelope. Patient satisfaction with the TS was measured using the seven item Short Assessment of Patient Satisfaction (SAPS), a validated, convenient satisfaction survey tool. The SAPS assesses the core satisfaction domains including treatment satisfaction, explanation of treatment results, clinician care, participation in decision-making, respect by the clinician, time with the clinician, and satisfaction with clinic care. The SAPS utilizes 5-point responses (0-4), with the continuous score range from 0 (extremely dissatisfied) to 28 (extremely satisfied), and categorical responses (0-10 very dissatisfied, 11-18 dissatisfied, 19-26 satisfied, and 27-28 very satisfied). Additionally, five patient characteristic questions were included. Patients were also given the opportunity to respond to an open-ended question regarding the care they received. Participant characteristics and responses are presented using descriptive statistics; linear regression was used to explore variations across characteristics. Qualitative content analysis of open-ended question comments was used to further our understanding of the patient experience and perceived quality of care. RESULTS A total of 563 surveys were returned for a response rate of 53%. Nine were excluded due to more than 2 missing SAPS item answers. Most respondents (87%, n=481) were 50 years of age or older, and 51% (n=285) were male. About two-thirds (67%, n=368) had post-secondary education. About half (54%, n=296) were taking a direct oral anticoagulant (DOAC), about one fifth taking warfarin (19%, n=102), or on no anticoagulant (19%, n=104) at the time of survey response. Almost half had taken the anticoagulant for 1 to 5 years at the time of survey response (47%, n=255), with the remainder split between less than 1 year (28%, n=152), and greater than 5 years (25%, n=137). The mean score for the SAPS was 22.1 (SD 4.1, range 8 to 28). Based on the categorical response, 85% were satisfied or very satisfied with the TS. Multivariate analysis showed that patients with post-secondary education were more satisfied with the TS (β=16.153, p=0.024), and patients taking warfarin were less satisfied with the TS (β= -15.832, p=0.039). The SAPS tool demonstrated a high internal consistency when assessed for reliability using Composite reliability tests (0.86). Forty percent (n=223) provided written responses to the open-ended question. The majority of responses described positive patient experiences and perceptions regarding the TS and quality of care received. Four major themes emerged: service organization and coordination of care, patient-provider relationship, pharmacist-led medication therapy management, and patient-centered delivery and communication of health information. CONCLUSION To our knowledge, this is the first survey to assess patient satisfaction with a multidisciplinary TS. We found a high proportion (85%) of respondents were satisfied with the care provided. Disclosures Young: Sanofi Canada: Honoraria, Research Funding; Bayer: Research Funding; Pfizer: Honoraria. Chitsike:Sanofi Canada: Honoraria, Research Funding; Bayer Canada: Research Funding.

Incidence and risk factors for medical care interruption in people living with HIV in a French provincial city.

The aim of our study was to identify HIV-positive patients at risk of medical care interruption (MCI) in a provincial city of a high-income country. We estimated the incidence rate of MCI in 989 individuals followed in an HIV clinic in Caen University Hospital, Normandy, France, between January 2010 and May 2016. We enrolled patients over 18 years old who were seen at the clinic at least twice after HIV diagnosis. Patients were considered to be in MCI if they did not attend care in or outside the clinic for at least 18 months, regardless of whether or not they came back after interruption. We investigated sociodemographic, clinical and immunovirological characteristics at HIV diagnosis and during follow-up through a Cox model analysis. The incidence rate of MCI was estimated to be 3.0 per 100 persons-years (95% confidence interval [CI] = 2.6-3.5). The independent risk factors for MCI were a linkage to care >6 months after HIV diagnosis (hazard ratio [HR] = 1.14; 95% CI = 1.08-1.21), a hepatitis C coinfection (HR = 1.76; 95% CI = 1.07-2.88), being born in Sub-Saharan Africa (HR = 2.18; 95% CI = 1.42-3.34 vs. in France) and not having a mailing address reported in the file (HR = 1.73; 95% CI = 1.07-2.80). During follow-up, the risk of MCI decreased when the patient was older (HR = 0.28; 95% CI = 0.15-0.51 when >45 vs. ≤ 30 years old) and increased when the patient was not on antiretroviral therapy (HR = 2.78; 95% CI = 1.66-4.63). Our findings show that it is important to link HIV-positive individuals to care quickly after diagnosis and initiate antiretroviral therapy as soon as possible to retain them in care.

Fast food restaurant density and weight status: A spatial analysis among Filipina migrant workers in Macao (SAR), People's Republic of China.

Female migrant populations are at high risk of being overweight or obese. Beyond individual risk factors, exposure to the neighborhood food environment may contribute to their unhealthy weight status in the host region. Incorporating spatial analysis, this study examined the association between exposure to fast food restaurants and unhealthy weight status among Filipina domestic workers in Macao (SAR), China. Data were collected from 1388 Filipina domestic workers recruited using respondent-driven sampling between November 2016 to August 2017. Self-reported data on demographic characteristics, residential mailing address, and health-related behaviors were collected using tablet devices. Height and weight were objectively measured at the study site. Restaurant locations and resident addresses were geocoded and integrated into a shapefile for residential locations using ArcGIS. Nearly 64% of participants were classified as being overweight or obese, with 25.02% overweight and 38.96% obese. Adjusted multivariable logistic regression indicated that increased fast food restaurant density within a 0.5-mile buffer zone around a residential address was positively associated with higher odds of being overweight and obese (aOR=1.07; 95% CI [1.01-1.14]. Increased fast food restaurant density was associated with unhealthy weight status among Filipina domestic workers in Macao (SAR), China. Providing healthy working environment, including access to healthy food, is indicated to improve the health of this population.

Michigan and the Eaglet: The Lindbergh Kidnapping, Purple Gang, and Governor Wilber M. Brucker

The Michigan Historical Review 46:2 (Fall 2020): 93-138©2020 Central Michigan University. ISSN 0890-1686 All Rights Reserved Michigan and the Eaglet: The Lindbergh Kidnapping, Purple Gang, and Governor Wilber M. Brucker By Robert Knapp Charles A. Lindbergh set the Spirit of St. Louis down at Le Bourget Aerodrome in Paris after the first solo flight across the Atlantic Ocean. Instantly he became the most famous person in the world. The adoration that followed the flight by “Lucky Lindy,” the “Lone Eagle,” on May 2021 , 1927, catapulted him to a level of fame seldom seen in American history. He soon married Anne Morrow, settled down, and had a son, Charles A. Lindbergh Jr. On the night of March 1, 1932, sometime between seven and ten o’clock, a homemade ladder was set beside the Lindbergh home, Highfields, in Hunterdon County, New Jersey.1 Someone climbed up to the baby’s room, through an opened window, snatched the baby and disappeared into the night. The kidnapping became front page news on March 2. The story transfixed the nation. Lindbergh’s child was quickly dubbed the “Eaglet.” Almost immediately, advice and tips were coming from every direction. A command post had to be set up in the garage of the Lindbergh estate to handle and cull the calls and telegrams. Sightings came from as far away as Iowa. Boy Scouts scoured the woods of Westchester County. The entire country was in an uproar. In attempts to find the kidnapped child, all sorts of strange offers were made to authorities, many by gangsters. As early as March 4, newspapers carried rumors that the Purple Gang was involved. The Purple Gang had become Detroit’s most well-known mobsters. Their origins lie, as with so many American cities, in the neighborhoods 1 The Highfields estate straddled East Amwell Township, Hunterdon County, and Hopewell Township, New Jersey. “Hopewell” commonly appears as the place of the kidnapping and subsequent murder of the baby. This is because the Lindberghs used Hopewell (Mercer County) as their mailing address. Bruno Hauptmann’s subsequent trial for the kidnapping and murder took place in Flemington, Hunterdon County, because that was the county where the Lindbergh house was located. 94 The Michigan Historical Review Charles and Anne Lindbergh Source: Library of Congress crammed with recent immigrants from Europe.2 In what was at the time America’s fourth largest city, Jews who had fled the pogroms of the Russian Empire settled around Hastings Street. This area teemed with life. Young men, whether infants at the time of immigration or born in the United States, struggled with what it meant to be simultaneously part of the culture of the “old country” and Americans in an entirely different 2 See Robert Knapp, Mystery Man. Gangsters, Oil, and Murder in Michigan (Clare, MI: Cliophile Press, 2011). Fundamental evidence cited includes: C.H. Burnham, Lieutenant, Michigan State Police, Department of Public Safety Special Report on case 2499 [the Lindbergh kidnapping] investigation in Calhoun County, Michigan, March 14, 1932March 23, 1932 [hereafter Burnham Special Report], Geo. K. Karkeet, Detective, Michigan State Police, Department of Public Safety Supplementary Report on case 2499 [the Lindbergh kidnapping] investigation, March 31, 1932-April 4, 1932 [hereafter Karkeet wiretaps], and William Watkins and Philip L. Hutson, Lieutenants, Michigan State Police, Department of Public Safety Special Report on case 2499 [the Lindbergh kidnapping] investigation, April 2, 1932 [hereafter Watkins Special Report], Michigan Department of State Police Criminal Justice Information Center, Statistical Records Division, Lansing, Michigan; Morris “Mickey” Rosner, untitled typescript, Hoffman Collection [hereafter Rosner memoir], George Clarke, untitled typescript, Hoffman Collection [hereafter Clarke memoir], and copy of New York District FBI case 162-3057 (see pp. 302-310 on the Purple Gang connection; pp. 141-156 on Mickey Rosner’s) [hereafter FBI 162-3057], New Jersey State Police Museum Archive, West Trenton, NJ. Michigan and the Eaglet 95 New York Daily News (March 2, 1932) milieu. Some took up their fathers’ businesses. Some studied hard, went to college, and began professional lives. But the streets beckoned a different kind of youth. Poor students at school, or simply disregarding school, immune to their parents’ entreaties to “be good boys,” envious of the...

Cohort profile: The Canadian Census Health and Environment Cohorts (CanCHECs).

The Canadian Census Health and Environment Cohorts (CanCHECs) are population-based linked datasets of the household population at the time of census collection. The CanCHECs combine data from respondents to the long-form census or the National Household Survey between 1991 and 2011 with administrative health data (e.g., mortality, cancer incidence, hospitalizations, emergency ambulatory care) and annual mailing address postal codes. The CanCHEC datasets are rich national data resources that can be used to measure and examine health inequalities across socioeconomic and ethnocultural dimensions for different periods and locations. These datasets can also be used to examine the effects of exposure to environmental factors on human health. Because of their large size, the CanCHECs are an excellent resource for examining rare health outcomes and small population groups. They are ideally suited for environmental health research because of their geographic coverage across all regions of Canada, their long follow-up periods and their linkage to annual postal code history.

Lichen planopilaris in women: A survey-based study examining baseline hair characteristics and product use in 129 patients seen at Mayo Clinic.

BackgroundCicatricial alopecia is a type of permanent hair loss in which the hair follicle is replaced by scar tissue. Given its relatively low incidence, limited information is available regarding baseline hair characteristics, onset, and other disease-associated factors.ObjectiveWe sought to further elucidate this information in our lichen planopilaris (LPP) patients.MethodsBetween 1993 and 2016, 505 patients were diagnosed with biopsy-proven LPP. Of these patients, we mailed a 20-question survey to 420 patients with updated mailing address and contact information. Responses were received from 129 of 420 patients for a response rate of 30.7%. A total of 108 patients completed the survey and 21 patients declined participation. Descriptive analysis was performed using JMP software.ResultsMedian age at time of pathologic diagnosis was 58 years, with self-reported average age of onset accordingly from 50 to 60 years. Approximately 15% of patients were diagnosed with frontal fibrosing alopecia (FFA), a subtype of LPP. Median follow-up from date of pathologic diagnosis was 72 months. At baseline, 46 out of 108 patients (42.6%) endorsed having thicker hair than peers in childhood. No trend was identified in the rate of traction hairstyle use in childhood, current use of cosmetics, sunscreen, or facial cleanser.ConclusionsWithin our LPP cohort, FFA subtype pathology comprised approximately 15% of cases. There was no trend toward sunscreen use and FFA subtype. Our findings support previously published studies in terms of average age at disease onset, location of hair loss, and median follow-up at 72 months (range: 29–273) from date of pathologic diagnosis.

Examining the Shape of the Association between Low Levels of Fine Particulate Matter and Mortality across Three Cycles of the Canadian Census Health and Environment Cohort.

Background:Ambient fine particulate air pollution with aerodynamic diameter () is an important contributor to the global burden of disease. Information on the shape of the concentration–response relationship at low concentrations is critical for estimating this burden, setting air quality standards, and in benefits assessments.Objectives:We examined the concentration–response relationship between and nonaccidental mortality in three Canadian Census Health and Environment Cohorts (CanCHECs) based on the 1991, 1996, and 2001 census cycles linked to mobility and mortality data.Methods:Census respondents were linked with death records through 2016, resulting in 8.5 million adults, 150 million years of follow-up, and 1.5 million deaths. Using annual mailing address, we assigned time-varying contextual variables and 3-y moving-average ambient at a spatial resolution from 1988 to 2015. We ran Cox proportional hazards models for adjusted for eight subject-level indicators of socioeconomic status, seven contextual covariates, ozone, nitrogen dioxide, and combined oxidative potential. We used three statistical methods to examine the shape of the concentration–response relationship between and nonaccidental mortality.Results:The mean 3-y annual average estimate of exposure ranged from 6.7 to over the three cohorts. We estimated a hazard ratio (HR) of 1.053 [95% confidence interval (CI): 1.041, 1.065] per change in after pooling the three cohort-specific hazard ratios, with some variation between cohorts (1.041 for the 1991 and 1996 cohorts and 1.084 for the 2001 cohort). We observed a supralinear association in all three cohorts. The lower bound of the 95% CIs exceeded unity for all concentrations in the 1991 cohort, for concentrations above in the 1996 cohort, and above in the 2001 cohort.Discussion:In a very large population-based cohort with up to 25 y of follow-up, was associated with nonaccidental mortality at concentrations as low as . https://doi.org/10.1289/EHP5204

Household Incomes in Tax Data

Tax return data are increasingly the standard for tracking income statistics in the United States. However, these data have traditionally been limited by their inability to capture non-filers and to identify members of separate tax units living in the same household. We overcome these obstacles and create household records directly in the tax data using mailing address information included on tax forms. We then present the first set of tax-based household income and inequality measures for the entire income distribution. When comparing household income inequality results in the tax data to those using the March CPS, we confirm previous findings that the March CPS understates the inequality of household income. However, we also find that the previous approach of using tax units in the IRS data to proxy for households leads to an overstatement of household income inequality. Finally, using households in the IRS tax records, we illustrate how focusing on tax units rather than households alters the observed distribution of tax programs such as the Earned Income Tax Credit.

A pilot study examining Toronto-area family physician perspectives on thyroid neoplasm evaluation

ObjectiveThe incidence of thyroid cancer (TC) is known to be very high in the Greater Toronto Area of Ontario, Canada. We performed a pilot survey study examining Toronto-area family physician (FP) perspectives on thyroid neoplasm evaluation (i.e. thyroid nodules [TNs] or thyroid cancer [TC]) in this region, to explore for potential factors leading to overdiagnosis.MethodsWe performed a cross-sectional mail-out written survey of a random sample of 300 FPs in active practice in the Greater Toronto Area (Markham and Brampton).ResultsThe overall response rate was 22.3, 95% confidence interval (CI) 18.0, 27.4% (67/300); the effective response rate was 19.9, 95% CI 15.7, 24.9% (58/291), after excluding 6 FPs that reported TN evaluation was outside their scope of practice and three FPs with an invalid mailing address. There were no missing responses to questions. The demographic characteristics were as follows: 58.6% (34/58) from Markham, 55.2% (32/58) were female, 58.6% (34/58) were in practice > 10 years, and 32.8% (19/58) affiliated with a University. All FPs reported easy access to thyroid ultrasound (TUS). About half of FPs were concerned about overdiagnosis of TC and most did not believe that there was any TC survival advantage with routine screening TUS. Although appropriate indications for TUS were endorsed by most respondents (e.g. palpable TN, incidental TN on other imaging), inappropriate recommendations were observed in a third of FPs (19/57) who recommended TUS for abnormal thyroid blood tests about half of FPs (30/56) who endorsed biopsy of sub-centimeter nodules. About half of FPs (31/58) reported that their patients sometimes request medically unnecessary TUS.ConclusionThere are likely multiple complex factors leading to potential overdiagnosis of TC in primary care, including some physicians’ knowledge gaps about appropriate indications for TN investigations as well as patients’ requests and expectations.

Older Adults with Acute Myeloid Leukemia in Rural Areas Are Less Likely to Receive Azacitidine with Worsened Overall Survival

IntroductionAcute myeloid leukemia (AML) in older adults is a challenging clinical problem with a poor prognosis. Hypomethylating agents, such as azacitidine, improve survival in this population. (Oran B, Haematologica 2012) These treatments can be challenging to deliver, particularly in patients far from tertiary care centres. We examined whether residence outside of a major metropolitan area impacted referral patterns, treatments, and outcomes in a population-based cohort of AML patients over age 60 in British Columbia (BC), Canada.MethodsPatients with ICD-10 diagnoses of AML were identified from the population based BC Cancer registry and BC Cancer pharmacy database. Diagnoses between 2010 and 2016 were included. Exclusion criteria included diagnosis age less than 60 years, any treatment outside BC, or APL. The diagnosis of AML was verified by chart review. Azacitidine was available at our institution in 2010, and is used primarily for patients with bone marrow blast counts below 30%.Patients were defined as having a hematologist/oncologist assessment if a provider with these credentials was listed in notes or pathology reports. Patients were defined as having received a treatment if it was dispensed at least once, with a date after AML diagnosis. Patients were defined as urban if they had a mailing address in a center of >/= 100,000 people, per the Statistics Canada definition, and rural if they had a mailing address elsewhere. Urban residences included greater Vancouver, Victoria and Kelowna, which comprise 71.5% of the population. (Statistics Canada, 2016 census) Between group differences were assessed by 2-tailed t-test or chi-square tests. Overall survival (OS) was assessed by Kaplan-Meier, with a log-rank test, and Cox regression. A p < 0.05 was significant.ResultsA total of 879 patients over age 60 with AML, excluding APL, were identified. Of these, 525 (60%) resided in urban areas vs 354 (40%) residing in rural areas. These groups were similar for median age at diagnosis (urban 75.9 years, rural 74.3 years, p = 0.067), adverse cytogenetic profile (urban 56%, rural 44%, p = 0.356), NPM1 positivity (urban 69%, rural 31%, p = 0.101) and FLT3 positivity (urban 76%, rural 24%, p = 0.052). Rural residents were less likely to have a documented hematologist/oncologist assessment (urban 84%, rural 65%, p < 0.001).Few patients overall received induction chemotherapy (151, 17%), with no difference between rural and urban residency (p = 0.524). Similarly, few patients underwent hematopoietic stem cell transplantation (38, 4%), with no difference with place of residence (p = 1.000). Median OS for patients treated with induction chemotherapy was 11.0 months (95% CI 9.0 - 13.1 mo). Median OS for patients treated with subcutaneous (SC) azacitidine was 7.1 months (95% CI 4.8 - 9.5 mo) vs 4.7 months (95% CI 3.3 - 6.1 mo) with SC cytarabine. With best supportive care, the median OS was 1.7 months (95% CI 1.5 - 1.9 mo). Median follow-up was 43.7 months (95% CI 39.2 - 48.2 mo), with 706 (97%) of patients deceased at last follow-up.Amongst the 728 patients who did not receive induction chemotherapy, 82 (11%) received SC cytarabine and 127 (17%) received SC azacitidine. Place of residence did not impact whether patients received SC cytarabine (urban 10%, rural 13%, p = 0.285). Rural residents were, however, less likely to receive SC azacitidine (urban 21%, rural 12%, p = 0.002). In patients not undergoing induction, rural residents had a worse OS by Kaplan-Meier analysis (p = 0.021), with a hazard ratio of 1.2 (95% CI 1.026 - 1.387, p = 0.022) on univariate Cox regression.ConclusionsOlder adults with a diagnosis of AML who reside in rural areas of BC are less likely to have a documented hematologist/oncologist assessment, and are less likely to receive SC azacitidine. This group also has a worsened OS, though the effect size is modest. There was no difference in rates of treatment with potentially curative regimens, although this approach applied to a minority of patients.We hypothesize that this difference may be partially due to the travel burdens placed on rural patients who receive SC azacitidine, which must be administered in a healthcare facility, unlike SC cytarabine. Less access to supportive care in rural areas is also likely a contributing factor. Policymakers should direct additional resources for rural oncologic healthcare delivery, and the importance of low burden drug formulations is AML should be emphasized. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.