Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior.

Drug overdose is the leading cause of accidental death in the U.S. with deaths from opioid overdose occurring at a higher rate in rural areas. The gaps in the provision of healthcare services have been exacerbated by the opioid crisis leaving vulnerable populations without access to preventative care and education, harm reduction, both chronic and acute treatment of the symptoms of opioid use disorder (OUD), and long-term psychological support for those with OUD and their families. There has been a call in the literature -and a federal mandate-for increased access to opioid treatment facilities, but to date this access has not been operationalized using best practices in geography. Medication for Opioid Use Disorder (MOUD) with FDA-approved methadone or buprenorphine has been shown to increase treatment retention, reduce opioid use and associated health and societal harms, and reduce opioid related overdose, and as such is considered the most effective treatment for OUD. The objective of this study is to examine U.S. adults' spatial access to MOUD - specifically locations of certified Opioid Treatment Programs (OTPs) and DATA-waived Buprenorphine providers. A gravity-based variant of the enhanced two-step floating catchment area model is employed, where friction of distance is based on previously published willingness to travel distances for patients visiting OTPs, to assess how opioid agonist treatment accessibility varies across the nation. Findings suggest that there are extensive 'treatment deserts' where there is little to no physical access to MOUD, especially in rural areas. The significance of this work lies in the incorporation of treatment utilization behavior in the access metric, and the continued confirmation of gaps in access to OUD services despite federal efforts to improve accessibility.

Self-Care Instruments to Measure Nutrition Practices in Children and Parents: Psychometric Analysis.

The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem's self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem's Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem's operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

COVID-19 and Morbid Obesity: Associations and Consequences for Policy and Practice.

While the impact of obesity on chronic disease has been widely examined, there has been less research regarding the influence of obesity on infectious diseases, particularly respiratory diseases. This exploratory research uses the currently available data on COVID-19 cases and mortality, along with estimates of the morbidly obese populations in the United States by county, to examine the association between morbid obesity and deaths from COVID-19 and to identify potential coincident spatial clusters of morbid obesity and COVID-19 deaths. Results indicate a statistically significant positive correlation between population-adjusted COVID-19 deaths and cases and the estimated population with a body mass index ≥ 40. Clustering analyses show there is a predominant similarity in the distribution of COVID-19 deaths and obesity. Our findings suggest it is critical to include an awareness of obesity when developing infectious disease control measures and point to a greater need to focus resources toward obesity education and policy initiatives.

Health-care availability, preference, and distance for women in urban Bo, Sierra Leone.

OBJECTIVES: To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to preferred health-care providers. METHODS: A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each woman's home to her preferred provider. RESULTS: Preferred health-care providers for acute febrile illnesses (commonly referred to as "malaria" in the study communities) were hospitals (62.3 %), clinics (12.6 %), and pharmacies (12.4 %). Participants lived a median distance of 0.6 km from the nearest provider, but on average each woman lived 2.2 km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown. CONCLUSIONS: The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill.

A New Model for a Carpool Matching Service.

Carpooling is an effective means of reducing traffic. A carpool team shares a vehicle for their commute, which reduces the number of vehicles on the road during rush hour periods. Carpooling is officially sanctioned by most governments, and is supported by the construction of high-occupancy vehicle lanes. A number of carpooling services have been designed in order to match commuters into carpool teams, but it known that the determination of optimal carpool teams is a combinatorially complex problem, and therefore technological solutions are difficult to achieve. In this paper, a model for carpool matching services is proposed, and both optimal and heuristic approaches are tested to find solutions for that model. The results show that different solution approaches are preferred over different ranges of problem instances. Most importantly, it is demonstrated that a new formulation and associated solution procedures can permit the determination of optimal carpool teams and routes. An instantiation of the model is presented (using the street network of Guangzhou city, China) to demonstrate how carpool teams can be determined.

Exploratory space-time analysis of dengue incidence in Trinidad: a retrospective study using travel hubs as dispersal points, 1998-2004.

BACKGROUND: Dengue is an acute arboviral disease responsible for most of the illness and death in tropical and subtropical regions. Over the last 25 years there has been increase epidemic activity of the disease in the Caribbean, with the co-circulation of multiple serotypes. An understanding of the space and time dynamics of dengue could provide health agencies with important clues for reducing its impact. METHODS: Dengue Haemorrhagic Fever (DHF) cases observed for the period 1998-2004 were georeferenced using Geographic Information System software. Spatial clustering was calculated for individual years and for the entire study period using the Nearest Neighbor Index. Space and time interaction between DHF cases was determined using the Knox Test while the Nearest Neighbor Hierarchical method was used to extract DHF hot spots. All space and time distances calculated were validated using the Pearson r significance test. RESULTS: Results shows that (1) a decrease in mean distance between DHF cases correlates with activity leading up to an outbreak, (2) a decrease in temporal distance between DHF cases leads to increased geographic spread of the disease, with an outbreak occurrence about every 2 years, and (3) a general pattern in the movement of dengue incidents from more rural to urban settings leading up to an outbreak with hotspot areas associated with transportation hubs in Trinidad. CONCLUSION: Considering only the spatial dimension of the disease, results suggest that DHF cases become more concentrated leading up to an outbreak. However, with the additional consideration of time, results suggest that when an outbreak occurs incidents occur more rapidly in time leading to a parallel increase in the rate of distribution of the disease across space. The results of this study can be used by public health officers to help visualize and understand the spatial and temporal patterns of dengue, and to prepare warnings for the public. Dengue space-time patterns and hotspot detection will provide useful information to support public health officers in their efforts to control and predict dengue spread over critical hotspots allowing better allocation of resources.

Maternal-child overweight/obesity and undernutrition in Kenya: a geographic analysis.

OBJECTIVE: The purpose of the study was to examine geographic relationships of nutritional status (BMI), including underweight, overweight and obesity, among Kenyan mothers and children. DESIGN: Spatial relationships were examined concerning BMI of the mothers and BMI-for-age percentiles of their children. These included spatial statistical measures of the clustering of segments of the population, in addition to inspection of co-location of significant clusters. SETTING: Rural and urban areas of Kenya, including the cities of Nairobi and Mombasa, and the Kisumu region. SUBJECTS: Mother-child pairs from Demographic and Health Survey data including 1541 observations in 2003 and 1592 observations in 2009. These mother-child pairs were organized into 399 locational clusters. RESULTS: There is extremely strong evidence that high BMI values exhibit strong spatial clustering. There were co-locations of overweight mothers and overweight children only in the Nairobi region, while both underweight mothers and children tended to cluster in rural areas. In Mombasa clusters of overweight mothers were associated with normal-weight children, while in the Kisumu region clusters of overweight children were associated with normal-weight mothers. CONCLUSIONS: These findings show there is geographic variability as well as some defined patterns concerning the distribution of malnutrition among mothers and children in Kenya, and suggest the need for further geographic analyses concerning the potential factors which influence nutritional status in this population. In addition, the methods used in this research may be easily applied to other Demographic and Health Survey data in order to begin to understand the geographic determinants of health in low-income countries.