Statewide Study Research Articles

Greenspace Morphology and Preterm Birth: A State-Wide Study in Georgia, United States (2001-2016).

Residential greenness is linked to birth outcomes. However, the role of greenspace morphology remains poorly understood. Additionally, evidence is lacking regarding whether these relationships vary by subpopulation. We examined the association between preterm birth and residential greenspace morphology, including percentage, shape, connectedness, aggregation, closeness, and fragmentation. We analyzed 2,063,444 singleton live births between 2001 to 2016 in Georgia, USA. Thirty-meter resolution landcover data from National Land Cover Databased (2001-2016) were obtained to calculate greenspace morphology metrics for 1,953 census tracts in Georgia. A two-stage logistic regression examined associations between each greenspace morphology metric and preterm birth at individual level. Stratified analysis was conducted by maternal race, ethnicity, education, urbanicity, poverty rate, and greenspace percentage. Higher greenspace percentage, aggregation, closeness, shape complexity, connectedness, and lower fragmentation were linked to a lower risk of preterm birth. After adjusting for poverty rate, associations with morphology attenuated, except for fragmentation [odds ratio (OR) = 1.014; 95% confidence interval (CI): 1.0001, 1.026] across the entire population. Strongest associations were found among black mothers and in high-poverty areas. Specifically, the odds of preterm birth in the highest quartile of greenspace percentage were 0.962 (95% CI: 0.933, 0.991) times the odds in the lowest quartile. Additionally, a lower risk of preterm birth was associated with higher greenspace aggregation (OR = 0.969; 95% CI: 0.947, 0.992), and a higher risk of preterm birth was associated with higher fragmentation (OR = 1.028; 95% CI: 1.009, 1.047), both in the black mothers group. In tracts with a high poverty rate, a lower risk of preterm birth associate with higher greenspace percentage (OR = 0.953; 95% CI: 0.910, 0.999), aggregation (OR = 0.976; 95% CI: 0.955, 0.997), and lower fragmentation (OR = 0.976; 95% CI: 0.958, 0.994). The association with greenspace morphology was most pronounced in census tracts with a medium level of greenspace percentage. Our study complements other studies by showing the importance and protective effects of greenspace morphology. The observed effects are particularly prominent in census tracts characterized by a moderate level of greenspace percentage, high poverty rates, and among black women. Our findings suggest the need for tailored greenspace planning strategies based on varying levels of greenness in different areas. For locations with low greenness, increasing the greenspace percentage may be prioritized. In areas with a medium level of greenness, strategic enhancement of greenspace morphology is recommended. For areas with high greenness, the focus should be on improving spatial closeness of greenspace. https://doi.org/10.1289/EHP14571.

Nursing faculty perceptions of entry to nursing practice competencies expected at day one of hire: A statewide study

BackgroundNo universal nursing education framework exists aligning competency expectations of new-to-practice nurses graduating from the varying prelicensure academic degree programs. PurposeThis study aimed to identify a set of core competencies expected of all prelicensure nursing programs in Maryland, including associate degree (ADN), entry-level bachelor of science nursing degree (BSN), and master of science entry into nursing (MSN Entry) programs. MethodA mixed-method approach was used to identify necessary competencies, including a survey consisting of 109 outcome statements and a series of focus groups with faculty representatives from the prelicensure degree programs. FindingsUnexpected findings showed few differences between ADN, BSN, and MSN Entry nursing program faculty perceptions regarding their program graduates' ability to meet the expected competencies. Faculty were not surprised that few differences emerged. Barriers like overloaded curricula, the necessity of prioritizing teaching specific components of nursing content for NCLEX, and competing priorities were faculty concerns. ConclusionsA comprehensive examination of all BSN and MSN entry knowledge not included in the NCLEX-RN is suggested for students, nurse residents, and professional nurses, delineating entry-level and ongoing minimal core competencies expected of a competent professional nurse. Results support the development of a competency-based education framework to clearly communicate learning and performance expectations among the varying degree programs.

Vicki L. Clifton: Stress, sex, and the placenta: its role in fetal and child development

Professor Vicki Clifton, PhD, GAICD, Dip Manag, Dip Counselling, FRSM, is a Mater Research Institute-University of Queensland Amplify Fellow specializing in obstetrics research through clinical trials and basic biology. With 327 publications, h-Index: 61, and over 14,000 citations, her research focuses on stress and maternal asthma during pregnancy, examining their effects on maternal health, placental function, fetal growth, and child health. She is notably recognized for her work on sex-specific placental function and stress responses influencing fetal growth and pregnancy outcomes. Professor Clifton has led her institution's asthma and pregnancy research program, establishing multi-disciplinary, end-user-engaged research programs in Australia and overseas. Her innovative research has advanced our understanding of factors affecting asthma during pregnancy, leading to new models of care and improved fetal outcomes. Her work has influenced national and international asthma management guidelines, identified sex-specific mechanisms affecting maternal-fetal health, and expanded the frontiers of existing knowledge on fetal-neonatal physiology. Through preclinical studies and clinical partnerships, she has rapidly translated findings into practice guidelines and consumer information. She currently leads the Queensland Family Cohort study, a state-wide longitudinal study linking parental and child health outcomes to biological mechanisms. A Fellow of the Royal Society of Medicine, she pioneered women's leadership as the first female President of the Endocrine Society of Australia and the first female Editor of Placenta (Elsevier). As an NHMRC Research Fellow (2000–2023), she has secured over $25 million in category 1 grants. We are privileged to have Professor Clifton share her personal and professional insights with our readers in this Genomic Press Interview.

Prospective Evaluation of Routine Statewide Integration of Molecular Epidemiology and Contact Tracing to Disrupt Human Immunodeficiency Virus Transmission.

Human immunodeficiency virus (HIV) remains a global challenge and novel measures for transmission disruption are needed. Contact tracing is limited by reluctance or inability of newly diagnosed individuals to name at-risk contacts. Molecular cluster analysis is mostly used for outbreak investigations, and its role in routine public health activities remains uncertain. We conducted a 2-year prospective statewide study in Rhode Island to evaluate integration of HIV cluster analyses into routine contact tracing, by attempting to reinterview all new diagnoses who clustered, notifying them of clustering, and evaluating benefits of this strategy. Clustering was compared between a phylogenetic ensemble versus distance-based HIV-TRACE. Of 100 new diagnoses during 2021-2022, 52 individuals clustered, of whom only 31% were reinterviewed. Reinterviewing did not improve contact tracing beyond initial interviews, and the study was stopped early for futility. Clustering concordance within the phylogenetic ensemble was high (88%-89%), but lower (74%) for HIV-TRACE. Despite hypothesis rejection, we established a public health-academic partnership, developed a bioinformatics pipeline enabling near real-time cluster analysis, and identified gaps and unique opportunities for intervention. Attempting to reinterview all statewide new HIV diagnoses in molecular clusters showed no evidence of improving contact tracing. However, a strong academic-public health partnership enabled near real-time, longitudinal integration of molecular cluster analysis into routine public health activities, and identified barriers and opportunities tailoring data-driven approaches to unique individual and community characteristics, guiding future work on optimal use of molecular epidemiology to disrupt HIV transmission.

Identification of statewide core competencies for new graduate nurses at the beginning of practice and after a 12-month nurse residency program

AimTo inform the development of statewide core competencies for new graduate nurses at the beginning of their professional career and after completing a 12-month nurse residency program. BackgroundAlthough studies have attempted to clarify the expected core competencies of new graduate nurses at the beginning of their professional career, results are mixed. Additionally, nurse residency program competency expectations vary. DesignA retrospective cross-sectional study using a purposive sample of a national nurse residency program database. MethodsWilcoxon Signed Rank tests compared retrospective self-report data between January 1st 2017 and December 31st 2019, from 2916 acute care hospital new graduate nurses working in the state of Maryland, USA, to examine their perceptions of competency at hire and after completing a nationally standardized 12-month nurse residency program. The study used six domains from the Casey Fink Graduate Nurse Experience Survey© 2006 and the Vizient/AACN Nurse Residency Program™ Progression survey. ResultsNew graduate nurses' self-report of competency increased from a mean score of 4.81 at the beginning of a nurse residency program to 6.67 after completion of 12-month nurse residency program (scale of 0–10). At the beginning of a nurse residendy program, new graduate nursesreported a low level of comfort in three of the six survey domains: communication and leadership, high-intensity skills and patient safety. At 12 months, new graduate nurses reported higher levels of comfort in all six survey domains, with statistically significant increases (Wilcoxon Signed Rank test, α =0.05). ConclusionsFour domains for ongoing competency development were identified for the nurse residency program curriculum—communication and leadership, patient safety, complex patient assignments and end-of-life care—with the expectation that new graduate nurses achieve competency at program completion. New graduate nurses’ perceptions corroborated findings from a statewide study of academicians and practice leaders, thus helping to develop realistic core competencies for new graduate nurses entering the workforce and after completing a 12-month nurse residency program.

Novel methods to construct a representative sample for surveying California's unhoused population: the California Statewide Study of People Experiencing Homelessness.

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. We designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions. The multistage design randomized at three levels: county, venue, and individual. Stratifying the state into eight regions, we sampled one county per region to reflect statewide demographics. Within counties, sampled venues matched the expected proportion of sheltered and unsheltered residents. Within venues, interviewers randomly sampled individuals. We adjusted for nonresponse and incorporated poststratification to benchmarks. In parallel, respondent-driven sampling reached subpopulations through social networks who may otherwise have been under-sampled. Our community-engaged study yielded 3200 quantitative surveys. We purposively sampled 365 participants for qualitative interviews. Demographic estimates match those found in the PIT with the added strength of statistical inference. This is the first large representative study of PEH, beyond a single county, to draw inference on a large population that did not depend on service utilization. Our methods may inform future efforts to understand homelessness.

Prehospital factors predicting mortality in patients with shock: state-wide linkage study

BackgroundPatients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe...

Evaluation of follow-up colposcopy procedures after abnormal cervical screening result across a statewide study in Mississippi

PurposeCervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result.MethodsThe STRIDES (Studying Risk to Improve DisparitiES) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening.ResultsOf the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented colposcopy follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Individuals 30 + were more likely to have follow up with a colposcopy compared to individuals < 30 years (49% and 38.7%, respectively; p < .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up guidelines (p < .001). In total, we found that 78% of individuals had some type of follow-up, including a repeat screening visit.ConclusionDespite high cervical cancer screening rates among Mississippians, a substantial proportion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.

Greenspace Morphology and Preterm Birth: A State-Wide Study in Georgia, United States (2000–2016)

Greenspace Morphology and Preterm Birth: A State-Wide Study in Georgia, United States (2000–2016)

Acute Myocardial Infarction Presentations During COVID-19 Pandemic in New South Wales, Australia: A State-Wide Population-Linkage Study

Acute Myocardial Infarction Presentations During COVID-19 Pandemic in New South Wales, Australia: A State-Wide Population-Linkage Study

Impact of COVID-19 Infection During Acute Myocardial Infarction on Outcomes: A State-Wide Case-Control Study of 161,582 Patients in Australia

Impact of COVID-19 Infection During Acute Myocardial Infarction on Outcomes: A State-Wide Case-Control Study of 161,582 Patients in Australia

The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness.

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.

Disparities in Psychiatric Emergency Department Boarding of Children and Adolescents

Since the COVID-19 pandemic, emergency department boarding of youth with mental health concerns has increased. To summarize characteristics (including gender, age, race, ethnicity, insurance, diagnosis, and barriers to placement) of youth who boarded in emergency departments while awaiting inpatient psychiatric care and to test for racial, ethnic, and gender disparities in boarding lengths and inpatient admission rates after boarding. Secondarily, to assess whether statewide demand for inpatient psychiatric care correlated with individual outcomes. This cross-sectional analysis included administrative data collected from May 2020 to June 2022 and represented a statewide study of Massachusetts. All youth aged 5 to 17 years who boarded in Massachusetts emergency departments for 3 or more midnights while awaiting inpatient psychiatric care were included. Boarding for 3 or more midnights while awaiting inpatient psychiatric care. Emergency department boarding length (number of midnights) and whether inpatient care was received after boarding. Statistical analyses performed included logistic and gamma regressions; assessed gender, racial, and ethnic disparities; and correlations between statewide demand for psychiatric care and boarding outcomes. A total of 4942 boarding episodes were identified: 2648 (54%) for cisgender females, 1958 (40%) for cisgender males, and 336 (7%) for transgender or nonbinary youth. A total of 1337 youth (27%) were younger than 13 years. Depression was the most common diagnosis (2138 [43%]). A total of 2748 episodes (56%) resulted in inpatient admission, and 171 transgender and nonbinary youth (51%) received inpatient care compared with 1558 cisgender females (59%; adjusted difference: -9.1 percentage points; 95% CI, -14.7 to -3.6 percentage points). Transgender or nonbinary youth boarded for a mean (SD) of 10.4 (8.3) midnights compared with 8.6 (6.9) midnights for cisgender females (adjusted difference: 2.2 midnights; 95% CI, 1.2-3.2 midnights). Fewer Black youth were admitted than White youth (382 [51%] and 1231 [56%], respectively; adjusted difference: -4.3 percentage points; 95% CI, -8.4 to -0.2 percentage points). For every additional 100 youth boarding statewide on the day of assessment, the percentage of youth admitted was 19.4 percentage points lower (95% CI, -23.6% to -15.2%) and boarding times were 3.0 midnights longer (95% CI, 2.4-3.7 midnights). In this cross-sectional study, almost one-half of 3 or more midnight boarding episodes did not result in admission, highlighting a need to understand the effects of boarding without admission. Gender and racial disparities were identified, suggesting the need for targeted resources to reduce boarding and promote equitable access to care.

Investigating the efficacy of integrating video-directly observed therapy (VDOT) in the treatment of tuberculosis (TB): A statewide analysis from Florida

ObjectivesTo determine if integrating VDOT into TB therapy demonstrated non-inferiority to direct observation, and if VDOT utilization increased across Florida after the onset of Covid-19. MethodsA statewide programmatic review was conducted of all patients in Florida who initiated tuberculosis treatment between January 2018 – December 2018 and January 2020 – December 2021, as documented by the Florida Department of Health. Results1361 patients received treatment within the analysis timeframe. Therapy completion was 97.2% in those utilizing VDOT compared to 92.3% utilizing only DOT (p=<.001). Average duration of therapy was 220.5 days in the DOT-only cohort compared to 211.1 days with VDOT integration (p=.027). A 176.35% increase in VDOT utilization was seen across Florida during Covid-19. ConclusionsThis is the first and largest state-wide study evaluating the efficacy of integrating VDOT into TB therapy, finding statistically significant improvements in completion and duration of therapy. Despite increased VDOT utilization since the onset of Covid-19, we suspect that multiple barriers may be hindering further integration. VDOT should be recommended as a cost effective, non-inferior alternative to DOT in monitoring the treatment of tuberculosis.

T117 - Long-Term Mortality After Drug Use-Associated Endocarditis is High and Differs by Race and Sex: Results of a Statewide Study

T117 - Long-Term Mortality After Drug Use-Associated Endocarditis is High and Differs by Race and Sex: Results of a Statewide Study

The influence of the race of defendant and the race of victim on capital charging and sentencing in California

AbstractThe California Racial Justice Act of 2020 recognized racial and ethnic discrimination as a basis for relief in capital cases, expressly permitting several types of statistical evidence to be introduced. This statewide study of the influence of race and ethnicity on the application of capital punishment contributes to this evidence. We draw on data from over 27,000 murder and manslaughter convictions in California state courts between 1978 and 2002. Using multiple methods, we found significant racial and ethnic disparities in charging and sentencing decisions. Controlling for defendant culpability and specific statutory aggravators, we show that Black and Latinx defendants and all defendants convicted of killing at least one white victim are substantially more likely to be sentenced to death. We further examined the role that race and ethnicity have in decision‐making at various points in the criminal justice system. We found that prosecutors were significantly more likely to seek death against defendants who kill white victims, and that juries were significantly more likely to sentence those defendants to death. The magnitude of the race of the defendant and race of the victim effects is substantially higher than in prior studies in other states and in single‐jurisdiction research. The results show an entrenched pattern of racial disparities in charging and sentencing that privileges white victim cases, as well as patterns of racial disparities in who is charged and sentenced to death in California courts that are the natural result of California's capacious statutory definition of death eligibility, which permits virtually unlimited discretion for charging and sentencing decisions. This pattern of racial preferences illustrates the social costs of California's failure to follow the Supreme Court's directive in Furman v Georgia to narrow the application of capital punishment over 50 years ago.

Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis

BackgroundTranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The...

Prevalence of Noncommunicable Disease (NCDs) risk factors in Tamil Nadu: Tamil Nadu STEPS Survey (TN STEPS), 2020.

Noncommunicable diseases (NCDs) account for nearly 75% of all deaths in Tamil Nadu. The government of Tamil Nadu has initiated several strategies to control NCDs under the Tamil Nadu Health Systems Reform Program (TNHSRP). We aimed to estimate the prevalence of NCD risk factors and determine the predictors of diabetes and hypertension, which will be helpful for planning and serve as a baseline for evaluating the impact of interventions. A state-wide representative cross-sectional study was conducted among 18-69-year-old adults in Tamil Nadu in 2020. The study used a multi-stage sampling method to select the calculated sample size of 5780. We adapted the study tools based on WHO's STEPS surveillance methodology. We collected information about sociodemographic factors, NCD risk factors and measured blood pressure and fasting capillary blood glucose. The predictors of diabetes and hypertension were calculated using generalised linear models with 95% confidence intervals (95% CI). Due to the COVID-19 pandemic lockdown, we could cover 68% (n = 3800) of the intended sample size. Among the eligible individuals surveyed (n = 4128), we had a response rate of 92%. The mean age of the study participants was 42.8 years, and 51% were women. Current tobacco use was prevalent in 40% (95% CI: 33.7-40.0) of men and 7.9% (95% CI: 6.4-9.8) of women. Current consumption of alcohol was prevalent among 39.1% (95% CI: 36.4-42.0) of men. Nearly 28.5% (95% CI: 26.7-30.4) of the study participants were overweight, and 11.4% (95% CI: 10.1-12.7) were obese. The prevalence of hypertension was 33.9% (95% CI: 32.0-35.8), and that of diabetes was 17.6% (95% CI: 16.1-19.2). Older age, men, and obesity were independently associated with diabetes and hypertension. The burden of NCD risk factors like tobacco use, and alcohol use were high among men in the state of Tamil Nadu. The prevalence of other risk factors like physical inactivity, raised blood pressure and raised blood glucose were also high in the state. The state should further emphasise measures that reduce the burden of NCD risk factors. Policy-based and health system-based interventions to control NCDs must be a high priority for the state.

Nursing Students And Their Parents' Insight Towards Clinical Experience During Covid-19 Pandemic – A State-Wide Cross-Sectional Study

Nursing Students And Their Parents' Insight Towards Clinical Experience During Covid-19 Pandemic – A State-Wide Cross-Sectional Study

Emergency Medical Service Attendances for Adults with Repeat Falls in Western Australia: A State-Wide Retrospective Cohort Study

Objectives The risk of falls increases with age and often requires an emergency medical service (EMS) response. We compared the characteristics of patients attended by EMS in response to repeat falls within 30 days and 12 months of their first EMS-attended fall; and explored the number of days between the index fall and the subsequent fall(s). Methods This retrospective cohort study included all adults (> =18 years of age) who experienced their first EMS-attended fall between 1 January 2016 and 31 December 2020, followed up until 31 December 2021. Patients who experienced > =1 subsequent fall, following their first recorded fall, were defined as experiencing repeat falls. Multivariable logistic regression was used to identify the factors associated with repeat falls; and Kaplan-Meier analysis was used to estimate the time (in days) between consecutive EMS-attended falls. Results A total of 128,588 EMS-attended fall-related incidents occurred involving 77,087 individual patients. Most patients, 54,554 (71%) were attended only once for a fall-related incident (30,280 females; median age 73 years, inter-quartile range (IQR): 55–84). A total of 22,533 (29%) patients experienced repeat EMS-attended falls (13,248 females; median age 83 years, IQR: 74–89, at first call). These 22,533 patients accounted for 58% (74,034 attendances) of all EMS-attendances to fall-related incidents. Time between EMS-attended falls decreased significantly the more falls a patient sustained. Among the 22,533 patients who experienced repeat falls, 13,363 (59%) of repeat falls occurred within 12 months: 3,103 (14%) of patients sustained their second fall within 30 days of their index fall, and 10,260 (46%) between 31 days to 12 months. Patients who were transported to the hospital, via any urgency, at their first EMS-attended fall, had a reduced odds of sustaining a second EMS-attended fall within both 30 days and 31 days to 12 months, compared to non-transported patients. Conclusion Nearly 30% of all patients attended by EMS for a fall, sustained repeat falls, which collectively accounted for nearly 60% of all EMS-attendances to fall-related incidents. Further exploration of the role EMS clinicians play in identifying and referring patients who sustain repeat falls into alternative pathways is needed.