State variation in neighborhood COVID-19 burden across the United States

BACKGROUND

A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 infection burden has been distributed across neighborhoods, a key determinant of both risk and resilience. Without more spatially resolute data, efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities will remain difficult to quantify and intervene on.

METHODS

We leveraged spatially-referenced data from 21 states collated through the COVID Neighborhood Project to examine the distribution of COVID-19 cases across neighborhoods and states in the U.S. We also linked the COVID-19 case data with data on the neighborhood social environment from the National Neighborhood Data Archive. We then estimated correlations between neighborhood COVID-19 burden and features of the neighborhood social environment.

RESULTS

We find that the distribution of COVID-19 at the neighborhood-level varies within and between states. The median case count per neighborhood (coefficient of variation (CV)) in Wisconsin is 3078.52 (0.17) per 10,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (CV) is 810.98 (0.84) per 10,000 population. We also find that correlations between features of the neighborhood social environment and burden vary in magnitude and direction by state.

CONCLUSIONS

Our findings underscore the importance that local contexts may play when addressing the long-term social and economic fallout communities will face from COVID-19.

State Variation in Neighborhood COVID-19 Burden: Findings from the COVID Neighborhood Project

A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 burden has been distributed across neighborhoods, a known geographic unit of both risk and resilience, and is hampering efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities. Using spatially-referenced data from 21 states at the ZIP code or census tract level, we documented how the distribution of COVID-19 at the neighborhood-level varies significantly within and between states. The median case count per neighborhood (IQR) in Oregon was 3,608 (2,487) per 100,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (IQR) was 8,142 (11,031) per 100,000. We also found that the association between features of the neighborhood social environment and burden varied in magnitude and direction by state. Our findings underscore the importance of local contexts when addressing the long-term social and economic fallout communities will face from COVID-19.

CONTEXTS OF COGNITIVE DECLINE: MAPPING NEIGHBORHOOD OPPORTUNITIES AND BARRIERS FOR HEALTHY AGING IN PLACE

Stark geographic variation in later-life health outcomes suggests that local built and social environments are critical in shaping disease and disability, physical and cognitive function, and engagement in everyday life among older adults. This paper presents a community-engaged mapping project aiming to depict the uneven distribution of hazards and amenities relevant to cognitive aging across the United States. Living in neighborhoods with opportunities for social interaction (e.g., coffee shops, senior centers), intellectual stimulation (e.g., museums, libraries) and physical activity (e.g., parks, walkable streets) may slow rates of cognitive decline and reduce risk for Alzheimer’s disease. We assembled a community advisory board to translate research findings into a pilot website and interactive map that assesses neighborhoods for cognitive aging resources and amenities. The objective is to increase public awareness and inform public health and policy efforts to ameliorate community barriers and create more equitable opportunities to promote healthy aging in place.

Next-generation three-dimensional modelling software for personalized surgery decision-making in perihilar cholangiocarcinoma: multicentre study

Next-generation three-dimensional modelling software for personalized surgery allows spatially accurate depiction of the hepatic and vasculature anatomy based on the complexity and individual variation in each patient, and could facilitate decision-making about preoperative strategy in perihilar cholangiocarcinoma.

Association between temperature exposure and cognition: a cross-sectional analysis of 20,687 aging adults in the United States

BACKGROUND

Older adults are particularly vulnerable to the adverse health effects of extreme temperature-related events. A growing body of literature highlights the importance of the natural environment, including air pollution and sunlight, on cognitive health. However, the relationship between exposure to outdoor temperatures and cognitive functioning, and whether there exists any differences across climate region, remains largely unexplored. We address this gap by examining the temperature-cognition association, and whether there exists any variation across climate regions in a national cohort of aging adults.

METHODS

In this cross-sectional study, we obtained data on temperature exposure based on geocoded residential location of participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. For each participant, this information was linked to their cognitive scores from Word List Learning and Recall tests to assess cognitive functioning. We used distributed lag non-linear models (dlnm) to model temperature effects over 2 days. Multivariable linear regression was used to compute temperature-cognitive functioning associations, adjusted for important covariates. Region-specific ("Dry", "Mediterranean/oceanic", "Tropical" and "Continental") associations were examined by including an interaction term between climate region and temperature.

RESULTS

Amongst 20,687 individuals (mean age = 67.8; standard deviation = 9.2), exposure to region-specific extreme cold temperatures in the "dry" region (e.g., Arizona) over 2 days was associated with lower cognitive scores (Mean Difference [MD]: -0.76, 95% Confidence Interval [CI]: - 1.45, - 0.07). Associations remained significant for cumulative effects of temperature over 2 days. Extremely cold exposure in the "Mediterranean/oceanic" region (e.g., California) over 2 days was also associated with significantly lower cognitive performance (MD: -0.25, 95% CI: - 0.47, - 0.04). No significant associations were observed for exposure to hot temperatures. Cognitive performance was slightly higher in late summer and fall compared to early summer.

CONCLUSION

We noted adverse cognitive associations with cold temperatures in traditionally warmer regions of the country and improved cognition in summer and early fall seasons. While we did not observe very large significant associations, this study deepens understanding of the impact of climate change on the cognitive health of aging adults and can inform clinical care and public health preparedness plans.

Can Neighborhood Social Infrastructure Modify Cognitive Function? A Mixed-Methods Study of Urban-Dwelling Aging Americans

Objectives: Socialization predicts cognitive aging outcomes. Neighborhoods may facilitate socially engaged aging and thus shape cognition. We investigated places where older adults socialized and whether availability of these sites was associated with cognitive outcomes. Methods: Qualitative analysis of interviews and ethnography with 125 older adults (mean age 71 years) in Minneapolis identified where participants socialized outside of home. This informed quantitative analysis of a national sample of 21,151 older Americans (mean age at baseline 67 years) from the Reasons for Geographic and Racial Differences in Stroke study. Multilevel generalized additive models described associations between access to key social places and cognitive function and decline. Results: Qualitative analysis identified eateries, senior centers, and civic groups as key places to socialize. We identified significant positive associations between kernel density of senior centers, civic/social organizations, and cognitive function. Discussion: Specific neighborhood social infrastructures may support cognitive health among older adults aging in place.

Weather Woes? Exploring Potential Links between Precipitation and Age-Related Cognitive Decline

Rain, snow, or ice may discourage older adults from leaving their homes with potential consequences for social isolation, decreased physical activity, and cognitive decline. This study is the first to examine potential links between annual precipitation exposure and cognitive function in a large population-based cohort of older Americans. We examined the association between precipitation (percent of days with snow or rain in the past year) and cognitive function in 25,320 individuals aged 45+ from the Reasons for Geographic and Racial Differences in Stroke Study. Linear mixed models assessed the relationship between precipitation and cognitive function, as well as rates of change in cognitive function with age. We found a non-linear relationship between precipitation and cognitive function. Compared to those exposed to infrequent precipitation (less than 20% of days with rain/snow in the past year), cognitive function was higher among older adults experiencing moderately frequent precipitation (20–40% of annual days with precipitation). However, beyond more than about 45% of days with precipitation in the past year, there was a negative association between precipitation and cognitive function, with faster rates of cognitive decline with age. These exploratory findings motivate further research to better understand the complex role of precipitation for late-life cognitive function.

WINTER WOES? IMPACT OF SNOW, SLEET, AND RAIN ON AGE-RELATED COGNITIVE DECLINE

Snowfall, sleet and rain can adversely affect the mobility of older adults, with negative consequences for engagement in daily activities and socializing. This can lead to isolation and loneliness, which can negatively impact cognitive functioning. We tested whether long-term exposure to precipitation – particularly snow and cold rain (precipitation at ambient temperatures between 0°C and 10°C) – negatively impacts age-related cognitive function trajectories among a national sample of over 30,000 Americans (aged 45+) in the Reasons for Geographic and Racial Differences in Stroke study followed since 2003. Linear growth mixture models showed that living in an area with a 25% greater proportion of days with snow/rain in the past year was associated with a 0.6 unit decrease in cognitive function score (p<.001). Effects were stronger among those aged 75+, who experienced faster rates of cognitive decline. The findings motivate further research on the role of cold-season precipitation for cognitive decline.

RACIAL RESIDENTIAL SEGREGATION AND COGNITIVE DECLINE AMONG OLDER ADULTS

Racial residential segregation may be a fundamental cause of health disparities in the U.S., and few studies employ objective measures of segregation to estimate its impacts on cognitive decline. Using data from 21,446 REGARDS participants in urban areas, we employed race-stratified growth curve models to examine how city racial segregation was associated with trajectories of cognitive decline over time. Controlling for demographics and health conditions/behaviors, higher segregation for blacks was marginally associated with lower cognitive function at baseline (b=-0.159, p&lt;.10) while higher segregation for whites was associated with better cognitive function (b=0.158, p&lt;.01). For both blacks and whites, there were no significant associations between segregation and rate of cognitive decline but neighborhood poverty was adversely related to cognitive function (b=-0.171, p&lt;.01 for blacks, b=-0.289, p&lt;.001 for whites). Further research into mechanisms that contributes to heterogeneity in associations between racial segregation and cognitive function is needed to develop effective prevention interventions.

TOO HOT OR TOO COLD? EXPOSURE TO EXTREME TEMPERATURES AND COGNITIVE FUNCTION IN OLDER ADULTS

Research on temperature and cognition is sparse, including effects of outdoor air temperature on cognitive testing performance. Furthermore, little is known about the modifying role of region and seasonality in temperature-cognition associations. We linked daily temperature data from National Oceanic and Atmospheric Administration weather stations to REGARDS participants by cognitive assessment date. Controlling for season, generalized linear models including spline terms for temperature showed an adverse effect of hotter temperatures on cognition. At higher temperatures (30°C vs 0°C), there was a significant decrease in cognitive performance on the Word List Learning test (β=-0.68; 95% CI: -1.1, -0.25). Results also show regional differences in testing scores on hotter and colder days. The findings provide new understanding of cognitive susceptibility to extreme temperatures and factors that exacerbate or buffer this association. This can inform development of evidence-based public health guidelines and mitigation strategies aimed at reducing temperature-related morbidity in older adults.

Physical Intimate Partner Violence and Contraceptive Behaviors Among Young Women

BACKGROUND

Understanding the link between physical intimate partner violence (IPV) and contraception is key to preventing unintended pregnancy and sexually transmitted infections.

MATERIALS AND METHODS

Data from the Relationship Dynamics and Social Life study, a longitudinal study of a racially and socioeconomically diverse population-representative random sample of 18- to 19-year-old women residing in a Michigan county in 2008-2009 and followed weekly through 2011-2012, were used. Logistic regression models of contraceptive behaviors on temporally specific measures of physical violence victimization: recent, history in the current relationship, and history in prior relationships were conducted among 711 women.

RESULTS

Women who experienced physical IPV in their current relationship had lower odds of using contraception (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.28, 0.76 for recent; OR, 0.53; 95% CI, 0.33, 0.83 for past). Condom use was lower among women who experienced past physical IPV in their current relationship (OR, 0.44; 95% CI, 0.26, 0.73), while withdrawal use was higher (OR, 1.99; 95% CI, 1.24, 3.19). Women who experienced physical IPV used condoms less consistently (OR, 0.34; 95% CI, 0.13, 0.85 for recent; OR, 0.27; 95% CI, 0.14, 0.52 for prior relationships).

CONCLUSIONS

Physical IPV victimization is a dynamic and strong predictor of contraceptive use, method type, and consistency of condom use.

Cognitive function in the community setting: the neighbourhood as a source of 'cognitive reserve'?

BACKGROUND

Existing research has found a positive association between cognitive function and residence in a socioeconomically advantaged neighbourhood. Yet, the mechanisms underlying this relationship have not been empirically investigated.

OBJECTIVE

To test the hypothesis that neighbourhood socioeconomic structure is related to cognitive function partly through the availability of neighbourhood physical and social resources (eg, recreational facilities, community centres and libraries), which promote cognitively beneficial activities such as exercise and social integration.

METHODS

Using data from a representative survey of community-dwelling adults in the city of Chicago (N=949 adults aged 50 and over), cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status instrument. Neighbourhood socioeconomic structure was derived from US census indicators. Systematic social observation was used to directly document the presence of neighbourhood resources on the blocks surrounding each respondent's residence.

RESULTS

Using multilevel linear regression, residence in an affluent neighbourhood had a net positive effect on cognitive function after adjusting for individual risk factors. For white respondents, the effects of neighbourhood affluence operated in part through a greater density of institutional resources (eg, community centres) that promote cognitively beneficial activities such as physical activity. Stable residence in an elderly neighbourhood was associated with higher cognitive function (potentially due to greater opportunities for social interaction with peers), but long term exposure to such neighbourhoods was negatively related to cognition.

CONCLUSIONS

Neighbourhood resources have the potential to promote 'cognitive reserve' for adults who are ageing in place in an urban setting.

[Prolonged convulsions treated with buccal midazolam in a setting of mentally retarded patients with refractory epilepsy]

INTRODUCTION

Convulsive status epilepticus is a common major complication of epilepsy that results in high morbidity and mortality. Early treatment of prolonged seizures with rectal diazepam has been the method of choice in order to avoid this complication. However, several randomized trials in recent years suggest that buccal midazolam is as effective and safe as rectal diazepam. This study aims to seek further confirmation of the efficacy and safety of buccal midazolam in daily clinical practice.

METHOD

Ten out of 73 adult epileptic patients who were residents in a center for people with severe encephalopathy were included. We recorded all seizures over a one-year period. Prolonged seizures, defined as a seizure lasting one minute or longer, were treated by placing buccal midazolam 5 mg (1 ml) between the lower lip and the gum. We administered a second dose of midazolam when the seizure lasted more than two minutes and a third dose of midazolam, or a combination of rectal diazepam 5 mg together with midazolam, as a rescue therapy when the seizure lasted for more than 3 minutes. Vital constants were monitored.

RESULTS

We treated 52 prolonged seizures in 10 patients enrolled in the study. The treatment was effective with a single dose within two minutes in 80.7% of seizures. No cardiorespiratory complications were detected and no patients presented a convulsive status epilepticus.

CONCLUSION

Buccal midazolam is effective and safe in the treatment of prolonged seizures and has the advantage of being a convenient and socially acceptable administration form.

Pathological complete response (pCR) in stage II and III breast cancer patients treated with neoadjuvant chemotherapy (CT): Dose dense ACx4 followed by AT/Tx4 (weekly paclitaxel)

10746

Background: This is a prospective study of a single Institution to determine the pCR in stage II and II breast cancer patients after dose dense and sequential CT using the most active drugs. Patients and Methods: Between June/2004 and July/2005 we collected 28 patients, they have echocardiogram and needle biopsy for IHC before starting the treatment. All of them received Adriamicin 60mg/m2 in 3hrs infusion and Cyclophosphamide 600mg/m2 x4 in dose dense schedule (every 2 weeks) with G-CSF support and then Adriamicin 60mg/m2 and Taxol 80mg/m2 days 1,8 every 3 weeks. Once the treatment was finished they went to surgery. Results: Six (21%) patients were stage II and 22 (79%) were stage III; 8 (35%) patients achieve pCR, 50% of them had Her2/neu positive and 7/8 (90%) were ER/PR negative; 60% (5) had T more than 5cm and 75% were post menopausal. 12 patients had clinical complete remission. Eight patients had progressive disease with 50% ER/PR negative, 37% Her2/neu positive and all of them with T more than 5cm. 50% were premenopausal. Conclusion: This is one of the highest pCR of the literature (35%) achieved and it is interesting to note that 90% of them were ER/PR negative, so this is a potential target group for CT intensification. There is a group of patients (with progressive disease) that will never respond to CT, and it would be worst in the adjuvant setting (blindly treatment) because the great toxicity. We need more studies to confirm this hypothesis.

No significant financial relationships to disclose.

Isolated herpes simplex keratoconjunctivitis in a neonate born by cesarean delivery

Herpes simplex virus (HSV) infection can be devastating in the neonate. The disease most commonly presents as 1 of 3 clinical manifestations: disseminated visceral infection (with and without central nervous system involvement), isolated meningoencephalitis, and infection limited to the skin, eyes, and/or mucous membranes (SEM). Exposure leading to neonatal infection typically occurs as peripartum vertical transmission, most typically by direct contact with urogenital lesions or infected genital secretions, or as an ascending infection exploiting disrupted chorioamniotic membranes. We present a novel case of a newborn girl who developed HSV-2 keratoconjunctivitis despite being delivered via an elective, uncomplicated, repeat cesarean over intact chorioamniotic membranes in the absence of active clinical maternal HSV infection and despite having a negative medical history of previous orolabial or genital herpetic infection.

Retinal Function Assessed by ERG Before and After Induction of Ocular Aspergillosis and Treatment by the Anti-fungal, Micafungin, in Rabbits

This study was conducted to evaluate the effectiveness of a new antifungal drug, micafungin, and standard antifungal drugs against endophthalmitis induced in a rabbit by intravitreal injection of Aspergillus fumigatus, an important fungal pathogen. Effectiveness was evaluated by the preservation of b-wave amplitude at 72 h after injection of the fungus relative to the b-wave amplitude at baseline before any intravitreal injections. A 0.06 ml inoculum of 10(6) conidia of A. fumigatus was injected into the vitreous of the right eye of all rabbits; and, 12 h later, a 0.06 ml solution containing one of 3 antifungal drugs or saline was injected into the vitreous of both eyes. All three antifungal drugs produced significant b-wave preservation at 72 h in infected eyes compared to that in infected eyes receiving saline injections. There was no statistically significant difference between the effects of micafungin and amphotericin B in the right eyes with fungal endophthalmitis, and both produced significantly more preservation of b-wave amplitude than voriconazole. Amphotericin B, but neither micafungin nor voriconazole produced significant reduction of the b-wave amplitude in the left eyes.

Stroke in Hispanic veterans: a descriptive study

BACKGROUND

Differences in risk factor prevalence and distribution of atherosclerotic cerebrovascular disease have been reported among different racial-ethnic groups. Identification of stroke syndromes and risk factors specific to the Puerto Rican male population should lead to more effective diagnosis, treatment, and prevention programs.

METHODS

We prospectively and consecutively evaluated 118 Hispanic male veterans admitted to our Stroke Unit from June 1994 to September 1995.

RESULTS

Ninety patients (76%) had an ischemic infarct, 26 (22%) had a transient ischemic attack, and 2 (2%) had an intracerebral and/or subarachnoid hemorrhage. Hypertension was the most common risk factor. Echocardiographic studies were done in 64% of the patients, and the most common findings were concentric left ventricular hypertrophy and diastolic dysfunction. Cerebral angiography was done in 40 cases, and findings were abnormal in 32 (80%).

CONCLUSIONS

We believe this is the largest descriptive study of Hispanic male veterans with stroke syndromes. It provides baseline data to serve as a comparison group for future research.

Initial screening for antituberculous drug resistance at an inpatient facility in Leon, Nicaragua

Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.

Pharmacokinetics of intravenously, intramuscularly and intra-adiposely administered carazolol in pigs

The beta-blocking agent carazolol is used for the prevention of stress syndromes in pigs. Little is known of the pharmacokinetics of this drug, and therefore of its residue status in meat. In this study carazolol pharmacokinetics were investigated in a randomized three-way cross-over design in five pigs. A dose of 0.025 mg/kg was given intravenously, intramuscularly and intra-adiposely (in the subcutaneous fat layer). Carazolol was rapidly distributed and had a short half-life of 1.2-4.2 h. The distribution volume was calculated to be 0.22-0.65 l/kg. After intramuscular or intra-adipose administration the absorption pattern was biphasic. A rapid initial phase was followed by a slow second phase. Absorption was found to be incomplete at 24 h after intramuscular and intra-adipose administration ranging from 24 to 59% and 25 to 66%, respectively. The biphasic behaviour could be explained by retention of the drug in the tissues after absorption of the solvent was complete. A few hours after intravenous administration only negligible amounts of the drug were circulating in the body; however, considerable amounts of drug might have remained at the intramuscular or intra-adipose injection site.

Rectal prolapse caused by blunt abdominal trauma

We describe a case of incarcerated rectal prolapse caused by blunt abdominal trauma. Emergency treatment consisted of manual reduction with the patient under general anesthesia, proctosigmoidoscopy, and peritoneal lavage. Subsequent definitive surgical therapy was then performed after bowel preparation and consisted of anterior resection of the sigmoid colon with posterior (sacral) rectopexy.

Seroepidemiology of bovine anaplasmosis and babesiosis in Venezuela

The serological prevalence of bovine anaplasmosis and babesiosis in the Centro-Occidental region of Venezuela was determined using the indirect fluorescent antibody (IFA) and latex agglutination (LAT) tests. Anaplasma marginale IFA and LAT prevalence rates were 57.7 and 48.6% respectively for cattle of all ages and breeds. The respective prevalence of IFA activity to B. bigemina and B. bovis was 78.2 and 38.8%. The LAT test specific only for Babesia spp. revealed that 61.4% of the animals tested were serologically positive for Babesia parasites. Anaplasma marginale and B. bigemina organisms were detected in peripheral blood smears of 21.1 and 7.5% respectively of cattle surveyed. A longitudinal survey of antibody activity and incidence of parasitaemia for Anaplasma and Babesia infections was conducted in two groups of calves from their birth to seven months of age. The animals generally experienced infections between three and four months of age the period subsequent to decline in colostral antibody levels. Seroepidemiological data are considered in the formulation of proposed vaccination regimens for anaplasmosis and babesiosis.