The Association of Stair Climbing Behaviors With Hazard of All-Cause Mortality in Adults With or At Risk of Knee Osteoarthritis.

OBJECTIVE: To investigate the association of stair climbing difficulty and stair climbing frequency with the risk of all-cause mortality over 13 years in adults with or at high risk for knee OA. METHODS: We used data from the Osteoarthritis Initiative (OAI), a prospective cohort study of community-dwelling adults with or at high risk for symptomatic knee OA. The exposures were stair climbing difficulty and frequency, assessed at baseline using self-report questionnaires. The outcome was all-cause mortality, assessed from baseline through 13 years of follow-up. Kaplan-Meier survival curves and Cox proportional hazards regression were used to investigate the association between stair climbing exposures and all-cause mortality. RESULTS: Three hundred seven (6.81%) and 310 (6.84%) participants in the difficulty and frequency samples, respectively, died during 13 years of follow-up. Those who were limited in any capacity in terms of their stair climbing ability had 54% to 84% greater hazard of all-cause mortality, and those who climbed at least 7 flights of stairs per week had 38% lower hazard of all-cause mortality. CONCLUSION: Adults with or at high risk for knee OA who report difficulty with climbing stairs or who infrequently use stairs are at greater hazard of all-cause mortality. Stair climbing difficulty and frequency are simple to collect and changes may occur early in OA progression, allowing for early intervention. Brief questions about stair climbing behaviors can serve as a functional vital sign within the clinician's toolbox.

Changes in anxiety and depression among public health workers during the COVID-19 pandemic response.

OBJECTIVES: The COVID-19 pandemic has negatively impacted mental health indicators, leading to an increase in symptoms of anxiety and depression in both the general population of adults and children and many occupational groups. This study aims to examine changes in anxiety and depression among a cohort of public health workers in the U.S. during the first year of the COVID-19 pandemic and identify potential risk factors. METHODS: Longitudinal data were collected from a sub-sample (N = 85) of public health workers in 23 U.S. states who completed two surveys in 2020 and 2021. Information on background characteristics, personal well-being, and work environment as well as validated scales to assess generalized anxiety disorder (GAD), depressive disorder, and burnout was collected. Data were analyzed using Stata Version 17, and significant differences were determined using Pearson's Chi2 and Fisher's Exact tests. RESULTS: The proportion of those reporting GAD (46.3% to 23.2%) or depression (37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety saw the largest improvement. Persistent depression was associated with sustained burnout, changes in social support, and days worked per week. CONCLUSION: Public health workers experienced elevated levels of anxiety and depression during the initial pandemic response, but a reduction in these symptoms was observed in the subsequent year after vaccines had become widely available. However, unmet needs remain for ongoing workplace mental health supports to address burnout, as well as for additional emotional supports outside of work for public health professionals.

Disease burden among refugees in camps on mainland Greece, 2016-2017: a retrospective cross-sectional study.

BACKGROUND: Despite the importance of baseline health data for evidence-informed decision-making, these data are rarely available for displaced populations. At the height of the European refugee crisis, most of those seeking asylum in Europe were from regions with high prevalences of communicable and non-communicable diseases. To create an epidemiologic profile for refugees in camps on mainland Greece, this study assessed the prevalence of 11 communicable and non-communicable diseases among refugees utilizing Médecins du Monde (MdM) in-camp clinics. METHODS: The proportional morbidity of selected diseases among individuals utilizing MdM services were determined from data collected at refugee camp clinics on mainland Greece from April 2016 - July 2017. Overall and age-specific proportional morbidities were reported. Differences in disease burden among refugees from the largest sending countries - Afghanistan and Syria - were compared using proportional morbidity ratios and 95% confidence intervals. Patterns in results were compared with disease burden estimates in sending countries and with findings from comparable settings. RESULTS: Respiratory tract infections (RTIs) were the most prevalent outcome. Among RTIs, upper RTIs were most common, with a proportional morbidity of nearly 40%; throughout the study period, over 46% of children under 18 years had at least one upper RTI consultation. Musculoskeletal conditions (3.64%), were the most prevalent non-communicable outcome, followed by hypertension (2.21%) and asthma (1.28%). Afghans were 31.68% more likely than Syrians to have a consultation for at least one condition (PR: 1.32; 95% CI: 1.25, 1.39). The proportional morbidity of RTIs was comparable to sending countries, but there was a comparatively lower burden of other conditions among refugees than literature estimates from sending countries. CONCLUSION: Refugees utilizing MdM clinics in camps had higher burdens of communicable diseases - predominantly RTIs - relative to non-communicable diseases. Non-communicable disease burdens were comparatively lower than reported prevalences from in-country populations. These findings can be attributed to a range of considerations including differences in demographic profiles between sending countries and refugee populations and missed opportunities for utilizing clinical care. Further investment is needed to capture the health profiles of displaced populations to support evidence-informed decision-making processes in humanitarian emergency responses.

Characterizing the impacts of public health control measures on domestic violence services: qualitative interviews with domestic violence coalition leaders.

BACKGROUND: Prior to the availability of pharmaceutical control measures, non-pharmaceutical control measures, including travel restrictions, physical distancing, isolation and quarantine, closure of schools and workplaces, and the use of personal protective equipment were the only tools available to public health authorities to control the spread of COVID-19. The implementation of these non-pharmaceutical control measures had unintended impacts on the ability of state and territorial domestic violence coalitions to provide services to victims. METHODS: A semi-structured interview guide to assess how the COVID-19 pandemic impacted service provision and advocacy generally, and how COVID-19 control measures specifically, created barriers to services and advocacy, was developed, pilot tested, and revised based on feedback. Interviews with state and territorial domestic violence coalition executive directors were conducted between November 2021 and March 2022. Transcripts were inductively and deductively coded using both hand-coding and qualitative software. RESULTS: Forty-five percent (25 of 56) of state and territorial domestic violence coalition executive directors representing all 8 National Network to End Domestic Violence (NNEDV) regions were interviewed. Five themes related to the use of non-pharmaceutical pandemic control measures with impacts on the provision of services and advocacy were identified. CONCLUSIONS: The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies.

Biosensor applications in contaminated estuaries: Implications for disaster research response.

BACKGROUND: Given the time and monetary costs associated with traditional analytical chemistry, there remains a need to rapidly characterize environmental samples for priority analysis, especially within disaster research response (DR2). As PAHs are both ubiquitous and occur as complex mixtures at many National Priority List sites, these compounds are of interest for post-disaster exposures. OBJECTIVE: This study tests the field application of the KinExA Inline Biosensor in Galveston Bay and the Houston Ship Channel (GB/HSC) and in the Elizabeth River, characterizing the PAH profiles of these region's soils and sediments. To our knowledge, this is the first application of the biosensor to include soils. METHODS: The biosensor enables calculation of total free PAHs in porewater (C free), which is confirmed through gas chromatography-mass spectrometry (GC-MS) analysis. To determine potential risk of the collected soils the United States Environmental Protection (USEPA) Agency's Regional Screening Level (RSL) Calculator is used along with the USEPA Region 4 Ecological Screening Values (R4-ESV) and Refined Screening Values (R4-RSV). RESULTS: Based on GC-MS results, all samples had PAH-related hazard indices below 1, indicating low noncarcinogenic risks, but some samples exceeded screening levels for PAH-associated cancer risks. Combining biosensor-based C free with Total Organic Carbon yields predictions highly correlated (r > 0.5) both with total PAH concentrations as well as with hazard indices and cancer risks. Additionally, several individual parent PAH concentrations in both the GB/HSC and Elizabeth River sediments exceeded the R4- ESV and R4-RSV values, indicating a need for follow-up sediment studies. CONCLUSIONS: The resulting data support the utility of the biosensor for future DR2 efforts to characterize PAH contamination, enabling preliminary PAH exposure risk screening to aid in prioritization of environmental sample analysis.

Surveys of community garden affiliates and soils in Houston, Texas.

Although urban community food gardens have the capacity to strengthen and support neighborhoods in need, the benefits of such operations must be considered in tandem with the potential risks associated with urban environmental contamination. Therefore, research is needed to characterize existing community gardens in urban areas. In the present study, a survey of Houston, TX, community gardeners (N = 20) was conducted to better understand their risk-based knowledge and perceptions, current gardening practices, and willingness to implement risk mitigation measures. Soil samples collected from the beds (N = 22) and surrounding grounds (N = 24) of existing community garden sites in Houston, TX, were screened for trace and heavy metals using X-ray fluorescence spectrometry. The survey indicated that community gardeners had few concerns with regard to potential soilborne hazards and were generally willing to use diverse strategies to reduce potential hazards related to garden soil contamination. Ground and garden bed soil collected from community gardens were found to have excess concentrations of arsenic compared to federal health screening limits. The information provided here provides insight into possible discordance between community gardening risk perception and contamination risk that could be addressed through outreach, engagement, and remediation approaches.

Public Health Student Response to COVID-19.

To understand the role public health students play in response to COVID-19 despite cuts in funding for graduate student emergency response programs (GSERPs), we reviewed the websites of the Association of Schools and Programs of Public Health, Council on Education in Public Health, and individual schools and programs to identify student participation in COVID-19 response activities. Thirty schools and programs of public health are supporting public health agencies in response to COVID-19, primarily through the provision of surge capacity (n = 20, 66.7%), contact tracing (n = 19, 63.3%), and training (n = 11, 36.7%). The opportunity to participate in formal and informal applied public health experiences like practica, service-learning, and field placements can benefit both public health students and agency partners. Although recent publications have identified gaps in academic public health response to COVID-19, in part due to the cessation of funding for workforce development and other university-based programs in public health preparedness, schools and programs of public health continue to support public health agencies. Future funding should explicitly link public health students to applied public health activities in ways that can be measured to document impacts on public health emergency response and the future public health workforce.

Traumatic Brain Injury Related Hospitalizations: Factors Associated with In-hospital Mortality among Elderly Patients Hospitalized with a TBI.

Background: This study aims to describe TBI-related hospitalizations for the whole population and identify factors associated with in-hospital mortality among elderly (≥65 years) patients hospitalized with TBI in Texas.Methods: Using Texas Hospital Discharge Data from 2012 to 2014, TBI-related hospitalizations were identified using International Classification of Diseases - Ninth Revision - Clinical Modification (ICD-9-CM) codes. Rates for age and gender were estimated using U.S. Census data. Univariate and multivariate analyses were used to identify factors associated with in-hospital mortality among those aged at least 65 years.Results: There were 51,419 TBI-related hospitalizations from 2012 to 2014 in Texas. Falls were the leading cause of TBI-related hospitalizations 6235 (36.64%), 6595 (38.40%), and 5412 (37.59%) for 2012, 2013, and 2014, respectively. Males had higher rates of hospitalizations while rates were highest for those above 80 years of age. Compared to Whites, Hispanics had 1.18 higher adjusted odds of in-hospital mortality [OR = 1.18: 95% CI (1.01-1.40)]. Similarly, adjusted odds of in-hospital mortality were higher among males [OR = 1.55: 95% CI (1.36-1.77)].Conclusion: This study provided evidence of demographic disparities in the burden and outcome of TBI in Texas, findings could serve as a foundation for targeted TBI prevention interventions.

Addressing Challenges to Building Resilience Through Interdisciplinary Research and Engagement.

Resilient communities are less affected by, and recover faster from, natural disasters. To be resilient in rapidly changing contemporary environments subject to the effects of complex factors such as climate change and urbanization, communities must effectively and efficiently adapt to new conditions to minimize future risks. To develop resilience, the hazards to which the community is exposed and vulnerable (i.e., future hurricanes, subsidence, salt water intrusion) must be accurately assessed, the systems (i.e., natural, built, and social) must be well understood, and the community must be engaged in the proactive planning and priority setting process. An approach to building resilience that utilizes the adaptive capacity of planning highlights opportunities to work collaboratively across disciplines to incorporate models and data from different disciplines to reduce uncertainty. We present one interdisciplinary group's approach to addressing challenges to building resilience through proactive planning, including: (1) characterizing hazards more accurately; (2) improving understanding of the vulnerability of natural (e.g., climate and infrastructure) systems subject to hazards; and (3) capturing potential synergies from interactions between planning and policies that govern decisions about the design of human settlements in hazardous areas.

Associations Between State Public Health Agency Structure and Pace and Extent of Implementation of Social Distancing Control Measures.

OBJECTIVE: To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response. DESIGN: State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing. SETTING: State health departments in the United States. RESULTS: States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86). CONCLUSION: State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.

Recent testosterone drop-off and risk of cardiovascular events.

Low baseline testosterone level has been associated with the development of risk factors for cardiovascular disease such as insulin resistance and obesity. In addition to the absolute testosterone level, remarkable changes in testosterone level may have an acute effect on cardiovascular disease development and progression, which has been rarely investigated. In this study, we used a clinical dataset of 376 hypogonadal men whose testosterone levels were measured every six months for up to 11 years from a registry study in Germany, and conducted survival analyses to investigate the effect of testosterone changes since the last visit (time-varying) on the risk of cardiovascular events. Given the potential discrepancies in comorbidity conditions among patients with prior cardiovascular events and those without, all the analyses were stratified by patients' prior cardiovascular event status. We found the effects were not different among patients with prior cardiovascular events and those without. Regardless of patients' prior cardiovascular event status, patients with larger testosterone declines (≥3.12 nmol/L, 90th percentile) since the last visit were more likely to experience myocardial infarction. In conclusion, recent pronounced testosterone drop-offs may affect the risk of cardiovascular events among hypogonadal men. Future longitudinal studies are needed to confirm our exploratory study findings.

Using the 12-item short form health survey (SF-12) to assess self rated health of an engaged population impacted by hurricane Harvey, Houston, TX.

BACKGROUND: In the last decade there has been an increase in community-based organizations providing support and educational outreach to populations effected by hazards. Prior research has demonstrated various roles that community social capital can play in both the enhancement of disaster preparedness and the mitigation of physical and mental health impacts following a natural disaster. METHODS: To assess self-reported health of residents of South Houston, Texas impacted by Hurricane Harvey, attendees of a community event completed a survey that included the 12 item short form health survey version 2 (SF-12v2). RESULTS: Although survey participants were older and more likely to be African-American than the overall population of Houston, they had higher mental health composite scores that the national average, with increases in mental wellbeing associated with a longer length of residence in their neighborhood. CONCLUSIONS: The City of Houston, with highly segregated, socially vulnerable populations at high risk from natural hazards, should consider ways to support community engagement around disaster preparedness, response, and recovery that may build community cohesion and improve post-disaster mental health.

Self-Rated Mental and Physical Health of U.S. Gulf Coast Residents.

Repeated exposure to hurricanes and tropical storms likely impacts the mental and physical health of populations living along the U.S. Gulf Coast. In this study, the self-rated physical and mental health of residents in the U.S. Gulf Coast was estimated and factors associated with differences in self-rated health were identified. The 12-item Short Form Health Survey (SF-12) was administered online to a sample of 3030 residents of the U.S. Gulf Coast in December 2017. Responses were scored to calculate mental component summary scores and physical component summary scores. Multiple linear regression models were fitted to identify predictors of self-rated health among the residents. Residents of U.S. Gulf Coast States have poorer self-rated physical and mental health compared to the U.S. population. Women and respondents reporting higher perception of flood risk had worse self-rated mental health, while hurricane evacuees, adults of at least 25 years of age, those with self-reported hurricane damage, and respondents reporting higher perception of surge risk had worse self-rated physical health. Residents of U.S. Gulf Coast States have poorer self-rated health compared to national standards. These findings may have practical implications for hurricane-associated physical and mental health services planning and delivery.

Estimating Evacuation Shelter Deficits in the Houston-Galveston Metropolitan Area.

Evacuation is frequently used by emergency managers and other officials as part of an overall approach to reducing the morbidity and mortality associated with hurricane landfall. In this study, the evacuation shelter capacity of the Houston-Galveston Metropolitan Statistical Area (MSA) was spatially assessed and shelter deficits in the region were estimated. These data provide essential information needed to eliminate shelter deficits and ensure a successful evacuation from a future storm. Spatial statistical methods-Global Moran's I, Anselin Local Moran's I (Local Indicators of Spatial Association [LISA]), and Hot Spot Analysis (Getis-Ord Gi*) were used to assess for regional spatial autocorrelation and clustering of evacuation shelters in the Houston-Galveston MSA. Shelter deficits were estimated in four ways-the aggregate deficit for the Houston-Galveston MSA, by evacuation Zip-Zone, by county, and by distance or radii of evacuation Zip-Zone. Evacuation shelters were disproportionately distributed in the region, with lower capacity shelters clustered closer to evacuation Zip-Zones (50 miles from the Coastal Zip-Zone), and higher capacity shelters clustered farther away from the zones (120 miles from the Coastal Zip-Zone). The aggregate shelter deficit for the Houston-Galveston MSA was 353,713 persons. To reduce morbidity and mortality associated with future hurricanes in the Houston-Galveston MSA, authorities should consider the development and implementation of policies that would improve the evacuation shelter capacity of the region. Eliminating shelter deficits, which has been done successfully in the state of Florida, is an essential element of protecting the public from hurricane impacts.

Improving Hurricane Harvey Disaster Research Response Through Academic-Practice Partnerships.

After Hurricane Harvey, researchers, media, and public health agencies collected data in Houston, Texas, to assess potential health effects and inform the public. To limit redundancy and ensure sampling coverage of impacted areas, research and practice partners used disaster research response (DR2) resources and relied on partnerships formed during a 2015 DR2 workshop in Houston. Improved coordination after the disaster can improve the effectiveness and efficiency of DR2 and enable the use of data to improve recovery and preparedness for future disasters.

A Spatial Analysis of Possible Environmental Exposures in Recreational Areas Impacted by Hurricane Harvey Flooding, Harris County, Texas.

Hurricane Harvey made landfall on the Texas Gulf Coast in August 2017 causing catastrophic flooding. Harris County is highly vulnerable to flooding, which is controlled in part by a system of bayous that include parks and trails. The petrochemical industry, as well as thousands of documented sources of environmental pollution make recreational areas susceptible to environmental contamination during flood events. Recreational areas and toxic exposure sources were geocoded by subwatershed boundaries and overlaid with the area of Hurricane Harvey inundation. A total of 121 of 349 (36.78%) parks were flooded; 102 of 121 (84.30%) were located in subwatersheds with at least one exposure source. A total of 337 exposure sources (6 Superfund, 32 municipal solid waste, and 299 petroleum storage tanks) in 30 subwatersheds were flooded. Though parks provide flood mitigation and other postdisaster benefits, their susceptibility to environmental contamination should be considered, especially in areas with a large number of toxic exposure sources.

Disaster impacts on cost and utilization of Medicare.

BACKGROUND: To estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available county-level Medicare claims for the years 2008-2012 with Federal Emergency Management Agency (FEMA) data related to disasters in each U.S. County from 2007 to 2012. METHODS: Fixed-effects generalized linear models were used to calculate change in per capita costs standardized by region and utilization per 1000 beneficiaries at the county level. Aggregate county demographic characteristics of Medicare participants were included as predictors of change in county-level utilization and cost. FEMA data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with claims data to create a balanced panel dataset from 2008 to 2012. RESULTS: In general, both cost and utilization of Medicare services were higher in counties with more hazard exposure. However, utilization of home health services was lower in counties with more hazard exposure. CONCLUSIONS: Additional research using individual-level data is needed to address limitations and determine the impacts of the substitution of services (e.g., inpatient rehabilitation for home health) that may be occurring in disaster affected areas during the post-disaster period.

Conducting Community Health Needs Assessments in the Local Public Health Department: A Comparison of Random Digit Dialing and the Community Assessment for Public Health Emergency Response.

CONTEXT: Community health needs assessments (CHNAs) are now required by the Affordable Care Act (ACA) for nonprofit hospitals and the Public Health Accreditation Board (PHAB) for local health departments that seek accreditation. Currently, various primary data collection methods exist that meet the ACA and PHAB requirements. OBJECTIVE: To compare 2 CHNA data collection methods implemented in the same geographical area from a local health department perspective. DESIGN AND SETTING: Two community surveys, one door-to-door and one telephone, in the 76706 zip code area of McLennan County, Texas. PARTICIPANTS: Adult survey respondents (Community Assessment for Public Health Emergency Response [CASPER]: N = 184; random digit dialing [RDD]: N = 133) of the 76706 zip code in McLennan County, Texas. MAIN OUTCOME MEASURES: Survey response rates, sociodemographic characteristics of survey respondents, and self-reported health behaviors from both community survey types. RESULTS: The CASPER survey had a contact rate of 36.0% and a cooperation rate of 60.5%, compared with a 10.1% response rate for the RDD survey. CASPER respondents were younger (26.6% aged 18-24 years), had lower education attainment (17.4% less than high school), and had a higher proportion of Hispanics (24.5%) than RDD respondents (4.6%, 10.5%, and 17.3%, respectively). CASPER respondents were less likely to report being overweight or obese (56.5%), to report days where no fruit or vegetables were consumed (7.1%), and to report days where no walking activity was conducted (9.8%) than RDD respondents (70.2%, 27.8%, and 21.8%, respectively). The CASPER survey cost less to conduct ($13 500) than the RDD survey ($100 000) and was logistically easier for the local health department to conduct using internally available resources. CONCLUSIONS: Local health departments use various data collection methods to conduct CHNAs for their populations and require varying levels of commitment and resources. RDD and CASPER can be used to meet ACA and PHAB requirements, collecting valuable health needs estimates and offer various strengths and weaknesses. PHAB and ACA requirements can be met using the CASPER or RDD survey to conduct CHNAs. However, local health departments may consider the CASPER survey a viable alternative to the RDD survey when time and resources are limited. The CASPER survey offers flexibility and efficiency and requires limited equipment and training.

How Health Department Contextual Factors Affect Public Health Preparedness (PHP) and Perceptions of the 15 PHP Capabilities.

OBJECTIVES: To assess how health department contextual factors influence perceptions of the 15 Public Health Preparedness Capabilities, developed by the Centers for Disease Control and Prevention (CDC) to provide guidance on organizing preparedness activities. METHODS: We conducted an online survey and focus group between September 2015 and May 2016 with directors of preparedness programs in state, metropolitan, and territorial jurisdictions funded by CDC's Public Health Emergency Preparedness (PHEP) cooperative agreement. The survey collected demographic information and data on contextual factors including leadership, partnerships, organizational structure, resources and structural capacity, and data and evaluation. RESULTS: Seventy-seven percent (48 of 62) of PHEP directors completed the survey and 8 participated in the focus group. Respondents were experienced directors (mean = 10.6 years), and 58% led 7 or more emergency responses. Leadership, partnerships, and access to fiscal and human resources were associated with perception and use of the capabilities. CONCLUSIONS: Despite some deficiencies, PHEP awardees believe the capabilities provide useful guidance and a flexible framework for organizing their work. Contextual factors affect perceptions of the capabilities and possibly the effectiveness of their use. Public Health Implications. The capabilities can be used to address challenges in preparedness, including identifying evidence-based practices, developing performance measures, and improving responses.