Boston Population Research Articles

Mental health priorities and cultural-responsiveness of the Mental Health First Aid (MHFA) training for Asian immigrant populations in Greater Boston, Massachusetts

BackgroundAsians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 − 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.MethodsThis is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.ResultsIn total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese).ConclusionCultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.

Association between acetaminophen metabolites and CYP2E1 DNA methylation level in neonate cord blood in the Boston Birth Cohort

BackgroundAcetaminophen is a commonly used medication by pregnant women and is known to cross the placenta. However, little is known about the biological mechanisms that regulate acetaminophen in the developing offspring. Cytochrome 2E1 (CYP2E1) is the primary enzyme responsible for the conversion of acetaminophen to its toxic metabolite. Ex vivo studies have shown that the CYP2E1 gene expression in human fetal liver and placenta is largely controlled by DNA methylation (DNAm) at CpG sites located in the gene body of CYP2E1 at the 5’ end. To date, no population studies have examined the association between acetaminophen metabolite and fetal DNAm of CYP2E1 at birth.MethodsWe utilized data from the Boston Birth Cohort (BBC) which represents an urban, low-income, racially and ethnically diverse population in Boston, Massachusetts. Acetaminophen metabolites were measured in the cord plasma of newborns enrolled in BBC between 2003 and 2013 using liquid chromatography-tandem mass spectrometry. DNAm at 28 CpG sites of CYP2E1 was measured by Illumina Infinium MethylationEPIC BeadChip. We used linear regression to identify differentially methylated CpG sites and the “DiffVar” method to identify differences in methylation variation associated with the detection of acetaminophen, adjusting for cell heterogeneity and batch effects. The false discovery rate (FDR) was calculated to account for multiple comparisons.ResultsAmong the 570 newborns included in this study, 96 (17%) had detectable acetaminophen in cord plasma. We identified 7 differentially methylated CpGs (FDR < 0.05) associated with the detection of acetaminophen and additional 4 CpGs showing a difference in the variation of methylation (FDR < 0.05). These CpGs were all located in the gene body of CYP2E1 at the 5’ end and had a 3–6% lower average methylation level among participants with detectable acetaminophen compared to participants without. The CpG sites we identified overlap with previously identified DNase hypersensitivity and open chromatin regions in the ENCODE project, suggesting potential regulatory functions.ConclusionsIn a US birth cohort, we found detection of cord biomarkers of acetaminophen was associated with DNAm level of CYP2E1 in cord blood. Our findings suggest that DNA methylation of CYP2E1 may be an important regulator of acetaminophen levels in newborns.

Nicotinamide Adenine Dinucleotide Biosynthetic Impairment and Urinary Metabolomic Alterations Observed in Hospitalized Adults With COVID-19–Related Acute Kidney Injury

IntroductionAcute kidney injury (AKI) is common in COVID-19 and associated with increased morbidity and mortality. We investigated alterations in the urine metabolome to test the hypothesis that impaired nicotinamide adenine dinucleotide (NAD+) biosynthesis and other deficiencies in energy metabolism in the kidney, previously characterized in ischemic, toxic, and inflammatory etiologies of AKI, will be present in COVID-19–associated AKI.MethodsThis is a case-control study among the following 2 independent populations of adults hospitalized with COVID-19: a critically ill population in Boston, Massachusetts, and a general population in Birmingham, Alabama. The cases had AKI stages 2 or 3 by Kidney Disease Improving Global Outcomes (KDIGO) criteria; the controls had no AKI. Metabolites were measured by liquid chromatography–mass spectrometry.ResultsA total of 14 cases and 14 controls were included from Boston and 8 cases and 10 controls from Birmingham. Increased urinary quinolinate-to-tryptophan ratio (Q/T), found with impaired NAD+ biosynthesis, was present in the cases at each location and pooled across locations (median [interquartile range]: 1.34 [0.59–2.96] in cases, 0.31 [0.13–1.63] in controls, P = 0.0013). Altered energy metabolism and purine metabolism contributed to a distinct urinary metabolomic signature that differentiated patients with and without AKI (supervised random forest class error: 2 of 28 in Boston, 0 of 18 in Birmingham).ConclusionUrinary metabolites spanning multiple biochemical pathways differentiate AKI versus non-AKI in patients hospitalized with COVID-19 and suggest a conserved impairment in NAD+ biosynthesis, which may present a novel therapeutic target to mitigate COVID-19–associated AKI.

Review: The Atlas of Boston History

Review: <i>The Atlas of Boston History</i>

Visual and Ocular Conditions among a Homeless Adult Population of Boston.

The eye care needs of the homeless population in the United States are not well known. This study elucidates those needs for health care for the homeless programs and eye care practitioners. This information could result in an increase in the provision of necessary eye care services. The purpose of this study was to assess the extent of visual and ocular conditions, the frequency of eyeglass orders and receipt of eyeglasses, and the frequency of ophthalmology referrals and receipt of ophthalmological care in an adult homeless population in Boston. A cross-sectional retrospective chart review was conducted for patients of the Boston Health Care for the Homeless Program's Pine Street Inn eye clinic from September 26, 2016, to December 31, 2017. Data on sociodemographics, medical history, comprehensive eye examination findings, glasses orders and receipt, and ophthalmology referrals and receipt of care were collected and analyzed. A total of 424 patients were included in the study. The mean age of the study population was 52.7 (interquartile range, 46 to 60), and the majority were male (74%). The most common systemic conditions were hypertension (40.6%) and diabetes (23.8%). The most common refractive error was presbyopia (67.7%), followed by astigmatism (38.9%), hyperopia (34.0%), and myopia (30.7%). The most common ocular conditions were dry eye (28.6%), visually or clinically significant cataract (20%), and glaucoma/glaucoma suspicion (13.9%). Refractive correction was indicated for 356 patients (84%), but 82 (29%) did not receive ordered eyeglasses. Ophthalmology referrals were placed for 61 patients (14.4%), yet only 20 (32.8%) of those referrals were completed. A significant need for refractive correction and a large gap for ophthalmological care were found among the study population. Health care for the homeless programs and eye care practitioners should be aware of the visual and ocular needs of this patient population so as to better meet their needs.

Editorial Notes

Editorial Notes Craig S. Revels It is with great pleasure that I welcome you to this, the eighty-third volume of the Yearbook of the Association of Pacific Coast Geographers. Last year's volume was published in a time of great uncertainty as the COVID-19 pandemic swept across the world, and this year's unfortunately arrives under similar conditions, slowly improving though they may be. The tragedies, disruptions, and general state of societal affairs during the pandemic will not soon be forgotten. The pandemic also generated uniquely historic circumstances for the Association. The most immediate of these was the cancellation of the 2020 annual meeting, one of only four such years (the other three being 1943–45, during WWII) that APCG had failed to hold a meeting since its founding in 1935. Additionally, the annual meeting is essential to the official workings of the Association, including leadership transitions. With the cancellation, the Executive Council made the decision to extend official council positions for an additional year and forgo the awards and accolades that are a key part of our meetings. One of the traditional functions of the Yearbook is to serve as an official record of the annual meetings held by the Association of Pacific Coast Geographers. With no 2020 meeting, these elements are of course missing from this year's volume, though they will reappear next year. Instead, volume eighty-three is comprised solely of original research and reviews that collectively suggest a theme of vibrancy and relevance for geographic inquiry in the wider world. Our first article takes us to the Pacific Northwest, where the delicate balance between rural livelihoods and the ecosystems upon which they rely is a recurring topic of debate. Lisa Butler Harrington and John Harrington consider the oyster industry of Willapa Bay, placing the evolution of local livelihoods in the context of broader questions concerning invasive species, ecosystem health, and external policy decisions that have historically influenced resource management and will continue to do so in the future. Many residents of the Pacific Northwest take for granted the hydro-electric landscapes that form the foundation of the region's economy and contemporary character. Katherine Heslop delves deeply into the broad societal currents and local impulses that led to the development of those landscapes. Thus, we see them as facets of early twentieth-century progressive [End Page 9] movements and the advent of federally based regional planning in Roosevelt's New Deal, juxtaposed with deeper regional processes that in many ways are still at work today. Geographers have been at the forefront of research into the spread of COVID-19 since the earliest days of the pandemic, and Steve Graves and Petra Nichols contribute an analytical perspective on infection rates in Los Angeles County. In particular, they statistically identify a causal relationship between infection and a range of key socioeconomic and demographic variables, a relationship influencing the location and rate of spread for the disease. They leave us to consider how those factors must be addressed in any preparations for future public health crises. Race and racism have once again returned to the national discourse, with a great deal of emphasis on its structural and institutional forms in areas such as housing policy, gentrification, and urban inequality. As Mallory Stermon and Chris Lukinbeal remind us, the legacy of redlining—essentially housing segregation arising from governmental lending policy—remains pervasive in the urban landscape. The authors analyze the persistence of redlining through the use of historical GIS and spatial analysis of neighborhood demographics through time. Examining the changing demographics of minority populations in Boston, Detroit, and Los Angeles, they demonstrate the potential of spatial analysis to help address one of the most challenging urban issues of the twenty-first century. The next articles illustrate two different ways in which students can be trained in the techniques of analysis and observation, contributing not only to our own research agendas but also developing valuable skills for their own future endeavors. Understanding local fire history is increasingly important in the western United States, and macroscopic charcoal analysis is the leading method for reconstructing them. However, several key methodological questions remain unanswered. Here, lead author Megan Walsh discusses...

Ladies' Day at Boston Red Sox Games: How Discounted Admission for Women Impacted Game Schedules

Ladies' Day at Boston Red Sox GamesHow Discounted Admission for Women Impacted Game Schedules Charlie Bevis (bio) At a Monday afternoon ball game on June 23, 1947, an estimated twenty thousand women sought admission to Ladies' Day at Fenway Park for the game between the Boston Red Sox and Detroit Tigers. However, only 9,813 of those women actually scored entry into the ballpark, as the other ten thousand or so were shut out at the ticket window and remained milling outside the ball-park for more than an hour. The Boston Globe reported that it was "the largest Ladies' Day crowd in Boston baseball history," for a promotion that dated back twenty-four years to its reinstitution at Fenway Park in 1923.1 Red Sox management had to deny entrance to thousands of female fans because there were no more seats in the grandstand to fill that afternoon, since total attendance that day was a near-capacity crowd of 34,160. The paid attendance was 20,652, supplemented by those 9,813 with Ladies' Day passes and the 3,695 passes the Red Sox provided to members of local youth groups. The club never anticipated a sellout crowd that day. "Because of this situation, the Red Sox announced a new policy for future Ladies' Days," the Globe reported. "Women will have to buy their tax and service charge tickets in advance," rather than on the day of the game. The "tax and service charge" associated with a Ladies' Day ticket in 1947 was fifty cents, less than one-half the price of the usual $1.20 ticket for an unreserved grandstand seat.2 The unanticipated high demand for Ladies' Day tickets was sparked by the inaugural night game at Fenway Park ten days earlier on Friday, June 13, and accelerated by the next two night games there on Wednesday, June 18, and Friday, June 20. Night baseball's arrival at Fenway that season created enormous excitement in Boston. The Red Sox were the next-to-last ball club in the American League to install lights, expanding the opportunity to attend a weekday ball game to an entirely new swath of the Greater Boston population that had work or home obligations on weekday afternoons. The two Friday night games at Fenway Park kiboshed the usual Friday [End Page 112] afternoon Ladies' Day games, which the Red Sox had regularly staged since the Great Depression. This established June 23 as a replacement for Ladies' Day, which itself created a small pent-up demand. Perhaps more importantly, the fourth night game of the season was slated for Tuesday, June 24, for which advance-sale tickets were no longer available. Many women appear to have opted to attend Ladies' Day on June 23 rather than take their chances on obtaining day-of-game tickets for the June 24 night game, enlarging the usual quorum of women expected for a Ladies' Day game. This surge of women seeking discounted tickets for a two o'clock game on a Monday in June 1947 marked the apex of Ladies' Day attendance for a Red Sox game in Boston. However, the surge was also an omen of the forthcoming obsolescence of the promotion by the Boston Red Sox. Ladies' Day games played an important role in the development of professional baseball as a business. This article uses a five-stage model to examine how Ladies' Day was instrumental in the evolution of game scheduling, using the first seven decades of the Red Sox franchise as a specific example. Each of these five stages served a distinct purpose to bridge an issue, which involved a different discounting strategy for admission as well as a separate rationale to encourage female attendance at the discount: • Stage 1 (1901–1908)—Bridge to popularity in Boston • Stage 2 (1923–1929)—Bridge to Sunday games • Stage 3 (1930–1935)—Bridge through the Great Depression • Stage 4 (1936–1947)—Bridge to night games • Stage 5 (1948–1965)—Bridge to demise of weekday daylight games This essay is structured into six sections. After the first section reviews the roots of Ladies' Day in Boston during the nineteenth century, the essay proceeds chronologically to explore...

Addressing COVID-19 Among People Experiencing Homelessness: Description, Adaptation, and Early Findings of a Multiagency Response in Boston.

People experiencing homelessness are at high risk for coronavirus disease 2019 (COVID-19). In March 2020, Boston Health Care for the Homeless Program, in partnership with city and state public health agencies, municipal leaders, and homeless service providers, developed and implemented a citywide COVID-19 care model for this vulnerable population. Components included symptom screening at shelter front doors, expedited testing at pop-up sites, isolation and management venues for symptomatic people under investigation and for people with confirmed disease, quarantine venues for asymptomatic exposed people, and contact investigation and tracing. Real-time disease surveillance efforts in a large shelter outbreak of COVID-19 during the third week of operations illustrated the need for several adaptations to the care model to better respond to the local epidemiology of illness among people experiencing homelessness. Symptom screening was de-emphasized given the high number of asymptomatic or minimally symptomatic infections discovered during mass testing; contact tracing and quarantining were phased out under the assumption of universal exposure among the sheltered population; and isolation and management venues were rapidly expanded to accommodate a surge in people with newly diagnosed COVID-19. During the first 6 weeks of operation, 429 of 1297 (33.1%) tested people were positive for COVID-19; of these, 395 people were experiencing homelessness at the time of testing, representing about 10% of the homeless adult population in Boston. Universal testing, as resources permit, is a focal point of ongoing efforts to mitigate the effect of COVID-19 on this vulnerable group of people.

Colonial Military Garrisons as Labor‐Market Shocks: Quebec City and Boston, 1760–1775

AbstractThe military occupation of Boston in 1768 shocked the city's labor market. The soldiers, who were expected to supplement their pay by working for local businesses, constituted an influx equal to 12.5 percent of greater Boston's population. To assess the importance of this shock, we use the case of Quebec City, which experienced the reverse process (i.e., a reduction in the British military presence from close to 18 percent of the region's population to less than 1 percent). We argue that, in Boston, the combination of the large influx of soldiers and a heavy tax on the local population in the form of the billeting system caused an important wage reduction, while the lighter billeting system of Quebec City and the winding down of the garrison pushed wages up. We tie these experiences to political developments in the 1770s.

Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston

This study characterizes the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected on polymerase chain reaction (PCR) screening of a large homeless shelter population in Boston prompted by an outbreak of COVID-19 cases among shelter residents.

Cultural Perceptions of Healthy Eating in the Latino Multiethnic Population in Boston, MA (P04-097-19)

ObjectivesLittle is known about the deeply-rooted cultural beliefs and attitudes towards healthy eating of Hispanics/Latinos in the U.S. We aimed to identify existing dietary beliefs and attitudes of Latino adults living in the Boston metro area and to determine ethnic-specific differences in such, using a mixed-methods approach. MethodsAll participants were self-identified Latinos living in the Boston metro area, recruited in community or public settings. For the qualitative portion, 17 in-depth interviews were conducted in Spanish among men and women aged 30–60 years from multiple Latino heritages. Questions focused on cultural beliefs and attitudes towards healthy eating. Thematic analysis using deductive coding was conducted by heritage grouping. For the quantitative portion, 125 surveys with scale-based questions on attitudes and motivators of healthy eating were collected among Latino participants 25–65 years old. Frequency analysis was conducted in SAS v9.4. ResultsCommon themes emerging from the interviews amongst all heritages included an awareness of the difference in taste of US-based foods when compared to foods from their country of origin, need for education/skills on healthy eating, and common barriers when choosing healthy foods (i.e.,: lack of time, access, and cost). Dominicans and Puerto Ricans mentioned weight loss, appearance, and health (to care for their family) as a main incentive to eat healthier, while other Latino heritages mentioned variety, reduced costs, and being a role model for their family. Heritage-specific dietary traditions and foods were noted. The survey analysis showed that 93.6% of all Latinos agreed that eating healthy will keep them healthy, 88.9% agreed that it will help them look good, and 86.2% agreed that it should be done together as a family. Differences by heritage were noted in most statements, such as fewer Puerto Ricans agreeing on eating healthy for health, and more Central Americans agreeing on the role of family. ConclusionsLatinos have shared and ethnic-specific cultural beliefs and motivations for healthy eating. This information will help create tailored dietary interventions for the Latino community in Boston using deep-cultural strategies. Funding SourcesNHLBI Mentored Career Development Award to Promote Faculty Diversity: K01-HL120951.

Bicycle Facilities Safest from Crime and Crashes: Perceptions of Residents Familiar with Higher Crime/Lower Income Neighborhoods in Boston.

While studies of bicyclist’s perceptions of crime and crash safety exist, it is also important to ask lower-income predominantly-minority residents what bicycle-route surface or context they perceive as safest from crime and crashes. With their insights, their chosen bike environments could be in engineering guidelines and built in their neighborhoods to improve residents’ health and lessen their risk of exposure to crime or crashing. This study involved two populations in Boston: (a) community-sense participants (eight groups-church/YMCA n = 116); and (b) street-sense participants (five groups-halfway house/homeless shelter/gang members n = 96). Participants ranked and described what they saw in 32 photographs of six types of bicycle environments. Quantitative data (Likert Scale 0–6 with 0 being low risk of crime/crash) involved regression analysis to test differences. Qualitative comments were categorized into 55 themes for surface or context and if high or low in association with crime or crashes. For crime, two-way cycle tracks had a significantly lower score (safest) than all others (2.35; p < 0.01) and share-use paths had a significantly higher score (least safe) (3.39; p < 0.01). For crashes, participants rated shared-use paths as safest (1.17) followed by two-way cycle tracks (1.68), one-way cycle tracks (2.95), bike lanes (4.06), sharrows (4.17), and roads (4.58), with a significant difference for any two groups (p < 0.01) except between bike lane and sharrow (p = 0.9). Street-sense participants ranked all, except shared-use paths, higher for crime and crash. For surface, wide two-way cycle tracks with freshly painted lines, stencils, and arrows were low risk for crime and a cycle track’s median, red color, stencils, and arrows low risk for crash. For context, clean signs, balconies, cafes, street lights, no cuts between buildings, and flowers were low risk for crime and witnesses, little traffic, and bike signals low risk for crash. As bicycle design guidelines and general Crime Perception Through Environmental Design (CPTED) principles do not include these details, perhaps new guidelines could be written.

Using 3 Health Surveys to Compare Multilevel Models for Small Area Estimation for Chronic Diseases and Health Behaviors.

BackgroundWe used a multilevel regression and poststratification approach to generate estimates of health-related outcomes using Behavioral Risk Factor Surveillance System 2013 (BRFSS) data for the 500 US cities. We conducted an empirical study to investigate whether the approach is robust using different health surveys.MethodsWe constructed a multilevel logistic model with individual-level age, sex, and race/ethnicity as predictors (Model I), and sequentially added educational attainment (Model II) and area-level poverty (Model III) for 5 health-related outcomes using the nationwide BRFSS, the Massachusetts BRFSS 2013 (a state subset of nationwide BRFSS), and the Boston BRFSS 2010/2013 (an independent survey), respectively. We applied each model to the Boston population (2010 Census) to predict each outcome in Boston and compared each with corresponding Boston BRFSS direct estimates.ResultsUsing Model I for the nationwide BRFSS, estimates of diabetes, high blood pressure, physical inactivity, and binge drinking fell within the 95% confidence interval of corresponding Boston BRFSS direct estimates. Adding educational attainment and county-level poverty (Models II and III) further improved their accuracy, particularly for current smoking (the model-based estimate was 15.2% by Model I and 18.1% by Model II). The estimates based on state BRFSS and Boston BRFSS models were similar to those based on the nationwide BRFSS, but area-level poverty did not improve the estimates significantly.ConclusionThe estimates of health-related outcomes were similar using different health surveys. Model specification could vary by surveys with different geographic coverage.

Folate Nutrition Status in Mothers of the Boston Birth Cohort, Sample of a US Urban Low-Income Population.

To examine maternal folic acid supplementation and plasma folate concentrations in the Boston Birth Cohort, a predominantly urban, low-income, minority population in Boston, Massachusetts. This report includes 7612 mothers with singleton live births (3829 Black, 2023 Hispanic, 865 White, and 895 others) enrolled in the Boston Birth Cohort at the Boston Medical Center, during 1999 to 2014. Folic acid supplementation during preconception and each trimester was obtained via interview questionnaire. In a subset (n = 2598), maternal plasma folate concentrations were measured in blood samples drawn within a few days of delivery. The percentage of mothers taking folic acid supplementation almost daily during preconception and the first, second, and third trimesters were 4.3%, 55.9%, 59.4%, and 58.0%, respectively. Most striking, we observed a wide range of maternal plasma folate concentrations, with approximately 11% insufficient (< 13.4 nmol/L) and 23% elevated (> 45.3 nmol/L). Findings indicate that fewer than 5% of mothers in the Boston Birth Cohort started folic acid supplements before pregnancy, and approximately one third of mothers had either too low or too high plasma folate levels, which may have important health consequences on both the mother and the child.

Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care.

Objective To identify occupational groups' use of specialty voice clinic evaluation. Study Design Retrospective cohort study. Setting Tertiary subspecialty clinic. Subjects and Methods We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS). Results The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57). Conclusion Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.

The progression of corrected myopia.

This study seeks to demonstrate the existence of a feedback loop controlling myopia by comparing the prediction of a feedback model to the actual progression of corrected myopia. In addition to theoretical results, confirming clinical data are presented. The refraction of 13 continuously corrected myopic eyes was collected over a period of time ranging from 4 to 9 years from the time of their first correction. Refractive data was collected in an optometry office from myopic young subjects from the general population in Boston. Subjects were myopes, ages 2 to 22 at the time of first correction selected randomly from a larger population. All individuals were fully corrected with lenses; new lenses were prescribed every time that their myopia increased by 0.25 diopters or more. Subjects wore their spectacle lenses during the followed period. Subjects exhibit a linear time course of myopia progression when corrected with lenses. The observed rate of myopia increase is 0.2 to 1.0 diopters/year, with a mean correlation coefficient r = -0.971, p < 0.005. This report establishes that feedback control theory applies to the clinical phenomenon of progressive myopia. Continuous correction of myopia results in a linear progression that increases myopia. The Laplace transformation of temporal refractive data to the s-domain simplifies the study of myopia and emmetropia. The feedback transfer function predicts that continuous correction of myopia results in a linear progression because continuous correction opens the feedback loop. This prediction is confirmed with all subjects.

Preparedness in America’s prime danger zone and at the Boston Marathon bombing site

The area between Newark and Elizabeth, NJ, contains major transportation hubs, chemical plants, and a dense population. This makes it "the most dangerous two miles in America," according to counterterrorism officials at the Federal Bureau of Investigation. This study compares medical response capabilities for terror and disaster in Newark, New Jersey's largest city, with those in Boston in view of that city's favorable response to the Marathon bombings in April 2013. Boston's numerous world-class medical facilities offer advantages unavailable in Newark and most other metropolitan locations. Thus, preparedness in Newark, despite its prime-danger designation, can also be instructive for many communities with similar medical resources. Three categories of response capabilities are assessed: hospital resources, relevant personnel, and symposia/exercises. Data were derived from hospital Web sites, the New Jersey and Massachusetts Hospital Asso-ciations, communications with emergency response personnel, and interviews with spokespersons for hospitals. Boston's population (618,000) is more than twice Newark's (278,000), and the number of hospitals and hospital beds in each city reflects that proportion. However, Boston's seven general adult hospitals include five level 1 trauma centers (which can provide comprehensive trauma care), whereas Newark's four hospitals include only one such center.Beds per 1,000 people are similarly disparate in those trauma centers: five in Boston, 1.5 in Newark. Emergency Medical Services (EMS) personnel based in Boston and Newark are comparable in numbers, though full-time hospital physicians/dentists and nurses are not. The number of doctors at Boston's five level 1 centers is more than triple that at all four of Newark's hospitals (5,284 vs 1,494). The disparity between nurses at the two sites is even greater (6,784 vs 1,566).There is greater equivalency between the two cities both in content and frequency of symposia/exercises. Hospitals in each city have conducted numerous tabletop and action exercises including on communications efficiency, power outages, and dealing with a bombing or active shooter. Hospitals in each city also have participated in citywide drills with EMS, police, fire, and other responders. Commonalities in Newark and Boston's exercise approaches suggest that Boston's successful response at the Marathon might be replicated at least in part if the Newark area were similarly challenged. Whether Newark and similarly enabled communities would respond with comparable efficiency remains conjectural. Still, maintaining rigorous preparedness efforts seems a self-evident imperative, especially in an area deemed among the country's most inviting terrorist targets.

Superior semicircular canal dehiscence in East Asian women with osteoporosis.

BackgroundSuperior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis.MethodsA retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with Pöschl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans.ResultsOf the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the Pöschl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < −2.5 in the axial spine, while another had osteopenia with a T-score of −2.3 in the left femur.ConclusionsWe describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.

Disparities in the Prevalence of Obesity in Boston: Results from the Boston Area Community Health (BACH) Survey

This study examined disparities in the prevalence of obesity to determine how future prevention and/or intervention efforts should be developed to remedy obesity. We obtained individual information of sociodemographic characteristics, comorbid conditions, and lifestyle behaviors from the Boston Area Community Health (BACH) survey for 2002-2005. To account for the complex BACH sampling design, observations were weighted inversely to their probability of selection, and sampling weights were poststratified to the Boston population from the U.S. Census 2000. We tested all possible two- and three-way interaction terms from a multivariate logistic regression model. After controlling for individual determinants in detail and focusing on the population within a single city, the associations of sociodemographic characteristics, comorbid conditions, and lifestyle behaviors with obesity were consistent with previous findings. Notably, three two-way interaction terms were significantly associated with obesity: (1) race/ethnicity and gender, (2) gender and other people in the household, and (3) race/ethnicity and alcohol consumption. Future obesity prevention and/or intervention programs in Boston need to be primarily gender- and racially/ethnically specific to minimize cost and maximize results. Additional considerations are needed to take into account the differences in age, the presence of other people in the household, and education level.

Alcohol Advertising at Boston Subway Stations: An Assessment of Exposure by Race and Socioeconomic Status

We investigated the frequency of alcohol ads at all 113 subway and streetcar stations in Boston and the patterns of community exposure stratified by race, socioeconomic status, and age. We assessed the extent of alcohol advertising at each station in May 2009. We measured gross impressions and gross rating points (GRPs) for the entire Greater Boston population and for Boston public school student commuters. We compared the frequency of alcohol advertising between neighborhoods with differing demographics. For the Greater Boston population, alcohol advertising at subway stations generated 109 GRPs on a typical day. For Boston public school students in grades 5 to 12, alcohol advertising at stations generated 134 GRPs. Advertising at stations in low-poverty neighborhoods generated 14.1 GRPs and at stations in high-poverty areas, 63.6 GRPs. Alcohol ads reach the equivalent of every adult in the Greater Boston region and the equivalent of every 5th- to 12th-grade public school student each day. More alcohol ads were displayed in stations in neighborhoods with high poverty rates than in stations in neighborhoods with low poverty rates.