What's Missing from Data Modernization? A Focus on Structural Racism.

Public health data modernization efforts frequently overlook the far-reaching effects of structural racism across the data life cycle. Modernizing data requires creating data ecosystems grounded in six principles: dismantling structural racism and building community power explicitly; centering justice in all stages of data collection and analysis; ensuring communities can govern their data; driving positive population-level change; engaging nonprofit organizations; and obtaining commitments from governments to make changes in policy and practice. As government agencies spearhead and finance data modernization initiatives, it is imperative that they address structural racism head-on and integrate these principles into all aspects of their work.

Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019.

Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420-428. https://doi.org/10.2105/AJPH.2022.307192).

Connections Lab: a case study exploring a web-based innovation designed to advance shared risk and protective factor approaches to preventing injuries and violence.

BACKGROUND: Injuries and violence share many of the same risk and protective factors, which are rooted in the social determinants of health (SDOH) and the social determinants of equity. Addressing shared risk and protective factors (SRPFs)-common factors that make it more or less likely that a population will experience injuries or violence-is critical prevention efforts. The Safe States Alliance created the Connections Lab-a suite of web-based resources to help injury and violence prevention public health practitioners and their partners understand, describe, implement and evaluate SRPF approaches. DESIGN: A mixed-methods approach using the Diffusion of Innovation Theory assessed how the Connections Lab influenced users' knowledge, abilities and work related to SRPF approaches. A web-based survey was administered to 234 participants in April-May 2021. Semistructured virtual group discussions were conducted with a subset of 15 survey respondents who volunteered to participate. RESULTS: The case study revealed three key findings. The Connections Lab: was diffused among practitioners across sectors within and outside of public health; it increased practitioners' perceived proficiency across 10 skill sets related to describing, planning, implementing and evaluating SRPF approaches; and it increased understanding of the importance of upstream and structural drivers of injuries and violence. CONCLUSION: The Connections Lab was a critical first step to expand the definition of SRPF approaches, connect SRPFs to concepts of equity and the SDOH, and provide strategies for engaging partners in public health and across other sectors in SRPF approaches.

The Impact of the COVID-19 Pandemic on Public Interest in the Energy Labelling on Restaurant Menus.

No study has investigated the effect of the COVID-19 pandemic on the public's interest in using energy labelling on restaurant menus. This study explores the effects of the COVID-19 pandemic on the public interest in using energy labelling on restaurant menus and meal delivery applications and the impact of energy-labelling availability on food choices during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was completed by 1657 participants aged ≥ 18 years. Before the COVID-19 pandemic, 32% of customers visited a restaurant 2-4 times/week. However, during the pandemic, 35% of customers visited a restaurant only once per week. There was no difference in interest in reading energy labelling or using meal delivery applications before and during the pandemic. During the COVID-19 pandemic, about 55% of restaurant customers reported that they had noticed energy labelling, with 42% of them being influenced by the energy-labelling information. Regarding energy information on food delivery applications, 40% of customers noticed energy labelling when using the applications, with 33% of them being affected by the energy labelling. Customer interest in reading about energy on restaurant menus during the pandemic did not change significantly from the level of interest before the pandemic. The interest expressed by the public in using the energy labelling was low both before and during the COVID-19 pandemic.

Awareness of and Confidence to Address Equity-Related Concepts Across the US Governmental Public Health Workforce.

OBJECTIVE: To assess the governmental public health (GPH) workforce's awareness of and confidence to address health equity , social determinants of health ( SDoH ), and social determinants of equity ( SDoE ) in their work. DESIGN, SETTING, AND PARTICIPANTS: A nationally representative population of US local and state GPH employees (n = 41 890) were surveyed through the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021). MAIN OUTCOME MEASURES: Self-reported awareness and confidence were explored by self-identified racial and ethnic group identity, public health degree attainment, and supervisory status. RESULTS: GPH employees reported higher levels of awareness across concepts ( health equity -71%, 95% confidence interval [CI]: 70.5-71.6; SDoH -62%, 95% CI: 62.3-63.5; SDoE -48%, 95% CI: 47.2-48.4) than confidence ( health equity -48%, 95% CI: 47.8-49.0; SDoH -46%, 95% CI: 45.4-46.7; SDoE -34%, 95% CI: 33.4-34.6). Self-identified Black or African American employees reported higher confidence across all concepts ( health equity -56%, 95% CI: 54.3-57.6; SDoH -52%, 95% CI: 50.8-54.1; SDoE -43%, 95% CI: 41.3-44.6) compared to other self-identified racial groups. Employees with a PH degree reported higher confidence across all concepts ( health equity -65%, 95% CI: 63.8-68.8; SDoH -73%, 95% CI: 71.3-74.1; SDoE -39%, 95% CI: 36.9-40.1) compared with employees without a PH degree ( health equity -45%, 95% CI: 44.8-46.1; SDoH -41%, 95% CI: 40.6-41.9; SDoE -33%, 95% CI: 32.6-33.8). We found an inverse relationship between supervisory status and confidence to address SDoE : Nonsupervisors reported higher confidence (35%, 95% CI: 29.2-31.9) than supervisors (31%, 95% CI: 29.2-31.9), managers (31%, 95% CI: 28.8-32.6), and executives (32%, 95% CI: 27.5-34.4). CONCLUSION: PH WINS 2021 reveals that GPH employees are aware of equity-related concepts but lack confidence to address them. Public health agencies should build employees' confidence by prioritizing and operationalizing equity internally and externally in collaboration with communities and partners.

Effect of Whole-Genome Sequencing on the Clinical Management of Acutely Ill Infants With Suspected Genetic Disease: A Randomized Clinical Trial.

Importance: Whole-genome sequencing (WGS) shows promise as a first-line genetic test for acutely ill infants, but widespread adoption and implementation requires evidence of an effect on clinical management. Objective: To determine the effect of WGS on clinical management in a racially and ethnically diverse and geographically distributed population of acutely ill infants in the US. Design, Setting, and Participants: This randomized, time-delayed clinical trial enrolled participants from September 11, 2017, to April 30, 2019, with an observation period extending to July 2, 2019. The study was conducted at 5 US academic medical centers and affiliated children's hospitals. Participants included infants aged between 0 and 120 days who were admitted to an intensive care unit with a suspected genetic disease. Data were analyzed from January 14 to August 20, 2020. Interventions: Patients were randomized to receive clinical WGS results 15 days (early) or 60 days (delayed) after enrollment, with the observation period extending to 90 days. Usual care was continued throughout the study. Main Outcomes and Measures: The main outcome was the difference in the proportion of infants in the early and delayed groups who received a change of management (COM) 60 days after enrollment. Additional outcome measures included WGS diagnostic efficacy, within-group COM at 90 days, length of hospital stay, and mortality. Results: A total of 354 infants were randomized to the early (n = 176) or delayed (n = 178) arms. The mean participant age was 15 days (IQR, 7-32 days); 201 participants (56.8%) were boys; 19 (5.4%) were Asian; 47 (13.3%) were Black; 250 (70.6%) were White; and 38 (10.7%) were of other race. At 60 days, twice as many infants in the early group vs the delayed group received a COM (34 of 161 [21.1%; 95% CI, 15.1%-28.2%] vs 17 of 165 [10.3%; 95% CI, 6.1%-16.0%]; P = .009; odds ratio, 2.3; 95% CI, 1.22-4.32) and a molecular diagnosis (55 of 176 [31.0%; 95% CI, 24.5%-38.7%] vs 27 of 178 [15.0%; 95% CI, 10.2%-21.3%]; P < .001). At 90 days, the delayed group showed a doubling of COM (to 45 of 161 [28.0%; 95% CI, 21.2%-35.6%]) and diagnostic efficacy (to 56 of 178 [31.0%; 95% CI, 24.7%-38.8%]). The most frequent COMs across the observation window were subspecialty referrals (39 of 354; 11%), surgery or other invasive procedures (17 of 354; 4%), condition-specific medications (9 of 354; 2%), or other supportive alterations in medication (12 of 354; 3%). No differences in length of stay or survival were observed. Conclusions and Relevance: In this randomized clinical trial, for acutely ill infants in an intensive care unit, introduction of WGS was associated with a significant increase in focused clinical management compared with usual care. Access to first-line WGS may reduce health care disparities by enabling diagnostic equity. These data support WGS adoption and implementation in this population. Trail Registration: ClinicalTrials.gov Identifier: NCT03290469.

Prevalence and Predictors of Musculoskeletal Pain Among Undergraduate Students at a Dental School in Saudi Arabia.

OBJECTIVE: Musculoskeletal disorders (MSDs) are injuries to the musculoskeletal (MSK) system that occur due to repetitive or singular trauma and negatively affect one's daily life. Dentistry is a field that exposes professionals to the highest rate of work-related MSDs. This study aimed to assess the prevalence and predictors of MSK pain among a sample of dental students. METHODS: A cross-sectional study was conducted among a sample of 377 dental students and interns at the dental school of King Abdulaziz University, Jeddah, Saudi Arabia. We distributed a validated questionnaire, the Nordic Back Pain Questionnaire, which included additional questions, to all dental students participating in clinical practice and to dental interns. Categorical variables were described by presenting frequencies and percentages, and continuous variables by displaying means and standard deviations. Logistic regression was performed to identify predictors for developing MSK pain over the last 12 months. RESULTS: Overall, 91.2% of the participants experienced MSK pain or discomfort in one or more body parts over the last 12 months. The highest prevalence was for neck pain (69.2%), followed by shoulder pain (67.1%) and lower back pain (65%). Females were more likely than males to experience MSK pain (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.3-6.7), and those who exercised regularly were less likely to experience MSK pain than were those who did not (OR = 0.27, 95% CI: 0.1-0.6). CONCLUSION: This study showed a concerningly high prevalence of MSD symptoms among dental students, especially in the neck, shoulders, and lower back. Educational and occupational health programs in preclinical years could be effective for reducing MSK pain.

Characterization of the apical bridge barrier formed following amelogenin apexification.

BACKGROUND: Recombinant amelogenin protein (RAP) is reported to induce complete root apex formation in dog model when used as apexification therapy. It also induces pulp regeneration in 85% of the treated group. Thus, the aim of this study was to investigate the nature of the remaining regenerated calcified tissues of the RAP group that showed no pulp regeneration compared to the calcium hydroxide treated group (CH). METHODS: A total of 240 dogs' open apex root canals were used, after establishment of canals contamination. Canals were cleaned, irrigated, and filled with RAP as an apexification material and compared with CH. Treated teeth were assessed by H&E, trichrome staining, and/or immunohistochemistry technique, at 1, 3, and 6 months. RESULTS: A time-dependent increase in the calcified tissue barrier was observed in the apex of the RAP-treated group compared to the CH-treated group. The newly formed dentin in this RAP group was mainly tubular dentin and was functionally attached to the bone by periodontal ligament, while the CH group showed dentin-associated mineralized tissue (DAMT) associated with the newly formed apical barrier. CONCLUSIONS: Out results suggest that RAP can be used as novel apexification material, resulting in a thickening and strengthening of the canal walls, and achieving apical closure.

An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis.

BACKGROUND: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. OBJECTIVE: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). METHODS: We used commercial claims data from 2006 to 2010 linked to enrolled patients' medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. RESULTS: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. CONCLUSIONS: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. TRIAL REGISTRATION: ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj).

Law Accommodating Nonmotorized Road Users and Pedestrian Fatalities in Florida, 1975 to 2013.

OBJECTIVES: To examine the effect of Florida's adoption of Statute 335.065-a law requiring the routine accommodation of nonmotorized road users (i.e., a "Complete Streets" policy)-on pedestrian fatalities and to identify factors influencing its implementation. METHODS: We used a multimethod design (interrupted time-series quasi-experiment and interviews) to calculate Florida's pedestrian fatality rates from 1975 to 2013-39 quarters before and 117 quarters after adoption of the law. Using statistical models, we compared Florida with regional and national comparison groups. Semistructured interviews were conducted with 10 current and former Florida transportation professionals in 2015. RESULTS: Florida's pedestrian fatality rates decreased significantly-by at least 0.500% more each quarter-after Statute 335.065 was adopted, resulting in more than 3500 lives saved across 29 years. Interviewees described supports and challenges associated with implementing the law. CONCLUSIONS: Florida Statute 335.065 is associated with a 3-decade decrease in pedestrian fatalities. The study also reveals factors that influenced the implementation and effectiveness of the law. Public Health Implications. Transportation policies-particularly Complete Streets policies-can have significant, quantifiable impacts on population health. Multimethod designs are valuable approaches to policy evaluations.

Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality.

BACKGROUND: Racial disparities in trauma outcomes occur, but disparities in fall mortality are unknown. The objective of this study was to determine inhospital and 1-year fall mortality among patients discharged from an urban trauma center. METHODS: We conducted a retrospective analysis of fall patients in our trauma registry (1997 to 2008) linked to the National Death Index to determine postdischarge mortality. Statistical analysis included chi-square tests, multivariable logistic regression, and Cox proportional hazards models. RESULTS: There were 7,541 fall admissions. There was no clinically significant difference in inhospital mortality between blacks and whites with age stratification. One year after discharge, blacks younger than 65 years were more likely to die of disease (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.62). CONCLUSIONS: Although rates of inhospital mortality are similar, blacks younger than 65 years have a higher risk of dying after discharge due to disease when stratified by age highlighting the need for continued medical follow-up and prevention efforts.

Long-Term Outcomes of Incredible Years Parenting Program: Predictors of Adolescent Adjustment.

BACKGROUND AND METHOD: Fifty-eight boys and 20 girls with early onset conduct problems whose parents received the Incredible Years (IY) parent treatment program when they were 3-8 years (mean 58.7 months) were contacted and reassessed regarding their social and emotional adjustment 8-12 years later. Assessments included home interviews with parents and teenagers separately. RESULTS AND CONCLUSION: Adolescent reports indicated that 10% were in the clinical range on internalising behaviours, 23% had engaged in major delinquent acts, and 46% reported some substance use. Eighteen percent of children had criminal justice system involvement and 42% had elevated levels of externalising behaviours (mother report). Post-treatment factors predicting negative outcomes (delinquent acts) were maternal reports of behaviour problems and observed mother-child coercion.

Sedative and anxiolytic effects of different fractions of the Commelina benghalensis Linn.

The present study was designed to investigate sedative and anxiolytic properties of the four different fractions (chloroform, pet ether, n-butanol and hydromethanol soluble fractions, coded as CFCB, PECB, NBCB and HMCB, respectively) of the aerial parts of Commelina benghalensis using rodent behavioral models, such as hole cross, open field and thiopental sodium induced sleeping time tests for sedative property and elevated plus-maze (EPM) test for anxiolytic potential, respectively. All fractions, at the doses of 200 mg/kg, p.o. and 400 mg/kg, p.o., displayed dose dependent suppression of motor activity, exploratory behavior (in hole cross and open field tests) and prolongation of thiopental induced sleeping time in mice; maximum effect was shown by chloroform (CFCB) and pet ether (PECB) fractions. In EPM test, chloroform (CFCB) and pet ether (PECB) fractions with similar doses significantly (p < 0.05) increased exploration to and time spent by the treated mice in EPM open arms in a way similar to that of diazepam while the effect of NBCB and HMCB fractions on entry to and time spent in open arms was not found to be statistically significant. These findings provide in vivo evidence that aerial parts of C. benghalensis in general, and chloroform (CFCB) and pet ether (PECB) soluble fraction has significant sedative and anxiolytic effects. Furthermore, these results may justify the scientific basis for the use of this plant in traditional medicine as a modality for anxiety and related disorders.

A histidine scan to probe the flexibility of the rat P2X2 receptor zinc-binding site.

The response of P2X(2) receptors to submaximal concentrations of ATP is potentiated by low levels of extracellular zinc. Histidines 120 and 213 have previously been shown to be essential in binding zinc across an intersubunit binding site. We tested the flexibility of the zinc-binding site by making mutations that had the effect of shifting the two essential histidines up to 13 residues upstream or downstream from their original positions and then testing the ability of the mutated receptors to respond to zinc. Using this method, we were able to explore potential orientations of the two regions relative to one another. Our data are consistent with a moderately flexible zinc-binding site and inconsistent with parallel and anti-parallel orientations of the regions surrounding histidines 120 and 213.

Serum complement (C3, C4) levels in patients with acute myocardial infarction and angina pectoris.

Serum complement (C3, C4) levels in Libyan patients with acute myocardial infarction (AMI; 31 patients) and angina pectoris (AP; 11 patients) at the 1st day and 7th day of attack were estimated. A group of 26 healthy Libyans were taken as control subjects (CS). Serum C3 and C4 levels (mean +/- SD, mg/dl) were elevated at the 1st day in AMI as well as AP patients (C3 --> AMI1: 154.0 +/- 28.5, AP1: 152.0 +/- 45.0, CS: 132.0 +/- 8.0, ANOVA: p = 0.0072; C4 --> AMII1: 38 +/- 13, AP1: 37 +/- 17, CS: 29 +/- 6, ANOVA: p = 0.0160). No significant differences for the elevated C3 and C4 levels at the 1st day were observed between the two diseases groups (AMI1 vs AP1 --> C3: p = 0.879, C4: p = 0.818). At the 7th day, C3 and C4 levels were further elevated in AMI, while they remained at the similar elevated levels in AP (C3 --> AMI 7: 173.1 +/- 28.0, AP 7: 149.0 +/- 41.0, CS: 132.0 +/- 8.0, ANOVA: p = 0.0000; C4 --> AMI 7: 46.0 +/- 7.0, AP 7: 36.0 +/- 15.0, CS: 29.0 +/- 6.0, ANOVA: p = 0.0000). Again, no significance differences for the raised C3 and C4 levels at the 7th day was observed between AMI and AP patients (AMI 7 vs AP 7 --> C3: P = 0.059, C4: p = 0.06). The C3 elevation showed significant positive correlation in AMI group (r = 0.522, p = 0.003) while it was insignificant in AP patients (r = 0.037, p = 0.915). Regarding C4 levels, it was significantly correlated in AMI (r = 0.483, p = 0.006), and in AP, although it was positively correlated (r = 0.656, P = 0.028) the observed difference was not significant (t = 0.29, p = 0.778). In conclusion, serum C3 and C4 levels were more profoundly elevated in AMI compared to AP patients suggestive of an acute phase and inflammatory response.

A review of septic induced abortion cases in one year at Khyber Teaching Hospital, Peshawar.

BACKGROUND: Working in a tertiary level hospital we get complicated cases as a result of termination or attempts at termination of unwanted pregnancies. Most of the patients that we get are complicated and need expensive treatments including surgery. This study was conducted to assess the out come of septic induced abortion cases in a year. METHODS: It was conducted at the Department of Obstetrics and Gynaecology, unit B, Khyber Teaching Hospital, Peshawar, from 1.7.01 to 30.6.02. The data of a total of 28 patients admitted as emergency cases with septic induced abortion in above period were collected. History, management given, post operative care, complications and associated morbidity and mortality were taken into account and result compiled. RESULTS: 78.5% patients with unsafe abortions were multi gravida. Termination was attempted at home or other small centers. 57%, had history of surgical interference, 28.5% had used a mechanical device. 78.5% patients needed evacuation and curettage, 42% had laparotomy for visceral injuries. 15% patients had a subtotal hysterectomy. 57% patients had associated complications. 7.5% patients who came with septicemic shock died. CONCLUSION: Septic induced abortion is an important contributor to maternal morbidity and mortality, increasing the burden on not only the patients but health workers and their resources. However, it is preventable, and we suggest commitment to health education, family planning promotion and bringing down the rates of unsafe abortions as solutions to the problems.

Characterization and in silico mapping of a novel murine zinc finger transcription factor.

Transcription factors play important roles in development and homeostasis. We have completed an embryonic stem cell-based neural differentiation screen, which was carried out with a view to isolating early regulators of neurogenesis. Fifty eight of the expressed sequence tags isolated from this screen represent known transcription factors or sequences containing transcription factor motifs. We have determined the full-length sequence of a novel mouse zinc finger-containing gene (ZFEND; also known as Mus musculus zinc finger protein 358 (Zfp358)) that was identified from this screen. ZFEND has 87% nucleotide and 86% amino acid identity to a previously identified human cDNA, FLJ10390, which is moderately similar to zinc finger protein 135. Northern blotting and RPAs demonstrate highest expression of ZFEND during mid-late mouse embryogenesis. Expression is also observed in several adult tissues with highest expression in heart, brain, and liver. Whole-mount in situ hybridization studies reveal apparent ubiquitous expression of ZFEND during mid-gestation stages (embryonic days 11.5, 12.5), while sections of whole-mount embryos reveal much higher expression levels in the neural folds during neural tube closure and at the boundary between the forelimb buds and the body wall. Bioinformatic analysis maps ZFEND to mouse chromosome 8pter, while FLJ10390 resides on 19p13.3-p13.2, a gene-rich region to which a number of disorders have been mapped. More precise mapping indicates that the involvement of FLJ10390 in atherogenic lipoprotein phenotype, familial febrile convulsions 2, and psoriasis susceptibility cannot be ruled out.