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005) SD lower average English language/arts test scores. Similar associations were observed for NO
and ozone on math, and for NO
on English language/arts. The magnitudes of these associations are equivalent to the effects of short-term reductions of thousands of dollars in district median household income. The reductions in test scores were larger for GSDs with higher socioeconomic status, though most associations remained negative at all socioeconomic levels.
Our results show that ambient air pollution within a GSD is associated with lower academic performance among children. Further improving air quality may benefit children's overall academic achievement and socioeconomic attainment across the lifespan.
Our results show that ambient air pollution within a GSD is associated with lower academic performance among children. Further improving air quality may benefit children's overall academic achievement and socioeconomic attainment across the lifespan.
Cross-sectional studies suggest tungsten (W) exposure may be associated with diabetes. We assessed longitudinal associations between urinary W and fasting glucose, 2-hour glucose, insulin resistance (HOMA-IR), β-cell function (HOMA-β), and incident type 2 diabetes.
We used data from 1,609 Hispanic and non-Hispanic White adults with 20 to 74 years of age residing in rural Colorado and participating in the San Luis Valley Diabetes Study. Urinary metal exposure values were measured at baseline and natural log-transformed. We assessed longitudinal associations between urinary W and continuous outcome measures using linear-mixed effect models and associations with incident diabetes using Fine and Gray competing risks regression models (competing event = all-cause mortality). The main adjustment set of covariates included age, sex, ethnicity, education, smoking status, hypertension, body mass index, caloric intake, alcohol intake, and urinary creatinine levels. Secondary models were further adjusted for arsenic, cadmium, and lead exposures. We assessed whether sex or ethnicity were effect modifiers.
At baseline, the median W concentration was 0.22 μg/L (interquartile range = 0.20, 0.59). In the main cross-sectional analyses, lnW levels were significantly associated with 3% higher lnHOMA-IR (95% CI = 1 to 5). In the main longitudinal models, lnW was significantly associated with 1% higher natural log-transformed fasting glucose (95% CI = <1 to 1), 3% higher natural log-transformed HOMA-IR (95% CI = 2 to 5), and 28% higher incident diabetes (subdistribution hazard ratio=1.28, 95% CI = 1.09 to 1.50). Results remained significant when further adjusting for other metals. We observed evidence for effect modification by sex and ethnicity.
Urinary W was longitudinally associated with adverse metabolic health indicators.
Urinary W was longitudinally associated with adverse metabolic health indicators.
Prenatal exposure to hydraulic fracturing (HF), a chemically intensive oil and gas extraction method, may be associated with adverse birth outcomes, but no health studies have been conducted in California.
We conducted a retrospective cohort study of 979,961 births to mothers in eight California counties with HF between 2006 and 2015. Exposed individuals had at least 1 well hydraulically fractured within 1 km of their residence during pregnancy; the reference population had no wells within 1 km, but at least one oil/gas well within 10 km. We examined associations between HF and low birth weight (LBW), preterm birth (PTB), small for gestational age birth (SGA), and term birth weight (tBW) using generalized estimating equations and assessing urban-rural effect modification in stratified models.
Fewer than 1% of mothers (N = 1,192) were exposed to HF during pregnancy. Among rural mothers, HF exposure was associated with increased odds of LBW (odds ratio [OR] = 1.74; 95% confidence interval [CI] = 1.10, 2.75), SGA (OR = 1.68; 95% CI = 1.42, 2.27) and PTB (OR = 1.17; 95% CI = 0.64, 2.12), and lower tBW (mean difference -73 g; 95% CI = -131, -15). Among urban mothers, HF exposure was positively associated with SGA (OR = 1.23; 95% CI = 0.98, 1.55), inversely associated with LBW (OR = 0.83; 95% CI = 0.63, 1.07) and PTB (OR = 0.65; 95% CI = 0.48, 0.87), and not associated with tBW (mean difference -2 g; 95% CI = -35, 31).
HF proximity was associated with adverse birth outcomes, particularly among rural Californians.
HF proximity was associated with adverse birth outcomes, particularly among rural Californians.Combining datasets from multiple sites/scanners has been becoming increasingly more prevalent in modern neuroimaging studies. Despite numerous benefits from the growth in sample size, substantial technical variability associated with site/scanner-related effects exists which may inadvertently bias subsequent downstream analyses. Such a challenge calls for a data harmonization procedure which reduces the scanner effects and allows the scans to be combined for pooled analyses. In this work, we present MISPEL (Multi-scanner Image harmonization via Structure Preserving Embedding Learning), a multi-scanner harmonization framework. Unlike existing techniques, MISPEL does not assume a perfect coregistration across the scans, and the framework is naturally extendable to more than two scanners. Importantly, we incorporate our multi-scanner dataset where each subject is scanned on four different scanners. This unique paired dataset allows us to define and aim for an ideal harmonization (e.g., each subject with identical brain tissue volumes on all scanners). We extensively view scanner effects under varying metrics and demonstrate how MISPEL significantly improves them.Purpose Underrepresentation of racial and ethnic minorities in the health care workforce is a local and national issue. We describe and report on outcomes of a longitudinal service-driven prehealth pathway program in a low-income community intended to address this disparity and increase health equity. Methods The Bronx Community Health Leaders (BxCHL) is a prehealth pathway program for socioeconomically disadvantaged and underrepresented minority students seeking careers in health care. The program enrolls students in college or college graduates and provides longitudinal near-peer mentorship, exposure to the health care environment, and supports professional development. An academic federally qualified health center serves as the program's home site and learning environment. We conducted surveys and tracked the career advancement of program participants over a 6-year period, 2014-2020. Results One hundred sixty-eight students participated in BxCHL for >3 months. Of these, 76 students advanced into professional health career programs with 39 direct acceptances and 15 conditional acceptances to medical school programs, 9 nursing, 4 physician assistant, 9 health-related masters level programs, 1 respiratory therapy, and 1 optometry. The direct and overall acceptance (direct and conditional) rate of medical school applicants is 59% and 86%, respectively. The first 11 BxCHL alumni obtained their medical degree. Conclusions BxCHL's longitudinal service-driven and near-peer mentorship program design represents a replicable model to address health equity by supporting prehealth students from communities with limited access to mentors and professional learning environments in entering the health care workforce and serving their communities of origin.Purpose Refugee and immigrant patients face significant barriers to health care and are more likely to have poorly controlled chronic disease than the general U.S. Rosuvastatin in vitro population. I-Care aims to improve health equity for refugees and immigrants who face a disproportionate burden of chronic disease. Methods Refugees and immigrants with uncontrolled diabetes and associated cardiovascular risk factors were enrolled in a care management program within an academic adult medicine clinic. The program utilized a care manager to coordinate care and services between designated primary care providers, affiliated clinical teams, and community partners. Health literacy, chronic disease parameters, and care utilization were assessed at enrollment and 8-12 months later. Results A total of 50 refugees and immigrants were followed for 8 to 12 months. Clinical parameters found a reduced mean HbA1c from 9.32 to 8.60 (p=0.05) and reduced low-density lipoprotein mean from 96.22 to 86.60 (p=0.01). The frequency of normal blood pressures was 9 (18%) at enrollment and 16 (32%) at 1 year. The cumulative frequency of emergency room visits decreased from 66% to 36% and hospitalizations from 22% to 8%. Rates of comprehensive care monitoring, including monofilament testing and one-time ophthalmology visits, increased from 60% to 82% and from 32% to 42%, respectively. Cumulative frequency of interdisciplinary support engagement with pharmacy and nutrition visits increased from 58% to 78% and from 26% to 38%, respectively. Conclusion This program highlights the importance of a multidisciplinary community-engaged care model that has demonstrated improvement in quality metrics and health care costs for refugees and immigrants.Purpose Since the start of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, ∼40% of U.S. adults have experienced delayed medical care. Rates of uninsurance, delayed care, and utilization of mental health services during the course of the pandemic have not been analyzed in detail. We examined monthly trends and disparities in access to care by household income levels in the United States. Methods Using Census Bureau's nationally representative pooled 2020 Household Pulse Survey from April to December, 2020 (N=778,819), logistic regression models were used to analyze trends and inequalities in various access to care measures. Results During the COVID-19 pandemic, the odds of being uninsured, having a delayed medical care due to pandemic, delayed care of something other than COVID-19, or delayed mental health care were, respectively, 5.54, 1.50, 1.85, and 2.18 times higher for adults with income less then $25,000, compared to those with incomes ≥$200,000, controlling for age, sex, race/ethnicity, education, marital status, housing tenure, region of residence, and survey month. Income inequities in mental health care widened over the course of the pandemic, while the probability of delayed mental health care increased for all income groups. Although the odds of taking prescription medication for mental health were higher for low-income adults, the odds of receiving mental health services were generally lower for lower income adults, controlling for all covariates. Conclusion In light of our findings on persistent health care inequities during the pandemic, increased policy efforts are needed to improve access to care in low-income populations as an equitable COVID-19 recovery response.Background Limited research has explored mental health concerns and collective trauma experienced by Bhutanese refugees due to their displacement from Bhutan, refugee camp life in Nepal, and resettlement to U.S. society. Purpose To understand how collective trauma experienced by Bhutanese refugees influences the process of resettlement and integration into U.S. society to better address mental health concerns from the community. Methods Qualitative data were collected through four focus groups (N=40) with Bhutanese refugee women in central Massachusetts from June to November of 2016 to discuss refugee resettlement experiences and mental health concerns. Findings Bhutanese refugees shared insights on their resettlement experiences where several broader themes emerged, including historical collective trauma, closed-door culture, and processing mental health stigma. The displacement from Bhutan, hardships in Nepal refugee camps, and isolation in U.S. society led to a collective trauma among the community. Participants described America as having a closed-door culture that limits their integration into society, causing unique challenges based on their context of integration.