Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study.

BACKGROUND: COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures. METHODS: A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51). RESULTS: Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively). CONCLUSIONS: Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.

Risk Factors and Birth Outcomes of a High-Risk Cohort of Women Served by a Community-Based Prenatal Home Visiting Program.

Our study explored risk factors and birth outcomes of a community maternal and child outreach program for high poverty mothers in East and Central Harlem. We conducted a retrospective chart review of 75 mother-infant dyads, with singleton pregnancies, receiving antepartum and postpartum home visits. Inexperienced parenting was associated with increased odds of giving birth to an infant weighing <2,700 g compared to experienced parenting after adjustment for race/ethnicity and preeclampsia diagnosis (odds ratio (OR) 4.9, p = 0.04). Mothers had comparatively lower depression risk in the postpartum period compared to antepartum (p = 0.006).

Improving Physical Activity among Residents of Affordable Housing: Is Active Design Enough?

Physical inactivity increases risk of chronic disease. Few studies examine how built environment interventions increase physical activity (PA). Active design (AD) utilizes strategies in affordable housing to improve resident health. We assessed how AD housing affects PA among low-income families in Brooklyn, New York. Participants were recruited at lease signings in 2016 from a new AD apartment complex and two recently renovated comparison buildings without AD features. Eligibility included age ≥18 years with no contraindications to exercise. Anthropometric data were collected. PA was self-reported using the Recent and Global Physical Activity Questionnaires. Smartphone users shared their tracked step. Data collection was repeated one year after move-in. All data were analyzed using SPSS. Eighty-eight eligible participants completed the initial questionnaire (36 AD and 52 from 2 comparison buildings) at baseline (T0). There were no differences between AD and comparison cohorts in: stair use, PA, sitting time or, mean waist-to-hip ratio (WHR) at T0. However, the AD cohort had a lower baseline BMI (27.6 vs. 31.0, p = 0.019). At one-year follow-up (T1), 75 participants completed our survey including a 64% retention rate among those who previously completed the T0 questionnaire. Among T0 questionnaire respondents, mean daily steps increased at T1 among AD participants who moved from an elevator building (∆6782, p = 0.051) and in the comparison group (∆2960, p = 0.023). Aggregate moderate work-related activity was higher at T1 in the AD building (746 vs. 401, p = 0.031). AD building women reported more work-related PA overall but AD men engaged in more moderate recreational PA. Living in an AD building can enhance low-income residents' PA. More research with objective measures is needed to identify strategies to sustain higher PA levels and overall health.

Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program.

This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.

Active design in affordable housing: A public health nudge.

This pilot study investigates the impact of active design (AD) strategies on physical activity (PA) among adults living in two Leadership in Energy and Environmental Design (LEED) certified affordable housing developments in the South Bronx, New York. One building incorporates LEED Innovation in Design (ID) Credit: Design for Health through Increased Physical Activity. Tenants in an affordable housing building (AH) incorporating active design strategies completed PA self-assessments at their lease signing and one year later in 2015. Trained research assistants obtained body measurements. Residents of neighboring non-AD affordable housing (MCV) served as a comparison. Thirty four adults were recruited from AH and 29 from MCV, retention was 56% (n = 19) and 52% (n = 15) respectively at one year. The two groups' body mass index (BMI) and high-risk waist-to-hip ratio (WHR) were not statistically significantly different when analyzed as continuous variables, although BMI category had a greater decline at AH than at MCV (p = 0.054). There was a 31.5% increase in AH participants meeting MPA requirements and a statistically significant improvement in females (p = 0.031); while there was no change in the MCV participants overall or when stratified by gender. AH participants were significantly more likely to have reported increased stair use and less likely to have reported no change or decreased stair use than participants from MCV participants (p = 0.033). Housing has a role in individual health outcomes and behavior change, broad adoption of active design strategies in affordable housing is warranted to improve physical activity measures.

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx.

BACKGROUND: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. METHODS: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. RESULTS: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence. CONCLUSION: In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies. TRIAL REGISTRATION NUMBER: None/not applicable.

HPV vaccination: Population approaches for improving rates.

OBJECTIVE: To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. METHODS: We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. RESULTS: Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. CONCLUSIONS: There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.

Prevalence of human immunodeficiency virus testing in patients with hepatitis B and C infection.

OBJECTIVES: To determine the proportion of patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) who are adequately assessed for human immunodeficiency virus (HIV) and to identify variables associated with absence of HIV testing. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients who had positive serologic test results for reactive HBV and/or HCV between January 1999 and December 1999 and were followed up at a general internal medicine clinic in East Harlem, NY. Data were collected on patient demographics, HIV risk factors, and other variables that might influence the physician's decision to test the patient for HIV. Primary outcomes were HIV tests performed and documented discussions of at-risk HIV behavior. RESULTS: The HIV tests were performed in 40% (95% confidence interval [CI], 32%-49%) of the 141 patients with reactive HBV and/or HCV serologic test results. Predictors of HIV testing on multivariate logistic regression were age younger than 50 years (odds ratio [OR], 25; 95% CI, 13-3.8), male sex (OR, 1.6; 95% CI, 1.1-2.2), and having an established primary care provider (OR, 2.3; 95% CI, 1.2-3.9). Injection drug use was not significantly associated with HIV testing. CONCLUSIONS: Although HBV and HCV have clear epidemiological links with HIV, this study shows that a high percentage of these patients are not being tested. Although some of the factors associated with lack of testing were identified, further studies on the barriers to HIV testing are needed to reveal potential approaches to increase rates of HIV testing in this high-risk population.

Innovative Clinical Addiction Research Training Track in Preventive Medicine.

Medical education related to identification, diagnosis and management of alcohol and other drug problems receives inadequate attention in the undergraduate curriculum and during residency training. This article describes the design, implementation, and evaluation of a new track in Clinical Addiction Research Training (CART) in a General Preventive Medicine (GPM) residency program. CART is comprised of a new course in Addiction Medicine, new practicum sites in addiction medicine research and treatment, and a CART-designated resident. An Advisory Group of educators, researchers, scholars, and administrators in addiction medicine, has provided guidance and support for this new track. Evaluation of the CART track suggested improvements in residents' knowledge and attitudes. Residents engaged in high caliber clinical addiction research projects. The development of the CART track within the GPM residency is an approach that can be integrated into other specialties, such as internal medicine, family practice, and adolescent medicine, to develop residents' interest and expertise in the addictive behaviors.

Impact of LEED-certified affordable housing on asthma in the South Bronx.

BACKGROUND: Green housing reduces energy costs and may mitigate indoor allergens and pollutants, improving asthma morbidity. High asthma burden is seen in low-income neighborhoods. Past studies show improvements in respiratory symptoms when living in green homes. OBJECTIVE: Develop partnership with Blue Sea Development Company to determine impacts of living in Melrose Commons V (MCV), a Leadership in Energy and Environmental Design (LEED) Platinum-certified affordable housing complex, on asthma in the South Bronx. METHODS: Participants completed a home-based respiratory health questionnaire before moving into MCV. Follow-up occurred at 6, 12, and 18 months post-move. A home-based educational module was delivered on indoor environmental interventions to avoid asthma triggers. A pretest was given before the module and a posttest was given 9 months later, including an evaluation of behavioral practice changes. RESULTS: Outcomes included decreases in continuous daily respiratory symptoms (p < .001), asthma symptoms disrupting sleep in the past month (p = .028), and urgent visits to a healthcare professional for asthma in the past 3 months (p = .038). Clinically relevant outcomes included fewer days with asthma symptoms; asthma episodes; days of work, school, or daycare missed; and emergency department visits. Education changes from pretest to posttest included increased knowledge about dust mites, roaches, mold, and chemical irritants (p = .007). Common behavioral changes included using hypoallergenic mattress covers, using green cleaning products, and eliminating bedroom carpets. CONCLUSIONS: Findings support the beneficial effect of LEED Platinum-certified buildings on respiratory health. Trends may be clinically and economically relevant. Advocacy efforts should promote the expansion of green housing and emphasize the development of healthy communities.

Consumption of fish from polluted waters by WIC participants in east Harlem.

To minimize exposure to neurotoxins such as mercury, polychlorinated biphenyls (PCBs), dioxins, and pesticide residues, the New York State Department of Health issues health advisories about consumption of certain fish and shellfish caught from polluted local waters. Fetal exposure causes cognitive developmental deficits in children. Consumption of fish was assessed. We surveyed 220 WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) participants. Of the participants, 10% ate fish and shellfish caught in local polluted waters. Statistically significant factors associated with eating local, noncommercial fish included male gender and knowledge of the health advisory. Locally caught fish and crabs are consumed; thus, in utero and childhood exposure to these neurotoxins occurs. Interventions to promote safer choices of fish are needed.

Healthcare and the long haul: Long distance truck drivers--a medically underserved population.

BACKGROUND: Long distance trucking is associated with significant health risks. However, to our knowledge no published data exist regarding healthcare service access by the estimated two million long-haul truckers in the United States. METHODS: A cross-sectional study was designed to assess access to healthcare among these workers. Five hundred-twenty-one anonymous self-administered surveys were completed at 16 truck stops in 14 states from July through August 2002. RESULTS: Forty-seven percent of those surveyed lack a regular healthcare provider, 20% frequent emergency rooms and urgent care centers, 32% were unable to receive needed healthcare within the last year, and 56% had difficulty utilizing healthcare services at home. Individuals lacking health insurance (31%) experienced more difficulty with healthcare access than the insured within the last year, were more often without a regular provider (P = 0.002 and P < 0.001), and utilized urgent care centers and emergency rooms more often than the insured (25 vs. 17%). CONCLUSIONS: Long distance truck drivers are at risk for poor health outcomes and experience significant difficulty accessing healthcare services. Further studies concerning how to best provide healthcare to this vulnerable, underserved population are needed.