Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center.

Importance: The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas. Objective: To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses. Design, Setting, and Participants: This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023. Exposures: Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison. Main Outcomes and Measures: The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis. Results: This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis. Conclusions and Relevance: In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.

A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center.

BACKGROUND: The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS: Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS: Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS: The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT: Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.

Profissão e vocação: a enfermagem em questão / Profession and vocation: nursing in question / Profesión y vocación: la enfermería en cuestión

Objetivo: Identificar os motivos pelos quais levaram os estudantes a escolherem a formação universitário em Enfermagem. Metodologia: Estudo exploratório- descritivo, sob abordagem qualitativa, desenvolvido com 276 acadêmicos de Enfermagem de uma universidade pública do Noroeste do estado do Ceará, Brasil. As informações foram coletadas por meio de um questionário eletrônico, aplicado por meio da plataforma Google Forms®. Essas por sua vez, foram analisadas a partir de análise de conteúdo proposto por Minayo, com o suporte do software N VIVO 11®. Resultados: As palavras mais referidas pelos estudantes ao serem questionados acerca dos motivos na escolha do curso de Enfermagem, foram: "Área", "Saúde", "Curso" e "Profissão", as quais suscitam que em algumas situações a escolha do curso aconteceu pela área da Saúde e não pelo curso em específico. Entretanto, outras palavras com maior quantitativo de repetição foram identificadas: "Sempre", "Gosto" e "Enfermagem", que por sua vez, demonstram a identificação com o curso de Enfermagem em específico e com o fazer da profissão. A partir de então, foram definidas seis categorias de análise, a saber "Identificar-se com a profissão", "Determinação Social e Mercado de Trabalho", "Enfermagem como segunda ou única opção", "Influências externas", "Permanência na área da Saúde" e "Vocação e visão solidária-romântica". Considerações finais: A partir dos discursos dos participantes em estudo, evidenciou-se que os motivos pelos quais levaram esses a ingressarem no curso universitário em Enfermagem estão associados ao imaginário da vocação, da concepção da Enfermagem enquanto profissão voltada para o cuidar/cuidado, bem como pelo o interesse de atuação na área da saúde.

Objective: To identify the reasons why students chose a university degree in Nursing. Methodology: Exploratory-descriptive study, under a qualitative approach, developed with 276 Nursing students from a public university in the Northwest of the state of Ceará, Brazil. Information was collected through an electronic questionnaire, applied through the Google Forms® platform. These, in turn, were analyzed based on the content analysis proposed by Minayo, with the support of the N VIVO 11® software. Results: The words most mentioned by students when asked about the reasons for choosing the Nursing course were: "Area", "Health", "Course" and "Profession", which suggest that in some situations the choice of course happened by the Health area and not by the specific course. However, other words with a higher number of repetitions were identified: "Always", "I like" and "Nursing", which, in turn, demonstrate identification with the Nursing course in particular and with the profession. From then on, six categories of analysis were defined, namely "Identifying with the profession", "Social Determination and the Labor Market", "Nursing as a second or only option", "External influences", "Permanence in the area of Health" and "Vocation and solidarity-romantic vision". Final considerations: From the speeches of the participants in the study, it was evident that the reasons why they entered the university course in Nursing are associated with the imaginary of the vocation, of the conception of Nursing as a profession focused on care/care, as well as as well as the interest in acting in the health area.

Objetivo: Identificar las razones por las cuales los estudiantes eligieron la carrera universitaria de Enfermería. Metodología: Estudio exploratorio-descriptivo, con abordaje cualitativo, desarrollado con 276 estudiantes de Enfermería de una universidad pública del Noroeste del estado de Ceará, Brasil. La información se recolectó a través de un cuestionario electrónico, aplicado a través de la plataforma Google Forms®. Estos, a su vez, fueron analizados con base en el análisis de contenido propuesto por Minayo, con el apoyo del software N VIVO 11®. Resultados: Las palabras más mencionadas por los estudiantes cuando se les preguntó acerca de los motivos de la elección de la carrera de Enfermería fueron: "Área", "Salud", "Curso" y "Profesión", lo que sugiere que en algunas situaciones la elección de la carrera pasó por la carrera de Enfermería. área y no por el curso específico. Sin embargo, fueron identificadas otras palabras con mayor número de repeticiones: "Siempre", "Me gusta" y "Enfermería", que, a su vez, demuestran identificación con la carrera de Enfermería en particular y con la profesión. A partir de ahí, se definieron seis categorías de análisis, a saber, "Identificación con la profesión", "Determinación social y mercado de trabajo", "Enfermería como segunda o única opción", "Influencias externas", "Permanencia en el área de la Salud". " y "Vocación y visión solidaria-romántica". Consideraciones finales: A partir de los discursos de los participantes en el estudio, se evidenció que las razones por las cuales ingresaron a la carrera universitaria en Enfermería están asociadas al imaginario de la vocación, de la concepción de la Enfermería como profesión enfocada en el cuidado, así como el interés por actuar en el área de la salud.

A comparison of methods for measuring spatial access to health care.

OBJECTIVE: To compare measures of spatial access to care commonly used by policy makers and researchers with the more comprehensive enhanced two-step floating catchment area (E2SFCA) method. STUDY SETTING: Fourteen southwestern Pennsylvania counties. STUDY DESIGN: We estimated spatial access to buprenorphine-waivered prescribers using three commonly used measures-Euclidean travel distance to the closest prescriber, travel time to the closest provider, and provider-to-population ratios-and the E2SFCA. Unlike other measures, the E2SFCA captures provider capacity, potential patient volume, and travel time to prescribers. DATA COLLECTION/EXTRACTION METHODS: We measured provider capacity as the number of buprenorphine prescribers listed at a given address in the Drug Enforcement Agency's 2020 Controlled Substances Act Registrants Database, and we measured potential patient volume as the number of nonelderly adults in a given census tract as reported by the 2018 American Community Survey. We estimated travel times between potential patients and prescribers with Bing Maps and Mapbox application programming interfaces. We then calculated each spatial access measure using the R programming language. We used each measure of spatial access to identify census tracts in the lowest quintile of spatial access to prescribers. PRINCIPAL FINDINGS: The Euclidean distance, travel time, and provider-to-population ratio measures identified 48.3%, 47.2%, and 69.9% of the census tracts that the E2SFCA measure identified as being in the lowest quintile of spatial access to care, meaning that these measures misclassify 30%-52% of study area census tracts as having sufficient spatial access to buprenorphine prescribers. CONCLUSIONS: Measures of spatial access commonly used by policy makers do not sufficiently accurately identify geographic areas with relatively low access to prescribers of buprenorphine. Using the E2SFCA in addition to the commonly used measures would allow policy makers to precisely target interventions to increase spatial access to opioid use disorder treatment and other types of health care services.

Trends in Incidence and Transmission Patterns of COVID-19 in Valencia, Spain.

Importance: Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. Objective: To describe the local spread of SARS-CoV-2 in Valencia, Spain. Design, Setting, and Participants: This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. Exposures: Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. Main Outcomes and Measures: The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. Results: In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (ß2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (ß1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. Conclusions and Relevance: This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.

Prostate cancer diagnosis, staging, and treatment in Sweden during the first phase of the COVID-19 pandemic.

INTRODUCTION: The first case of COVID-19 in Sweden was diagnosed in late January 2020, the first recommendations against the spread of the virus were released in mid-March, and the peak of the first wave of the pandemic was reached in March-June. The aim of this cross-sectional study was to assess the short-term effects of the first wave of the COVID-19 pandemic on prostate cancer (PCa) diagnosis, staging, and treatment. MATERIALS AND METHODS: Data in the National Prostate Cancer Register (NPCR) of Sweden on newly diagnosed PCa cases and on the number of diagnostic and therapeutic procedures performed between 18 March 2020 and 2 June 2020 were compared with those in the corresponding time periods in 2017-2019, as reported until January 31 of the year after each study period. RESULTS: During the study period in 2020, 36% fewer PCa cases were registered in NPCR compared with the corresponding time period in previous years: 1458 cases in 2020 vs a mean of 2285 cases in 2017-2019. The decrease in new PCa registrations was more pronounced in men above age 75 years, down 51%, than in men aged 70-75, down 37%, and in men below age 70, down 28%. There was no decrease in the number of radical prostatectomies and number of radical radiotherapy courses increased by 32%. CONCLUSIONS: During the peak of the first phase of the COVID-19 pandemic, the number of men diagnosed with PCa in Sweden decreased by one third compared with previous years, whereas there was no decrease in the number of curative treatments.

Processo de trabalho em saúde bucal: disparidade entre as equipes no Brasil, 2014 / Proceso de trabajo de salud bucal: disparidad entre equipos en Brasil, 2014 / Oral health work process: disparity between teams in Brazil, 2014

Objetivo: Comparar o desempenho das equipes de saúde bucal (ESBs) das modalidades I e II no processo de trabalho e as diferenças entre regiões brasileiras. Métodos: Estudo transversal, com dados das ESBs que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (2013-2014). A análise de classes latentes identificou subgrupos de ESBs segundo desempenho (consolidado, em desenvolvimento ou incipiente) no processo de trabalho (planejamento das ações; promoção da saúde; atenção integral). Comparadas as modalidades, obteve-se o índice de disparidade. Resultados: Avaliadas 15.886 ESBs, as da modalidade II apresentaram maior percentual de processo de trabalho consolidado nas regiões Sudeste (67,8 a 94,6%) e Sul (54,8 a 93,0%); observou-se maior disparidade no processo de trabalho consolidado entre ESBs da modalidade II (6,3 a 26,5), comparadas à modalidade I (3,9 a 18,4). Conclusão: ESBs da modalidade II guardam potencial para melhor desempenho no processo de trabalho, com disparidades regionais.

Objetivo: Comparar Equipos de Salud Bucal (ESB) modalidades I y II cuanto al desempeño en el proceso de trabajo y diferencias entre regiones brasileñas. Métodos: Estudio transversal con datos de la ESB adherida al Programa Nacional de Mejoramiento del Acceso y la Calidad en Atención Primaria (2013-2014). Análisis de Clases Latentes identificaron subgrupos de ESB según el desempeño (consolidado, en desarrollo o incipiente) en el proceso de trabajo (planificación de acciones, promoción de salud y atención integral). Se compararon las modalidades y se obtuvo el Índice de Disparidad. Resultados: Participaron 15.886 ESBs, las de modalidad II presentaron mayor porcentaje de proceso de trabajo consolidado en la región Sudeste (67,8% a 94,6%) y Sur (54,8% a 93,0%). La disparidad fue mayor entre la modalidad II (6,3 a 26,5) en comparación con la I (3,9 a 18,4). Conclusión: las ESBs modalidad II tienen potencial para obtener mejor desempeño en el proceso de trabajo, pero hubo disparidad regional.

Objective: To compare Modality I and Modality II Oral Health Teams (OHT) regarding work process performance and differences between Brazilian regions. Methods: This was a cross-sectional study with OHTs that took part in the National Program for Primary Health Care Access and Quality Improvement (2013-2014). Latent Class Analysis identified OHT subgroups according to work process (action planning, health promotion actions and comprehensive health care) performance (consolidated, developing or incipient). OHT modalities were compared, resulting in an Index of Disparity. Results: After evaluating 15,886 OHTs, Modality II OHTs were found to have a higher percentage of consolidated work processes in the Southeast (67.8%-94.6%) and Southern (54.8%-93.0%) regions. Disparity in the consolidated work process was greater among Modality II OHTs (6.3-26.5) compared to Modality I OHTs (3.9-18.4). Conclusion: Modality II OHTs have the potential for better performance regarding the work process, but with regional disparities.

Unequable spatial accessibility to hospitals in developing megacities: New evidence from Beijing.

The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.

Rapidly measuring spatial accessibility of COVID-19 healthcare resources: a case study of Illinois, USA.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.

Capability ... what's in a word? Rural Doctors Network of New South Wales Australia is shifting to focus on the capability of rural health professionals.

Rural health services, and the workforces that provide those services, are under unprecedented pressure due to insufficient health workforce numbers and distribution of health workforce weighted to urban areas. This creates health service access issues in rural areas, compounding existing health inequalities between rural and urban people. Many approaches to date have aimed to rectify these issues, with moderate success. In this article we present a call to action to pursue a complementary approach: supporting the capability of the rural health workforce. We hypothesise that further exploring what it means to be a 'capable' rural health professional and what processes or conditions support or erode capability may additionally bolster efforts toward strong rural and remote health systems. The Capability Approach is a theory proposed by Amartya Sen, who was awarded the Nobel Memorial Prize in Economic Sciences in 1998 for this work. Although the Capability Approach inspired, for instance, the UN's Human Development Index, it has not been deeply explored in the context of rural health workforce. While still untested, a focus on capability may assist us in taking a broader view, which encompasses functioning and the freedom to pursue different functioning combinations. The feasible freedom and opportunities are paramount to the concept of capability. We posit that competence is static and the responsibility of the practitioner (and their education), but that capability is fluid and multi-dimensional and the responsibility of the practitioner, community and system. Therefore, we hypothesise that a focus on a Capability Approach, which modulates the relation between the contextual factors and outcomes, may provide us with greater understanding and avenues for action when we aim to improve outcomes such as rural health service sustainability. Developing a list of appropriate capabilities and setting strategies to support capability and its more nuanced domains may present unique opportunities for influence, and these may have positive effects on the rural health workforce. Of course it will need to be determined if improving rural primary health professionals' capability has positive impacts upon quality and access to care, and whether supporting capability is sustainable and worthy of investment.

Geosocial Factors Associated With Adherence to Statin Medications.

BACKGROUND: Individual patient characteristics, social determinants, and geographic access may be associated with patients engaging in appropriate health behaviors. OBJECTIVE: To assess the relationship between statin adherence, geographic accessibility to pharmacies, and neighborhood sociodemographic characteristics in Michigan. METHODS: The proportion of days covered (PDC) was calculated from pharmacy claims of a large insurer of adults who had prescriptions for statins between July 2009 and June 2010. A PDC ≥0.80 was defined as adherent. The predictor of interest was a ZIP code tabulation area (ZCTA)-level measure of geographic accessibility to pharmacies, measured using a method that integrates availability and access into a single index. We fit unadjusted models as well as adjusted models controlling for age, sex, and ZCTA-level measures of socioeconomic status (SES), racial isolation (RI) of non-Hispanic blacks, and urbanicity. RESULTS: More than 174 000 patients' claims data were analyzed. In adjusted models, pharmacy access was not associated with adherence (0.99; 95% CI: 0.96, 1.03). Greater RI (0.87; 95% CI: 0.85, 0.88) and urban status (0.93; 95% CI: 0.89, 0.96) were associated with lower odds of adherence. Individuals in ZCTAs with higher SES had higher odds of adherence, as were men and older age groups. CONCLUSION AND RELEVANCE: Adherence to statin prescriptions was lower for patients living in areas characterized as being racially segregated or lower income. Initiating interventions to enhance adherence, informed by understanding the social and systematic barriers patients face when refilling medication, is an important public health initiative that pharmacists practicing in these areas may undertake.

Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology.

Importance: Social determinants of health, such as income, education, housing quality, and employment, are associated with disparities in Alzheimer disease and health generally, yet these determinants are rarely incorporated within neuropathology research. Objective: To establish the feasibility of linking neuropathology data to social determinants of health exposures using neighborhood disadvantage metrics (the validated Area Deprivation Index) and to evaluate the association between neighborhood disadvantage and Alzheimer disease-related neuropathology. Design, Setting, and Participants: This cross-sectional study consisted of decedents with a known home address who donated their brains to 1 of 2 Alzheimer disease research center brain banks in California and Wisconsin between January 1, 1990, and December 31, 2016. Neither site had preexisting social metrics available for their decedents. Neuropathologic features were obtained from each site for data collected using the standardized Neuropathology Data Set form and from autopsy reports. Data were analyzed from June 7 to October 10, 2019. Exposures: Geocoded decedent addresses linked to neighborhood disadvantage as measured by the Area Deprivation Index calculated for the year of death. Main Outcomes and Measures: Presence of Alzheimer disease neuropathology. The association between neighborhood disadvantage and Alzheimer disease neuropathology was evaluated via logistic regression, adjusting for age, sex, and year of death. Results: The sample consisted of 447 decedents (249 men [56%]; mean [SD] age, 80.3 [9.5] years; median year of death, 2011) spanning 24 years of donation. Fewer decedents (n = 24 [5.4%]) originated from the top 20% most disadvantaged neighborhood contexts. Increasing neighborhood disadvantage was associated with an 8.1% increase in the odds of Alzheimer disease neuropathology for every decile change on the Area Deprivation Index (adjusted odds ratio, 1.08; 95% CI, 1.07-1.09). As such, living in the most disadvantaged neighborhood decile was associated with a 2.18 increased odds of Alzheimer disease neuropathology (adjusted odds ratio, 2.18; 95% CI, 1.99-2.39). Conclusions and Relevance: The findings of this cross-sectional study suggest that social determinants of health data can be linked to preexisting autopsy samples as a means to study sociobiological mechanisms involved in neuropathology. This novel technique has the potential to be applied to any brain bank within the United States. To our knowledge, this is the first time Alzheimer disease neuropathology has been associated with neighborhood disadvantage.

A primer for cancer research programs on defining and evaluating the catchment area and evaluating minority clinical trials recruitment.

National Cancer Institute (NCI) designated cancer centers are charged with reducing disparities, improving cancer-related health outcomes, and increasing clinical trial participation for the catchment area population. Succeeding in this endeavor requires a clear definition of each cancer center's geographic catchment area as well as the demographic characteristics of the populations residing in the catchment area. For this reason, the definition of the catchment area is now a required element of NCI grant applications. This primer provides detailed information related to the definition of cancer centers' catchment areas and provides a case example from the University of Texas MD Anderson Cancer Center to highlight best practice strategies for compiling and interpreting cancer health statistics for the catchment area.

A Linked Community and Health Facility Intervention to Improve Newborn Health in Cambodia: the NICCI Stepped-Wedge Cluster-Randomized Controlled Trial.

BACKGROUND: Newborn mortality in Cambodia remains high, with sepsis and complications of delayed care-seeking important contributing factors. Intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns; increase recognition of danger signs, and prompt care-seeking at an appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants. METHODS: The stepped-wedge cluster-randomized controlled trial took place in rural Cambodia from February 2015 to November 2016. Sixteen clusters consisted of public health center catchment areas serving the community. The intervention included health center staff training and home visits to mothers by community health volunteers within 24 hours of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs and counselling mothers. The trial participants included women who had recently delivered a newborn who were visited in their homes in the first week, as well as health center staff and community volunteers who were trained in newborn care. Women in their last trimester of pregnancy greater than 18 years of age were recruited and were blinded to their group assignment. Mothers and caregivers (2494) received counseling on handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. RESULTS: Health center staff in the intervention group had increased likelihood of hand washing at recommended key moments when compared with the control group, increased knowledge of danger signs, and higher recall of at least three hygiene messages. Of mother/caregiver participants at 14 days after delivery, women in the intervention group were much more likely to know at least three danger signs and to have received messages on care-seeking compared with controls. CONCLUSIONS: The intervention improved factors understood to be associated with newborn survival and health. Well-designed training, followed by regular supervision, enhanced the knowledge and self-reported behavior of health staff and health volunteers, as well as mothers' own knowledge of newborn danger signs. However, further improvement in newborn care, including care-seeking for illness and handwashing among mothers and families, will require additional involvement from broader stakeholders in the community.

Automated delineation of hospital service areas as a new tool for health care planning.

OBJECTIVE: To develop an automated, reproducible method for delineating hospital service areas (HSAs). DATA SOURCES/SETTING: Discharge data from all Swiss acute care hospitals for the years 2013 to 2016. STUDY DESIGN: We derived HSAs and hospital referral regions for Switzerland using a newly developed flow-based, automated, objective, and reproducible method using all discharge data. We compared our method to the classical, partially subjective approach used to delineate the Swiss Health Care Atlas by delineating four sets of intervention-specific HSAs. PRINCIPAL FINDINGS: Based on 4 105 885 discharges, the fully automated method delineated 63 HSAs. Comparison with existing HSAs reveals good overlap and comparable measures of health utilization between the methods and shows that in the Swiss setting, our method outperforms a cluster-based approach to defining HSAs. While the classical method potentially takes an entire day to delineate the regions, our method took approximately 10 minutes. CONCLUSIONS: Hospital service areas are used to analyze differences in use of health care that may indicate underuse and overuse. Our new, fully automated, objective, and reproducible method provides a useful tool for hospital services researchers that will enable them to delineate and update patient-flow-based HSAs.

Geospatial and seasonal variation of bronchiolitis in England: a cohort study using hospital episode statistics.

BACKGROUND: Rates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics. METHODS: Singleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1 year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level. RESULTS: Bronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95% CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing. CONCLUSIONS: Approximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages.

Increasing incidence and prevalence of ANCA-associated vasculitis in Northern Norway.

OBJECTIVE: ANCA-associated vasculitides (AAV) have increased in prevalence since the 1980s. We aimed to investigate the incidence and prevalence of AAV during a 15-year period from 1999 to 2013 in Northern Norway, looking for variations during this period. METHODS: Patient records were retrieved from The Northern Norwegian Vasculitis Registry; in addition we searched all regional hospital databases. Patients diagnosed with AAV from 1999 through to 2013 were included. For prevalence data, patients residing in the area, but with AAV diagnosis prior to 1999, were also included. The diagnosis of AAV was based on the European Medicines Agency algorithm. RESULTS: We identified 140 cases; 88 were classified as granulomatosis with polyangiitis (GPA), 37 as microscopic polyangiitis (MPA) and 15 as eosinophilic granulomatosis with polyangiitis (EGPA). Adult (age ≥15 years) annual incidence rates per million were as follows: for GPA 15.6 (95% CI: 12.5, 19.2), MPA 6.5 (95% CI: 4.6, 9.0), EGPA 2.7 (95% CI: 1.5, 4.5) and overall AAV 24.7 (95% CI: 20.8, 29.2). Incidences of MPA and overall AAV showed an increasing trend (P < 0.05). Adult point prevalence rates per million in 2013 were 261 (95% CI: 213, 316) for GPA, 58.2 (95% CI: 36.9, 87.3) for MPA, 32.9 (95% CI: 17.5, 56.3) for EGPA and 351 (95% CI: 296, 416) for overall AAV. CONCLUSION: The incidence rate of GPA and the prevalence rates of GPA and EGPA are currently the highest reported. MPA increased significantly from a prior low incidence. The overall AAV annual incidence and prevalence are still increasing.

Four-year trends in oral anticoagulant use and declining rates of ischemic stroke among 194,030 atrial fibrillation patients drawn from a sample of 12 million people.

BACKGROUND: Administrative data were used to investigate changes in hospitalizations for atrial fibrillation (AF), AF-related stroke, and treatment patterns between 2012 and 2016. METHODS: From the 'Ricerca e Salute' database, a population- and patient-based repository involving >12 million inhabitants and linking demographics, prescriptions, and hospital discharge records, all patients discharged alive with a diagnosis of AF between 2012 and 2015 were followed for 1 year. RESULTS: A total of 194,030 AF patients were included. The number of AF cases increased ~10% over time, from 4.0 per 1,000 inhabitants in 2012 to 4.4 per 1,000 in 2015. At 1 year, hospitalizations for ischemic stroke decreased from 21.3 per 1,000 patients with AF in 2012-2013 to 14.7 per 1,000 in 2015-2016 (-31%, 95% CI -18 to -41). Over the same period, oral anticoagulant (OAC) use increased from 56.7% to 64.4% (+14%, 95% CI +8 to +26), vitamin K antagonist use decreased (from 55.9 to 36.7%; -34%, 95% CI -21 to -44), whereas direct OACs (DOACs) increased (from <1% in 2012 to 27.7% in 2015). Antiplatelet prescriptions fell from 42.6% in 2012 to 28.1% in 2015. Hospitalizations for major bleeds, mainly gastrointestinal, increased from 1.5‰ in 2012-2013 to 2.3‰ in 2015-2016, whereas hemorrhagic stroke admissions decreased from 6.5‰ to 4.1‰. CONCLUSIONS: There was a slight increase in the prevalence of AF between 2012 and 2015, whereas the overall use of antiplatelet agents decreased and that of OAC, particularly DOACs, increased. Over the same period, 1-year hospitalizations for ischemic stroke declined substantially, with a declining rate of hemorrhagic strokes.

Perfil epidemiológico de los casos notificados de covid-19 residentes del área programática del Hospital Parmenio Piñero Período del 5 de marzo al 20 de agosto de 2020 / Epidemiological profile of the notified cases of covid-19 in residents of the programmatic area of the Parmenio Piñero Hospital Period from March 5 to August 20 of 2020

Introducción. La pandemia de covid-19 afecta al país. El objetivo de este estudio fue describir características clínicas y epidemiológicas de las personas con covid-19 residentes del área programática del Hospital P. Piñero. Metodología. Estudio descriptivo y transversal. Se analizaron los denominados "Caso sospechoso de covid-19, influenza y otros virus respiratorios" del SNVS 2.0. Se calculó la estadística descriptiva y la tasa de incidencia acumulada y letalidad. Resultados. Se notificaron hasta el 20 de agosto 33.847 casos sospechosos, de los cuales 14.418 fueron confirmados (42,6%). La tasa de incidencia acumulada fue 4674,6 por 100.000 habitantes. Hubo aumento de casos confirmados hasta la semana epidemiológica 26, luego se verifica el amesetamiento y la irregular distribución. La distribución de la edad fue similar en ambos sexos, la mediana fue de 33 años (RIC: 22-48). Los síntomas más frecuentes fueron respiratorios y neurológicos. Fallecieron 248 personas de covid-19. La tasa de letalidad fue 1,7%. Las comorbilidades más frecuentes fueron hipertensión arterial y diabetes, con una media de 70,7 años (DE 15,0). Aumentó la letalidad a mayor edad, y la Villa 1-11-14 tuvo una mayor letalidad. Conclusión. Hubo mayor riesgo de morbilidad y mortalidad por covid-19 en el área programática, mostrando una situación más crítica en la Villa 1-11-14, lo que refleja una desigualdad en el riesgo de enfermar y de morir dentro del área programática del Hospital P. Piñero

Introduction. The covid-19 pandemic affects the country. The objective of this study was to describe the clinical and epidemiological characteristics of people with covid-19 who live in the programmatic area of the Piñero Hospital. Methodology. Descriptive and cross-sectional study. SNVS 2.0 "Suspected cases of covid-19, influenza and other respiratory viruses" were analyzed. Descriptive statistics and cumulative incidence rate and fatality were calculated. Results. 33,847 suspected cases were reported up to august 20, 14,418 were confirmed (42.6%). The cumulative incidence rate was 4674.6 per 100,000 populations. There was an increase in the number of confirmed cases until the 26th epidemiologic week 26, when we observed a plateau. The age distribution was similar in both sexes; the median was 33 years (IQR: 22-48). The most frequent symptoms were respiratory and neurological. 248 people died of covid-19. The fatality rate was 1.7%. The most frequent comorbidities were arterial hypertension and diabetes, with a mean of 70.7 years (SD 15.0). The lethality increased at an older age, presenting in the Villa 1-11-14 higher lethality. Conclusion. There was a higher risk of morbility and mortality from covid-19 in the programmatic area, showing a more critical situation in Villa 1-11-14, reflecting an inequality about illness and death, in the Piñero hospital programmatic area

A diabetes profile of the eight districts in the public health sector, Eastern Cape Province, South Africa.

BACKGROUND: The International Diabetes Federation (IDF) recently reported that there are 1.8 million South Africans with diabetes, and estimates an additional undiagnosed population of 69% of the total number of diabetics. The African continent is expected to see the highest increase in diabetes globally by 2045. Healthcare measures to manage this surge in diabetes and its related complications should be tailored to Africa's unique challenges; however, the epidemiolocal data essential for policy development are lacking. Bridging the data gap will guide funding distribution and the creation of evidence-based initiatives for diabetes. OBJECTIVES: To investigate the frequency, age proportion and distribution of new patients diagnosed with diabetes in the public healthcare sector of Eastern Cape (EC) Province, South Africa (SA). METHODS: All data collected to date were obtained from the EC District Health Information System. According to the information collected from the Department of Health, diabetes-related data collection fields were implemented in 2013, which resulted in this 4-year study. Additional open-source data on population estimates, mortality and medical aid coverage were provided by Statistics SA. RESULTS: Of the eight districts in the province, O R Tambo was recorded as having the highest average proportion of new patients diagnosed with diabetes. A positive correlation was found between the calculated incidence of disease and the diabetes mortality rate. CONCLUSIONS: The study showed an annual growth in the incidence of diabetes in the EC since 2014, and highlights the issue of an increasing burden of diabetes in the rural population. This increase is consonant with predictions by authoritative bodies on the growing burden of diabetes in Africa. The pattern of distribution highlights the deprived district of O R Tambo contradicting the well-known link between diabetes and urbanisation.