Geographic and socioeconomic access disparities to Phase 3 clinical trials in ophthalmology in the United States.

BACKGROUND/OBJECTIVE: To identify geographic and socioeconomic variables associated with residential proximity to Phase 3 ophthalmology clinical trial sites. METHODS: The geographic location of clinical trial sites for Phase 3 clinical trials in ophthalmology was identified using ClinicalTrials.gov. Driving time from each United States (US) census tract centroid to nearest clinical trial site was calculated using real traffic patterns. Travel data were crosslinked to census-tract level public datasets from United States Census Bureau American Community Survey (ACS). Cross-sectional multivariable regression was used to identify associations between census-tract sociodemographic factors and driving time (>60 min) from each census tract centroid to the nearest clinical trial site. RESULTS: There were 2330 unique clinical trial sites and 71,897 census tracts. Shortest median time was to retina sites [33.7 min (18.7, 70.1 min)]. Longest median time was to neuro-ophthalmology sites [119.8 min (48.7, 240.4 min)]. Driving >60 min was associated with rural tracts [adjusted odds ratio (aOR) 7.60; 95% CI (5.66-10.20), p < 0.0001]; Midwest [aOR 1.84(1.15-2.96), p = 0.01], South [aOR 2.57 (1.38-4.79), p < 0.01], and West [aOR 2.52 (1.52-4.17), p < 0.001] v. Northeast; and tracts with higher visual impairment [aOR 1.07 (1.03-1.10), p < 0.001)]; higher poverty levels [4th v.1st Quartile of population below poverty, aOR 2.26 (1.72-2.98), p < 0.0001]; and lower education levels [high school v. Bachelor's degree or higher aOR 1.02 (1.00-1.03), p = 0.0072]. CONCLUSIONS: There are significant geographic and socioeconomic disparities in access to ophthalmology clinical trial sites for rural, non-Northeastern, poorer, and lower education level census tracts, and for census tracts with higher levels of self-reported visual impairment.

Race is a Risk Factor for the Deferral of Resection and Radiation for Early-Stage Lung Cancer.

PURPOSE: There remain profound race-related disparities in the treatment of non-small cell lung cancer (NSCLC). Deferral of operative management for early-stage disease is recognized as driver of this disparity. Black race has been associated with higher rates of surgical deferral. It remains unclear how race impacts likelihood of receiving radiation therapy after declining surgical management of NSCLC. PATIENTS AND METHODS: A retrospective cohort analysis was completed using data from the National Cancer Database (NCBD) for patients 18 and over with stage I NSCLC offered surgical resection from 2004 to 2015 (N = 89,462). Multivariable logistic regression identified predictors of surgical deferral and predictors for deferral of radiation after deferral of surgery. Kaplan-Meier survival analysis with log-rank tests and multivariable Cox proportional hazards regressions were performed. RESULTS: 87,293 (97.6%) patients underwent surgery, 2169 (2.4%) deferred. Patients who deferred had 2.1 times higher hazard ratio for mortality, (HR = 2.08, [1.97, 2.29], P < .001). Of those that deferred, 1250 (57.6%) received postdeferral radiation. Compared to White patients, Black patients had OR of 1.82 for deferring both surgery and radiation (aOR: 1.82, [1.31, 2.53], P < .001) and Asian and Pacific Island (API) patients had an OR of 2.67 (aOR: 2.67, [1.27, 4.64], P = .008). Other predictors of deferral of therapy included: Medicare or lack of insurance, and treatment at nonacademic medical centers. CONCLUSION: Insurance status and Black race, and API race are associated with deferring surgical therapy and radiation therapy for NSCLC. These findings are consistent with the large body of work showing worse outcomes for treatment of NSCLC in minority patients.

Impact of exergaming on young children's school day energy expenditure and moderate-to-vigorous physical activity levels.

BACKGROUND: Although emerging research is demonstrating the potential health impact of exergaming, investigations have primarily been conducted in laboratory settings among small samples with short-term interventions. Information on the effectiveness of exergaming in underserved children's objective physical activity (PA) in population-based settings is also scarce. Moreover, most empirical studies have only included 1 type of exergame in the intervention. Therefore, this study's purpose was to investigate the long-term impact of a multigame exergaming intervention among underserved children integrated within school curricula. Specifically, this study examined the effect of exergaming on children's accelerometer-determined sedentary behavior (SB), light PA, moderate-to-vigorous PA (MVPA), and energy expenditure (EE) over 2 years as compared with regular physical education (PE) classes. METHODS: A total of 261 second- and third-grade children (134 girls, 127 boys; mean age 8.27 years) were recruited from 2 Texas elementary schools. Children's pre-test 3-day SB, light PA, MVPA, and EE at school were assessed in the fall of 2012. Participants were assigned to 1 of 2 groups: (1) exergaming/PE group (125 min weekly of exergaming-based PA program) and (2) comparison group (125 min weekly of PE). PA (SB, light PA, and MVPA) and EE outcome variables were assessed again in 2013 (post-test) and 2014 (follow-up). RESULTS: Significant time effects were observed for SB (F(1, 162) = 25.0, p < 0.01, η 2 = 0.14), light PA (F(1, 162) = 9.6, p < 0.01, η 2 = 0.06), and MVPA (F(1, 162) = 6.2, p = 0.01, η 2 = 0.04) but not for EE (F(1, 162) = 0.63, p > 0.05, η 2 = 0.004). Subsequent pairwise comparisons revealed significant increases from pre- to post-test for light PA (p < 0.01), MVPA (p < 0.01), and EE (p = 0.02) with no changes in SB (p > 0.05). Conversely, significant decreases occurred in light PA (p < 0.01) from post-test to follow-up with no differences seen in MVPA (p = 0.08) and EE (p = 0.06) over the same time period. A significant increase was seen, however, for SB from post-test to follow-up. CONCLUSION: Exergaming PE can have the same positive effect on children's light PA, MVPA, and EE as regular PE. More research is necessary to discern how to promote long-term PA participation after conclusion of the intervention.

Walk on the wild side: estimating the global magnitude of visits to protected areas.

How often do people visit the world's protected areas (PAs)? Despite PAs covering one-eighth of the land and being a major focus of nature-based recreation and tourism, we don't know. To address this, we compiled a globally-representative database of visits to PAs and built region-specific models predicting visit rates from PA size, local population size, remoteness, natural attractiveness, and national income. Applying these models to all but the very smallest of the world's terrestrial PAs suggests that together they receive roughly 8 billion (8 x 109) visits/y-of which more than 80% are in Europe and North America. Linking our region-specific visit estimates to valuation studies indicates that these visits generate approximately US $600 billion/y in direct in-country expenditure and US $250 billion/y in consumer surplus. These figures dwarf current, typically inadequate spending on conserving PAs. Thus, even without considering the many other ecosystem services that PAs provide to people, our findings underscore calls for greatly increased investment in their conservation.