Unequal From the Start? Poverty Across Immigrant Generations of Hispanic Children.

Recent cohorts of U.S. children increasingly consist of immigrants or the immediate descendants of immigrants, a demographic shift that has been implicated in high rates of child poverty. Analyzing data from the 2014-2018 Current Population Survey and using the U.S. Census Bureau's Supplemental Poverty Measure, we describe differences in child poverty rates across immigrant generations and assess how these disparities are rooted in generational differences in the prevalence and impact of key poverty risk factors. Our estimates show that poverty rates among Hispanic children are very high, particularly among first-generation children and second-generation children with two foreign-born parents. Low family employment is the most significant risk factor for poverty, but the prevalence of this risk varies little across immigrant generations. Differences in parental education account for the greatest share of observed intergenerational disparities in child poverty. Supplemental comparisons with third+-generation non-Hispanic White children underscore the disadvantages faced by all Hispanic children, highlighting the continued salience of race and ethnicity within the U.S. stratification system. Understanding the role of immigrant generation vis-à-vis other dimensions of inequality has significant policy implications given that America's population continues to grow more diverse along multiple social axes.

Rural Population Health and Aging: Toward a Multilevel and Multidimensional Research Agenda for the 2020s.

The unique health and aging challenges of rural populations often go unnoticed. In fact, the rural United States is home to disproportionate shares of older and sicker people, there are large and growing rural-urban and within-rural mortality disparities, many rural communities are in population decline, and rural racial/ethnic diversity is increasing.Yet rural communities are not monolithic, and although some rural places are characterized by declining health, others have seen large improvements in population health. We draw on these realities to call for new research in five areas.First, research is needed to better describe health disparities between rural and urban areas and, because rural places are not monolithic, across rural America. Second, research is needed on how trends in rural population health and aging are affecting rural communities. Third, research is needed on the ways in which economic well-being and livelihood strategies interact with rural health and aging. Fourth, we need to better understand the health implications of the physical and social isolation characterizing many rural communities. Finally, we argue for new research on the implications of local natural environments and climate change for rural population health and aging.

Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated inflammation of the gastrointestinal tract. IBD includes two major disease entities: Crohn disease and ulcerative colitis. Imaging plays an important role in the diagnosis and surveillance of these complex disorders. Computed tomographic and magnetic resonance enterographic techniques have been refined in recent years to provide a superb means of evaluating the gastrointestinal tract for suspected IBD. Although the intestinal imaging manifestations of IBD have been extensively discussed in the radiology literature, extraintestinal imaging manifestations of IBD have received less attention. Multiple extraintestinal manifestations may be seen in IBD, including those of gastrointestinal (hepatobiliary and pancreatic), genitourinary, musculoskeletal, pulmonary, cardiac, ocular, and dermatologic disorders. Although many associations between IBD and extraintestinal organ systems have been well established, other associations have not been fully elucidated. Some extraintestinal disorders may share a common pathogenesis with IBD. Other extraintestinal disorders may occur as a result of unintended treatment-related complications of IBD. Although extraintestinal disorders within the abdomen and pelvis may be well depicted with cross-sectional enterography, other musculoskeletal and thoracic disorders may be less evident with such examinations and may warrant further investigation with additional imaging examinations or may be readily apparent from the findings at physical examination. Radiologists involved in the interpretation of IBD imaging examinations must be aware of potential extraintestinal manifestations, to provide referring clinicians with an accurate and comprehensive profile of patients with these complex disorders. © RSNA, 2017.

Climatic conditions and human mortality: spatial and regional variation in the United States.

Previous research on climatic conditions and human mortality in the United States has three gaps: largely ignoring social conditions, lack of nationwide focus, and overlooking potential spatial variations. Our goal is to understand whether climatic conditions contribute to mortality after considering social conditions and to investigate whether spatial non-stationarity exists in these factors. Applying geographically weighted regression to a unique nationwide county-level dataset, we found that (1) net of other factors, average July temperatures are positively (detrimentally) associated with mortality while January temperatures mainly have a curvilinear relationship, (2) the mortality-climatic condition associations are spatially non-stationary, (3) the relationships between social conditions (e.g., social capital) and mortality are stable geographically, and (4) without a spatial approach to understanding the environment-mortality relationship, important spatial variations are overlooked. Our findings suggest that a universal approach to coping with the relationships between rapid climate changes and health may not be appropriate and effective.

Risk Factors for Complications after Peripheral Vascular Surgery in 3,202 Patient Procedures.

BACKGROUND: Complications after open vascular surgery are a major health challenge for the healthcare system and the patients. Infrainguinal vascular surgery is often perceived as less risky than aortic surgery and the aim of this study was to identify which risk factors correlated with postoperative complications after open vascular surgery for infrainguinal occlusive disease in an 8-year cohort using the Danish National Vascular Registry (Karbase), which gathers information on all vascular procedures in Denmark. METHODS: This study is a retrospective cohort study. The Karbase was searched for the predefined procedures from January 1, 2005 through December 31, 2012 at our 2 vascular departments. Both elective and urgent surgeries were included. Complications were defined as wound, surgical, or general complication according to Karbase. RESULTS: Three thousand two hundred two procedures were identified. Median age was 70 years and 21% were octogenarians. Sixty percent were male. There was an overall complication rate of 30%, with 19% being wound complications, 6% surgical, and 10% general complications. The greatest risk factors for developing a complication were high age, cardiac and renal disease, high American Society of Anesthesiologists score, and general anesthetics. The 30-day mortality was 5% (1% for claudicants and 8% for acute ischemia) and the 30-day amputation rate was 7% (0.5% for claudicants and 21% for gangrene). CONCLUSIONS: There is a high risk of complication in peripheral vascular surgery. Risk factors are modifiable or nonmodifiable. It is important to identify the risk factors and treat and optimize the patient cardiac and renal status before surgery if time allows, and also to perform surgery in local or regional anesthesia whenever possible, to reduce the risk of postoperative complications.

Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease.

OBJECTIVE: Open surgery has given way to endovascular grafting in patients with aortoiliac occlusive disease. The growing use of endovascular grafts means that fewer patients with aortoiliac occlusive disease have open surgery. The declining open surgery caseload challenges the surgeon's operative skills, particularly because open surgery is increasingly used in those patients who are unsuitable for endovascular repair and hence technically more demanding. We assessed the early outcome after aortic bifurcated bypass procedures during two decades of growing endovascular activity and identified preoperative risk factors. METHODS: Data on patients with chronic limb ischemia were prospectively collected during a 20-year period (1993 to 2012). The data were obtained from the Danish Vascular Registry, assessed, and merged with data from The Danish Civil Registration System. RESULTS: We identified 3623 aortobifemoral and 144 aortobiiliac bypass procedures. The annual caseload fell from 323 to 106 during the study period, but the 30-day mortality at 3.6% (95% confidence interval [CI], 3.0-4.1) and the 30-day major complication rate remained constant at 20% (95% CI, 18-21). Gangrene (odds ratio [OR], 3.3; 95% CI, 1.7-6.5; P = .005) was the most significant risk factor for 30-day mortality, followed by renal insufficiency (OR, 2.5; 95% CI, 1.1-5.8; P = .035) and cardiac disease (OR, 2.1; 95% CI, 1.4-3.1; P < .001). Multiorgan failure, mesenteric ischemia, need for dialysis, and cardiac complications were the most lethal complications, with mortality rates of 94%, 44%, 38%, and 34%, respectively. CONCLUSIONS: Aortic bifurcated bypass is a high-risk procedure. Although open surgery has increasingly given way to endovascular repair, 30-day outcomes have remained stable during the past decade. Thus, it is still acceptable to consider an aortic bifurcated bypass whenever endovascular management is not feasible.

Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair: a randomized, placebo-controlled, clinical trial.

The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three nights after surgery. Postoperative cardiac morbidity was registered, and blood samples for analysis of troponin-I (TpI) were collected preoperatively, and at 5 min, 6, 24, 48, 72, and 96 hr after clamp removal/recirculation of the first leg. Continuous measurement of ST-segment depression was performed by Holter monitoring. A total of 26 patients received melatonin, while 24 received placebo. A significant reduction in cardiac morbidity was seen in the melatonin-treated patients compared with those given placebo [4% versus 29% (P = 0.02)]. Five patients (19%) who received melatonin had increased TpI levels in the postoperative period compared with 12 patients (50%) who were given placebo (P = 0.036). The median number of ST-segment deviations was less in the melatonin-treated patients compared with the placebo group [median 1 (range 0-4) versus 6 (range 0-13) (P = 0.01)], but no differences were found in the duration of ST-segment deviations. Melatonin treatment in the perioperative period decreased clinical cardiac morbidity as well as the occurrence of myocardial ischemia after abdominal aortic aneurism repair.

Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review.

This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.

Reducing delay of carotid endarterectomy in acute ischemic stroke patients: a nationwide initiative.

BACKGROUND AND PURPOSE: Guidelines recommend carotid endarterectomy (CEA) within 2 weeks from an ischemic event. However, previous studies have shown that only a minority of patients undergo CEA within this period. The aim of this study was to examine the effect of a multidisciplinary nationwide initiative aimed at reducing time to CEA after acute ischemic stroke. METHODS: We examined a historic population-based observational cohort based on individual patient-level records from the Danish Stroke Registry and the Danish Vascular Registry. The implementation of early ultrasound examination of the carotids (within 4 days from admission) in medical departments coupled with fast CEA after referral to a department of vascular surgery were monitored and audited systematically from 2008 and onward. RESULTS: A total of 813 acute ischemic stroke patients underwent CEA during 2007-2010. The percentage of patients undergoing CEA within 2 weeks increased from 13% in 2007 to 47% in 2010 (adjusted odds ratio, 5.8 [95% CI, 3.4-10.1]). The overall median time decreased from 31 days to 16 days. The percentage of relevant acute ischemic stroke patients receiving early ultrasound examination of the carotids increased from 41% in 2008 to 72% in 2010. The time from referral to operation at a vascular department was reduced by ≈40%. CONCLUSIONS: Establishing time limits of 4 days to ultrasound examination of the carotids and of 2 weeks to CEA from onset of stroke followed by a systematic multidisciplinary monitoring and auditing of processes was associated with a substantial increase in the proportion of acute ischemic stroke patients who undergo CEA within 2 weeks in Denmark.

Age differences in Allostatic Load among adults in the United States by rural-urban residence.

•Rural residence is associated with allostatic load levels by age groups.•Allostatic load is higher among rural adults with the exception of the oldest age group.•Evidence of a rural-urban convergence in allostatic load levels among oldest old.•These rural disadvantages remained strong even when accounting for covariates.•The study of allostatic load can improve our understanding of rural disparities.

Rural Population Health and Aging: Introduction to the Special Issue.

This special issue of the Journal of Rural Social Sciences (JRSS) focuses on rural population health and aging. It showcases the work of scholars from several backgrounds and social science disciplines to advance knowledge in a critical field of investigation. Assembled through an open call for submissions coordinated through the National Institute on Aging (NIA) funded Interdisciplinary Network on Rural Population Health and Aging (INRPHA), the collection of articles helps inform a more nuanced understanding of the factors associated with rural places, which often have different health outcomes and aging patterns than their urban counterparts. The authors achieve this through application of innovative analytical strategies used with a combination of data sources. This introductory essay provides background and an overview of the four articles, followed by discussion of future opportunities to advance an agenda for rural population health and aging research.

Postthrombotic syndrome and quality of life in patients with iliofemoral venous thrombosis treated with catheter-directed thrombolysis.

BACKGROUND: Postthrombotic syndrome (PTS) is a common complication after iliofemoral venous thrombosis, often resulting in poor quality of life (QOL) among the affected patients. This study assessed development of PTS and its effect on QOL among patients treated for iliofemoral venous thrombosis by catheter-directed thrombolysis. METHODS: Patients admitted with an iliofemoral venous thrombosis and treated with catheter-directed thrombolysis at Gentofte University Hospital from 1999 to 2008 were invited to participate. Duplex ultrasound imaging was used to assess venous patency and valve function. Each patient completed the generic Short-Form 36-item (SF-36) health survey assessment, producing physical component (PCS) and mental component summary (MCS) scores, and the disease-specific Venous Insufficiency Epidemiological and Economic Study (VEINES)-Quality of Life (QOL)/Symptoms (Sym), questionnaires to assess QOL. PTS was assessed using the Villalta scale. RESULTS: The study included 109 patients. Median follow-up was 71 months. PTS developed in 18 patients (16.5%) and of those, initial thrombolysis was successful in 13. Patients with PTS had significantly worse mean ± standard deviation scores than patients without PTS on VEINES-QOL (34.2 ± 9.6 vs 53.1 ± 6.6; P < .0001), VEINES-Sym (34.0 ± 8.8 vs 53.2 ± 6.6; P < .0001), SF-36 MCS (44.2 ± 15.5 vs 52.3 ± 11.0; P = .005), and SF-36 PCS (42.3 ± 9.1 vs 53.5 ± 7.8; P < .0001) subscales. Patients with reflux or chronic occlusions, or both, had significantly lower mean ± SD scores than patients with patent veins without reflux on VEINES-QOL (43.5 ± 14.3 vs 51.0 ± 8.8; P = .044) and SF-36 PCS (47.2 ± 10.9 vs 52.4 ± 8.5; P = .049) scales. CONCLUSION: PTS was associated with worse QOL, although only a few patients developed PTS after catheter-directed thrombolysis of iliofemoral venous thrombosis. Patients with patent veins and sufficient valves have higher QOL scores than patients with reflux and occluded veins.

Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis.

PURPOSE: To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT). MATERIALS AND METHODS: From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals. RESULTS: Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up. CONCLUSIONS: Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.

Saturation recovery-prepared magnetic resonance angiography for assessment of left atrial and esophageal anatomy.

OBJECTIVES: Magnetic resonance angiography (MRA) has been established as an important imaging method in cardiac ablation procedures. In pulmonary vein (PV) isolation procedures, MRA has the potential to minimize the risk of severe complications, such as atrio-esophageal fistula, by providing detailed information on esophageal position relatively to cardiac structures. However, traditional non-gated, first-pass (FP) MRA approaches have several limitations, such as long breath-holds, non-uniform signal intensity throughout the left atrium (LA), and poor esophageal visualization. The aim of this observational study was to validate a respiratory-navigated, ECG-gated (EC), saturation recovery-prepared MRA technique for simultaneous imaging of LA, LA appendage, PVs, esophagus, and adjacent anatomical structures. METHODS: Before PVI, 106 consecutive patients with a history of AF underwent either conventional FP-MRA (n = 53 patients) or our new EC-MRA (n = 53 patients). Five quality scores (QS) of LA and esophagus visibility were assessed by two experienced readers. The non-parametric Mann-Whitney U-test was used to compare QS between FP-MRA and EC-MRA groups, and linear regression was applied to assess clinical contributors to image quality. RESULTS: EC-MRA demonstrated significantly better image quality than FP-MRA in every quality category. Esophageal visibility using the new MRA technique was markedly better than with the conventional FP-MRA technique (median 3.5 [IQR 1] vs median 1.0, p < 0.001). In contrast to FP-MRA, overall image quality of EC-MRA was not influenced by heart rate. CONCLUSION: Our ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality and esophageal visibility than the established non-gated, breath-holding FP-MRA. Image quality of EC-MRA technique has the additional advantage of being unaffected by heart rate. ADVANCES IN KNOWLEDGE: Detailed information of cardiac anatomy has the potential to minimize the risk of severe complications and improve success rates in invasive electrophysiological studies. Our novel ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality of LA and esophageal structures than the traditional first-pass algorithm. This new MRA technique is robust to arrhythmia (tachycardic, irregular heart rates) frequently observed in AF patients.

Race, Residence, and Underemployment: Fifty Years in Comparative Perspective, 1968-2017.

High underemployment has been a chronic structural feature of the rural United States for decades. In this paper, we assess whether and how inequalities in underemployment between metropolitan (metro) and nonmetropolitan (nonmetro) areas have changed over the course of the last five decades. Drawing on data from the March Current Population Survey (CPS) from 1968 to 2017, we analyze inequality in the prevalence of underemployment between metro and nonmetro areas of the United States, paying special attention to differences between white, black, and Hispanic workers. Our results show that the underlying risk of underemployment has increased in both metro and nonmetro areas over the last fifty years. Nonmetro workers have consistently faced greater employment hardship compared to their metro counterparts, and these differences cannot be fully explained by differences in population characteristics. Nonmetro ethnoracial minorities have experienced particularly poor labor market outcomes. The disadvantage of ethnoracial minority status and rural residence is especially pronounced for nonmetro black workers, among whom underemployment has remained persistently high with only modest convergence with other workers. Hispanic workers also face elevated risk of underemployment, but we observe a unique convergence between metro and nonmetro workers within this population.

Smoke: How to Differentiate Flow-related Artifacts From Pathology on Thoracic Computed Tomographic Angiography.

Nonuniform contrast opacification of vasculature is frequently encountered on thoracic computed tomographic angiography. The purpose of this pictorial essay is to discuss the appearance of, and factors underlying mixing artifacts, which we term "smoke." We provide an approach to distinguish it from pathology including pulmonary embolism, aortic dissection, and thrombus. Smoke results from a combination of technical factors, abnormal physiology, or inflow of unopacified blood. Smoke produces ill-defined filling defects that may be confidently diagnosed in many cases if these fundamentals are applied.

Health Care Disparities in Radiology: A Primer for Resident Education.

As the population of the United States grows increasingly diverse, health care disparities become vital to understand and mitigate. The ethical and financial implications of how groups of Americans gain access to health care have evolved into some of today's most challenging socioeconomic problems. Educators in radiology are just beginning to tackle the concepts of health care disparities, unconscious bias, and cultural competency. In July 2017, the Accreditation Council for Graduate Medical Education required that all trainees and teaching faculty of accredited training programs receive training and experience in new areas of quality improvement to include an understanding of health care disparities as part of the core competencies. To our knowledge, there is no centralized curriculum regarding health care disparities for radiology residents and fellows. Many programs, in fact, have yet to introduce the concept to their trainees, who may have difficulty recognizing that this is even a problem affecting radiology. This manuscript serves as a primer for radiology trainees on health care disparities, with the goal of defining major concepts and providing examples of how variable access to radiological care can have substantial impact on patient outcomes.

Feasibility of multiple-view myocardial perfusion MRI using radial simultaneous multi-slice acquisitions.

PURPOSE: Dynamic contrast enhanced MRI of the heart typically acquires 2-4 short-axis (SA) slices to detect and characterize coronary artery disease. This acquisition scheme is limited by incomplete coverage of the left ventricle. We studied the feasibility of using radial simultaneous multi-slice (SMS) technique to achieve SA, 2-chamber and/or 4-chamber long-axis (2CH LA and/or 4CH LA) coverage with and without electrocardiography (ECG) gating using a motion-robust reconstruction framework. METHODS: 12 subjects were scanned at rest and/or stress, free breathing, with or without ECG gating. Multiple sets of radial SMS k-space were acquired within each cardiac cycle, and each SMS set sampled 3 parallel slices that were either SA, 2CH LA, or 4CH LA slices. The radial data was interpolated onto Cartesian space using an SMS GRAPPA operator gridding method. Self-gating and respiratory states binning of the data were done. The binning information as well as a pixel tracking spatiotemporal constrained reconstruction method were applied to obtain motion-robust image reconstructions. Reconstructions with and without the pixel tracking method were compared for signal-to-noise ratio and contrast-to-noise ratio. RESULTS: Full coverage of the heart (at least 3 SA and 3 LA slices) during the first pass of contrast at every heartbeat was achieved by using the radial SMS acquisition. The proposed pixel tracking reconstruction improves the average SNR and CNR by 21% and 30% respectively, and reduces temporal blurring for both gated and ungated acquisitions. CONCLUSION: Acquiring simultaneous multi-slice SA, 2CH LA and/or 4CH LA myocardial perfusion images in every heartbeat is feasible in both gated and ungated acquisitions. This can add confidence when detecting and characterizing coronary artery disease by revealing ischemia in different views, and by providing apical coverage that is improved relative to SA slices alone. The proposed pixel tracking framework improves the reconstruction while adding little computational cost.

Employment hardship among older workers: does residential and gender inequality extend into older age?

OBJECTIVES: The realities of a rapidly aging society make the employment circumstances of older workers an increasingly important social issue. We examine the prevalence and correlates of underemployment among older Americans, with a special focus on residence and gender, to provide an assessment of the labor market challenges facing older workers. METHODS: We analyzed data from the March Current Population Surveys for the years 2003, 2004, and 2005. We used descriptive statistics to explore the prevalence of underemployment among older workers and developed multivariate models to assess the impact of age, residence, and gender on the likelihood of underemployment, net of other predictors. RESULTS: We found clear disadvantages for older workers relative to their middle-aged counterparts, and particular disadvantages for older rural residents and women. Multivariate models showed that the disadvantages of older age held net of other predictors. The results also indicated that much of the disadvantage faced by older rural workers and women was explained by factors other than age, particularly education. DISCUSSION: In an aging society, underemployment among older workers comes at an increasing social cost. Policies aimed at supporting older workers and alleviating employment hardship among them are increasingly in the public interest.