Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial.

BACKGROUND: Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention. METHODS: The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION: This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings. REGISTRATION: ClinicalTrials.gov NCT05873569.

Estimating genus-specific effects of non-native honey bees and urbanization on wild bee communities: A case study in Maryland, United States.

Non-native species have the potential to detrimentally affect native species through resource competition, disease transmission, and other forms of antagonism. The western honey bee (Apis mellifera) is one such species that has been widely introduced beyond its native range for hundreds of years. There are strong concerns in the United States, and other countries, about the strain that high-density, managed honey bee populations could pose to already imperiled wild bee communities. While there is some experimental evidence of honey bees competing with wild bees for resources, few studies have connected landscape-scale honey bee apiary density with down-stream consequences for wild bee communities. Here, using a dataset from Maryland, US and joint species distribution models, we provide the largest scale, most phylogenetically resolved assessment of non-native honey bee density effects on wild bee abundance to date. As beekeeping in Maryland primarily consists of urban beekeeping, we also assessed the relative impact of developed land on wild bee communities. Six of the 33 wild bee genera we assessed showed a high probability (> 90 %) of a negative association with apiary density and/or developed land. These bees were primarily late-season, specialist genera (several long-horned genera represented) or small, ground nesting, season-long foragers (including several sweat bee genera). Conversely, developed land was associated with an increase in relative abundance for some genera including invasive Anthidium and other urban garden-associated genera. We discuss several avenues to ameliorate potentially detrimental effects of beekeeping and urbanization on the most imperiled wild bee groups. We additionally offer methodological insights based on sampling efficiency of different methods (hand netting, pan trapping, vane trapping), highlighting large variation in effect sizes across genera. The magnitude of sampling effect was very high, relative to the observed ecological effects, demonstrating the importance of integrated sampling, particularly for multi-species or community level assessments.

Neighborhood Disadvantage and Prostate Tumor Aggressiveness among African American and European American Men.

BACKGROUND: Studies have identified associations between neighborhood disadvantage (ND), which is more likely to affect African American (AA) individuals, and aggressive prostate cancer. Thus, ND may contribute to prostate cancer disparities. However, it is unknown what ND components drive aggressive disease and whether associations vary by race. METHODS: We evaluated associations between aggressive prostate cancer and four ND metrics-Area Deprivation Index (ADI), validated Bayesian Neighborhood Deprivation Index (NDI), racial isolation (RI) index, and historical redlining, and whether these factors interacted with race, among men with prostate cancer treated at the University of Maryland Greenebaum Comprehensive Cancer Center (2004-2021). RESULTS: We included 1,458 men (698 European American and 760 AA). AA men were more likely to experience ND. In adjusted models, the ADI, RI, and redlining were significantly associated with aggressive versus nonaggressive prostate cancer overall [ADI, OR for one SD increase = 1.14, 95% confidence interval (CI), 1.00-1.30; RI, OR = 1.27, CI, 1.07-1.51; redlining, OR = 1.77; CI, 1.23-2.56] and among AA men. The NDI was associated with aggressive prostate cancer among AA men (OR = 1.32, 95% credible interval: 1.13-1.57); percent in poverty received the largest importance weight. The ADI (P heterogeneity = 0.002) and NDI (exceedance probability heterogeneity = 98.1%) significantly interacted with race, such that associations were significantly stronger for AA men. CONCLUSIONS: We identified novel significant positive associations for racial segregation and historical redlining with aggressive prostate cancer and significant interactions between ND indices and race. IMPACT: Findings inform specific ND components that are associated with aggressive prostate cancer and suggest the ND effect is stronger for AA men, which has implications for interventions to reduce disparities.

Maryland opioid overdose deaths from 2018 to 2022: occupational patterns and their sociodemographic variations.

INTRODUCTION: We aimed to describe the occupational pattern of opioid overdose deaths in Maryland between 2018 and 2022 and determine the occupations at higher risk of opioid overdose death. METHODS: The sample included undetermined or unintentional opioid overdose deaths among those aged 16 years or older in Maryland, drawn from the State Unintentional Drug Overdose Reporting System. We calculated population-based incidence overdose rates by occupation, stratified by sex and race. We further calculated the incidence rate ratios (IRRs) comparing each occupation with all other groups combined and estimated the IRRs among males versus females and non-Hispanic whites versus other racial/ethnic groups. RESULTS: The pooled sample included 11 455 opioid overdose decedents (72% male and 55% non-Hispanic whites) of whom 80% were employed. The three occupation groups with the highest incidence rates were 'construction and extraction', 'transportation and material moving' and 'installation/maintenance and repair' with 291, 137 and 133 deaths per 100 000 workers in these respective occupational groups. Incidence rates were significantly higher in males than females in all categories except those 'Not in Labour Force' (IRR=0.51, p<0.001). Non-Hispanic whites relative to other racial/ethnic groups had a lower incidence of opioid overdose death in 'Military-Specific' occupations (IRR=0.53, p=0.031). CONCLUSION: Opioid overdose deaths vary by type of occupation and certain occupations are at higher risk of overdose death. The findings highlight the need for priority setting in the implementation and expansion of existing strategies to target the workers most impacted by opioid overdose.

The Influence of Dr. Rima Rudd's Organizational Health Literacy Scholarship in Maryland.

BACKGROUND: This article analyzes and reflects on Dr. Rima Rudd's organizational health literacy ideas and tools and their influence on the field generally and on four projects over 12 years in Maryland specifically. OBJECTIVE: We present four organizational health literacy projects - two from oral health and two from COVID-19 vaccination - that used or were influenced by Dr. Rudd's the Health Literacy Environment of Hospitals and Health Centers. METHODS: In the oral health projects, we describe the organizational assessments we conducted, the assessment results, and the actions organizations took in response. In a Frederick, Maryland, COVID-19 project, we worked with multiple organizations in a single city to train them in the organizational assessment process, and we report the activities and results of this training. In the Baltimore, Maryland COVID-19 project, we provided general information about organizational health literacy and trained key health professionals in local organizations. KEY RESULTS: Our results confirm that Dr. Rudd's tools work mainly as intended because they help organizations or third-party evaluators identify health literacy barriers and create health literacy insights. Also, we observed that organizational health literacy tools can support organizations' interest in equity goals and increase their willingness to spend time on health literacy projects. CONCLUSIONS: Translating knowledge and skills to actions can require more time than organizations can commit or be more difficult than they can handle. In our projects, the four most positive examples were driven by a collaboration between our team and a change champion who had the power to institute new ideas and actions. While it can take time and money to gain traction, our Maryland work shows that organizational assessments are accessible, practical and tangible. We conclude that Dr. Rudd's influence extends beyond specific tools and is reflected in the field's acceptance of organizational and professional responsibility for health literacy as an equity and justice issue. [HLRP: Health Literacy Research and Practice. 2024;8(3):e151-e158.].

PLAIN LANGUAGE SUMMARY: This article discusses Dr. Rudd's original and foundational contributions to organizational health literacy and the influence her tools and methods have had on 4 projects over 12 years in Maryland. We describe implementations and results for organizational health literacy assessments and training activities and conclude with lessons learned about organizational health literacy approaches and Dr. Rudd's impact on the field.

Race and Ethnicity and Diagnostic Testing for Common Conditions in the Acute Care Setting.

Importance: Overuse of diagnostic testing is pervasive, but the extent to which it varies by race and ethnicity in the acute care setting is poorly understood. Objective: To use a previously validated diagnostic intensity index to evaluate differences in diagnostic testing rates by race and ethnicity in the acute care setting, which may serve as a surrogate for diagnostic test overuse. Design, Setting, and Participants: This was a cross-sectional study of emergency department (ED) discharges, hospital observation stays, and hospital admissions using administrative claims among EDs and acute care hospitals in Kentucky, Maryland, North Carolina, and New Jersey, from 2016 through 2018. The diagnostic intensity index pairs nonspecific principal discharge diagnoses (nausea and vomiting, abdominal pain, chest pain, and syncope) with related diagnostic tests to estimate rates of nondiagnostic testing. Adults with an acute care encounter with a principal discharge diagnosis of interest were included. Data were analyzed from January to February 2024. Exposure: Race and ethnicity (Asian, Black, Hispanic, White, other [including American Indian, multiracial, and multiethnic], and missing). Main Outcomes and Measures: Receipt of a diagnostic test. Generalized linear models with a hospital-specific indicator variable were estimated to calculate the adjusted odds ratio of receiving a test related to the principal discharge diagnosis by race and ethnicity, controlling for primary payer and zip code income quartile. Results: Of 3 683 055 encounters (1 055 575 encounters [28.7%] for Black, 300 333 encounters [8.2%] for Hispanic, and 2 140 335 encounters [58.1%] for White patients; mean [SD] age of patients with encounters, 47.3 [18.8] years; 2 233 024 encounters among females [60.6%]), most (2 969 974 encounters [80.6%]) were ED discharges. Black compared with White patients discharged from the ED with a diagnosis of interest had an adjusted odds ratio of 0.74 (95% CI, 0.72-0.75) of having related diagnostic testing. No other racial or ethnic disparities of a similar magnitude were observed in any acute care settings. Conclusions and Relevance: In this study, White patients discharged from the ED with a nonspecific diagnosis of interest were significantly more likely than Black patients to receive related diagnostic testing. The extent to which this represents diagnostic test overuse in White patients vs undertesting and missed diagnoses in Black patients deserves further study.

Assessing the potential long-term effects of sea-level rise on salt marsh's coastal protective capacity under different climate pathway scenarios.

Salt marshes act as natural barriers that reduce wave energy during storm events and help protect coastal communities located in low-lying areas. This ecosystem can be an important asset for climate adaptation due to its particular capability of vertically accrete to adjust to long-term changes in water levels. Therefore, understanding marsh protection benefits thresholds in the face of sea-level rise (SLR) is important for planning future climate adaptation. In this context, the main goal of this manuscript is to examine how the storm protection benefits provided by salt marshes might evolve under SLR projections with different probability levels and emission pathways. In this study, a modeling framework that employs marsh migration predictions from the Sea Level Affecting Marshes Model (SLAMM) as parameterization into a hydrodynamic and wave model (ADCIRC + SWAN) was utilized to explicitly represent wave attenuation by vegetation under storm surge conditions. SLAMM predictions indicate that the SLR scenario, a combination of probability level and emission pathways, plays a substantial role in determining future marsh migration or marsh area loss. For example, results based on the 50% probability, stabilized emissions scenario show an increase of 45% in the marsh area on Maryland's Lower Eastern Shore by 2100, whereas Dorchester County alone could experience a 75% reduction in total salt marsh areas by 2100 under the 1% probability, growing emissions scenario. ADCIRC + SWAN results using SLAMM land cover and elevation outputs indicate that distinct temporal thresholds emerge where marsh extent sharply decreases and wave heights increase, especially after 2050, and exacerbates further after 2080. These findings can be utilized for guiding environmental policies and to aid informed decisions and actions in response to SLR-driven environmental changes.

Build It and They Will Come: Interdisciplinary Wellness Clinics in Low-Income Senior Housing.

PURPOSE: The purpose of this study was to describe the first 4 months of implementation of the University of Maryland Interdisciplinary Wellness Clinic (UM-IWC). The UM-IWC provided health care services that are difficult for older adults in low-income senior housing communities to access. DESIGN: This was a descriptive study including four low-income communities. METHODS: Measures included health information, participation, and services provided. FINDINGS: A total of 165 residents were seen (44%). The residents were mostly female (80%), Black (63%), and non-Hispanic (83%), with an average age of 77 years. We provided 253 patient visits with 98 residents seen once, 38 twice, 19 three times, and 10 four times. Visits included 165 intake assessments, 61 immunizations, 193 blood pressure checks, 28 foot care treatments, 12 cerumen removals, 12 completions of advance directives, 14 Annual Wellness Visits, and 3 home visits for acute medical problems. CONCLUSIONS: There was strong engagement of the residents, and we were able to provide a large number of services that were not easily accessible to these individuals. Future work will focus on increasing and maintaining the engagement of residents and sustainability of the clinics.

Patient experience with hospital care following the Maryland global budget revenue model: A difference-in-difference analysis.

INTRODUCTION: As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience. METHODS: Cross-sectional study using a difference-in-difference analysis to examine changes in patient experiences according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains before and after implementation of the GBR model. Acute care hospitals from 2010-2016 with completed HCAHPS surveys were included. Hospitals identified for inclusion were then matched, based on county location, to area level characteristics using the Area Health Resource File. RESULTS: A total of 844 hospitals were included. Compared to hospitals in non-GBR states, hospitals in GBR states experienced significant declines in the following HCAHPS domains: "would definitely recommend the hospital to others" [Average treatment effect (ATT) = -1.19, 95% CI = -1.97, -0.41)] and 9-10 rating of the hospital (ATT = -0.93, 95% CI = -1.71, -0.15). Results also showed significant increases in the HCAHPS domains: "if patient's rooms and bathroom were always kept clean" (ATT = 1.10, 95% CI = 0.20, 2.00). There were no significant differences in changes for the other domains, including no improvements in: nursing communication, doctor communication, help from hospital staff, pain control, communication on medicines, discharge information, and quietness of the patient environment. CONCLUSION: These findings suggest there should be efforts made to ascertain and mitigate potential adverse effects of care transformation initiatives on patient experience. Patients are stakeholders and their inputs should be sought and incorporated in care transformation efforts to ensure that these models align with improved patient experiences.

Collective Identity: Making the Case for a Stage Model Approach to Addressing Water Quality in the Chesapeake Bay Watershed.

The Chesapeake Bay watershed encompasses six states and the District of Columbia. Consequently, the people within it display great diversity in terms of values, allegiances, and experiences. That diversity may help to explain an apparent inability to coordinate actions aimed at redressing the dismal water quality throughout the watershed. In this paper, we bridge theory to an applied scenario to examine the importance of developing a collective identity within the watershed to bring about changes in individual behavior and policies. We present the current conditions of the Chesapeake Bay watershed, propose a stage model for the development of a collective watershed identity, outline theoretically grounded determinants of each stage, and discuss the challenges in developing a collective identity. We further suggest several guiding questions for future research.

The relationship between neighborhood economic deprivation and community-acquired pneumonia related admissions in Maryland.

Introduction: Community-acquired pneumonia (CAP) is a major health concern in the United States (US), with its incidence, severity, and outcomes influenced by social determinants of health, including socioeconomic status. The impact of neighborhood socioeconomic status, as measured by the Distressed Communities Index (DCI), on CAP-related admissions remains understudied in the literature. Objective: To determine the independent association between DCI and CAP-related admissions in Maryland. Methods: We conducted a retrospective study using the Maryland State Inpatient Database (SID) to collate data on CAP-related admissions from January 2018 to December 2020. The study included adults aged 18-85 years. We explored the independent association between community-level economic deprivation based on DCI quintiles and CAP-related admissions, adjusting for significant covariates. Results: In the study period, 61,467 cases of CAP-related admissions were identified. The patients were predominantly White (49.7%) and female (52.4%), with 48.6% being over 65 years old. A substantive association was found between the DCI and CAP-related admissions. Compared to prosperous neighborhoods, patients living in economically deprived communities had 43% increased odds of CAP-related admissions. Conclusion: Residents of the poorest neighborhoods in Maryland have the highest risk of CAP-related admissions, emphasizing the need to develop effective public health strategies beneficial to the at-risk patient population.

Sustainable Academic-Clinical Alliance: A Model to Improve Academic-Practice Partnerships.

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.

Lifetime abortion incidence when abortion care is covered by Medicaid: Maryland versus five comparison states.

OBJECTIVE: To estimate the association of Medicaid coverage of abortion care with cumulative lifetime abortion incidence among women insured by Medicaid. DATA SOURCES AND STUDY SETTING: We use 2016-2019 (Pre-Dobbs) data from the Survey of Women studies that represent women aged 18-44 living in six U.S. states. One state, Maryland, has a Medicaid program that has long covered the cost of abortion care. The other five states, Alabama, Delaware, Iowa, Ohio, and South Carolina, have Medicaid programs that do not cover the cost of abortion care. Our sample includes 8972 women residing in the study states. STUDY DESIGN: Our outcome, cumulative lifetime abortion incidence, is identified using an indirect survey method, the double list experiment. We use a multivariate regression of cumulative lifetime abortion on variables including whether women were Medicaid-insured and whether they were residing in Maryland versus in one of the other five states. DATA COLLECTION/EXTRACTION METHODS: This study used secondary survey data. PRINCIPAL FINDINGS: We estimate that Medicaid coverage of abortion care in Maryland is associated with a 37.0 percentage-point (95% CI: 12.3-61.4) higher cumulative lifetime abortion incidence among Medicaid-insured women relative to women not insured by Medicaid compared with those differences by insurance status in states whose Medicaid programs do not cover the cost of abortion care. CONCLUSIONS: We found that Medicaid coverage of abortion care is associated with a much higher lifetime incidence of abortion among individuals insured by Medicaid. We infer that Medicaid coverage of abortion care costs may have a very large impact on the accessibility of abortion care for low-income women.

The food environment and hypertension: A cross-sectional analysis in Black breast cancer survivors in Maryland.

OBJECTIVES: The Food Environment Index (FEI) has shown varying positive impacts on health outcomes related to diabetes, obesity, and hypertension. However, a relationship between FEI and hypertension among breast cancer (BC) survivors, particularly Black women survivors, remains underexplored. Black women who are BC survivors have a high prevalence of hypertension and increased risk of mortality compared to White women with BC. Our analysis aims to fill this gap by assessing the FEI's association with hypertension in this population. DESIGN: Utilizing social media recruitment strategies and BC survivor networks, 100 Black female BC survivors completed an online survey, that included sociodemographic and clinical characteristics as well as lifestyle factors. The 2023 FEI County Health Rankings was used to assess the food environment and the index ranges from 0 (worst) to 10 (best). Adjusted prevalence odds ratios (PORs) and 95 % confidence intervals (CI) were calculated for the associations between FEI, sociodemographic and clinical factors, and hypertension status. RESULTS: Among the 94 study participants with data on hypertension status, 54.3 % reported a diagnosis of hypertension. Residing in counties with a below-median FEI (<8.8 v. above median: ≥8.8) was significantly associated with hypertension (POR = 4.10, 95 % CI: 1.19-14.13). Age at survey (≥50 years compared to <50 years: POR= 0.29, 95 % CI: 0.10-0.87) and household income ($75,000-$99,999 compared to > $99,999/year: POR = 12.02, 95 % CI: 2.08-69.43) were also significantly associated with hypertension. CONCLUSION: Our study highlights the potential impact of the food environment on hypertension among Black BC survivors living in Maryland. Our findings call attention to the need for targeted interventions to improve food accessibility and quality in underserved communities, especially for special populations such as cancer survivors.

Patient perspectives on cancer care during COVID-19: A qualitative study.

PURPOSE: The COVID-19 pandemic posed unique challenges to cancer-related care as health systems balanced competing risks of timely delivery of care and minimizing exposure to infection in a high-risk, immunocompromised patient population. This study aimed to better understand how pandemic-related factors affected the patient experience of cancer care during this time. METHODS: We conducted fifteen semi-structured interviews with adults from rural counties in Maryland who were diagnosed with and/or actively treated for cancer at the TidalHealth healthcare network between January 2020 and October 2022. RESULTS: Interviews from fifteen participants were analyzed. Two major themes emerged including COVID Impact on Care, and COVID Impact on Mental Health. Subthemes under COVID Impact on Care include Staffing Shortages, Hospital Regulations, Visitation, Importance of Advocacy, and Telehealth Utilization, and subthemes under COVID Impact on Mental Health include Loneliness, Support Networks, and Perceptions of COVID and Personal Protection. Overall, participants described positive care experiences despite notable delays, disruptions to continuity of care, difficult transitions to telemedicine, visitation policies that limited patient support, increased mental health struggles related to social distancing measures, and greater desire for patient advocacy. CONCLUSION: Our findings reveal significant impacts of the COVID-19 pandemic on experiences of cancer treatment and survivorship in a more vulnerable, rural patient population with lower healthcare access and income level. Our findings suggest areas for targeted interventions to limit disruptions to quality care in future public health emergencies.

Neighborhood Disadvantage and Prostate Tumor RNA Expression of Stress-Related Genes.

Importance: African American men experience greater prostate cancer incidence and mortality than White men. Growing literature supports associations of neighborhood disadvantage, which disproportionately affects African American men, with aggressive prostate cancer; chronic stress and downstream biological impacts (eg, increased inflammation) may contribute to these associations. Objective: To examine whether several neighborhood disadvantage metrics are associated with prostate tumor RNA expression of stress-related genes. Design, Setting, and Participants: This cross-sectional study leveraged prostate tumor transcriptomic data for African American and White men with prostate cancer who received radical prostatectomy at the University of Maryland Medical Center between August 1992 and January 2021. Data were analyzed from May 2023 to April 2024. Exposures: Using addresses at diagnosis, 2 neighborhood deprivation metrics (Area Deprivation Index [ADI] and validated bayesian Neighborhood Deprivation Index) as well as the Racial Isolation Index (RI) and historical redlining were applied to participants' addresses. Self-reported race was determined using electronic medical records. Main Outcomes and Measures: A total of 105 stress-related genes were evaluated with each neighborhood metric using linear regression, adjusting for race, age, and year of surgery. Genes in the Conserved Transcriptional Response to Adversity (CTRA) and stress-related signaling genes were included. Results: A total of 218 men (168 [77%] African American, 50 [23%] White) with a median (IQR) age of 58 (53-63) years were included. African American participants experienced greater neighborhood disadvantage than White participants (median [IQR] ADI, 115 [100-130] vs 92 [83-104]; median [IQR] RI, 0.68 [0.34-0.87] vs 0.11 [0.06-0.14]). ADI was positively associated with expression for 11 genes; HTR6 (serotonin pathway) remained significant after multiple-comparison adjustment (ß = 0.003; SE, 0.001; P < .001; Benjamini-Hochberg q value = .01). Several genes, including HTR6, were associated with multiple metrics. We observed higher expression of 5 proinflammatory genes in the CTRA with greater neighborhood disadvantage (eg, CXCL8 and ADI, ß = 0.008; SE, 0.003; P = .01; q value = .21). Conclusions and Relevance: In this cross-sectional study, the expression of several stress-related genes in prostate tumors was higher among men residing in disadvantaged neighborhoods. This study is one of the first to suggest associations of neighborhood disadvantage with prostate tumor RNA expression. Additional research is needed in larger studies to replicate findings and further investigate interrelationships of neighborhood factors, tumor biology, and aggressive prostate cancer to inform interventions to reduce disparities.

Quantification of referrals received at two emergency-capable hyperbaric medicine centers.

Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by centers available 24 hours a day, seven days a week, 365 days a year. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO2). We logged calls from two HBO2 chambers on the East Coast of the United States that serve a densely populated region in 2021. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls on 180/365 (46%) days during the study period at UMD and 239/365 (63%) days at UPenn. The most common indication was carbon monoxide toxicity. The peak month of calls was March. Emergency HBO2 calls are common, and more centers must accept emergency cases. Data from geographically diverse centers would add generalizability to these results and capture more diving-related emergencies.

The relationship between neighborhood socioeconomic status and short-term outcomes following colon resection.

BACKGROUND: This study investigates the association between neighborhood socioeconomic status, measured by the Distressed Communities Index (DCI), and short-term outcomes following colon resection. METHODS: Utilizing the Maryland State Inpatient Sample database (SID 2018-2020), we determined the association between DCI and post-op outcomes following colon resection including length of stay, readmissions, 30-day in-hospital mortality, and non-routine discharges. Multivariate regression analysis was performed to control for potential confounding factors. RESULTS: Of the 13,839 patients studied, median age was 63, with 54.3 â€‹% female and 64.5 â€‹% elective admissions. Laparoscopic surgery was performed in 36.9 â€‹% cases, with a median hospital stay of 5 days. Patients in distressed communities faced higher risks of emergency admission (OR: 1.31), prolonged hospitalization (OR: 1.29), non-routine discharges (OR: 1.36), and readmission (OR: 1.33). Black patients had longer stays than White patients (OR: 1.3). Despite adjustments, in-hospital mortality did not significantly differ among neighborhoods. CONCLUSION: Our study reveals that patients residing in distressed neighborhoods face a higher risk of prolonged hospitalization, non-routine discharges, and readmission rate after colon resection.

Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers.

BACKGROUND: For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. METHODS: Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. RESULTS: Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. CONCLUSION: Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.

Parenting in African American families: Profiles of general and culturally specific dimensions of parent-adolescent relationships during late adolescence.

Developmental and parenting frameworks suggest that factors at the individual-level and multiple levels of adolescents' contexts are important determinants of how African American parents prepare their children to live in a racially stratified society. Using a person-centered approach, this study explored heterogeneity in profiles of African American parent-adolescent relationships (PARs) using indicators of parent-reported ethnic-racial socialization (cultural socialization, preparation for bias), general parenting practices (autonomy support, monitoring, behavioral control), and relationship quality (warmth, communication, conflict). We also examined how adolescents' characteristics, parents' personal and psychological resources, and contextual sources of stress and support contributed to profile membership. Data were from the Maryland Adolescent Development in Context Study (1991-2000) and consisted of 589 African American caregiver-adolescent dyads (caregivers: 89% female; 57.2% married; adolescents: 50.7% female; Mage = 17, SD = 0.64, range = 15-19 years old). Latent profile analysis revealed four profiles: (a) No-Nonsense High Socializers, (b) Indulgent Average Socializers, (c) Unengaged Silent Socializers, and (d) Authoritative Cultural Socializers. Adolescent characteristics (gender, depression, and problem behavior), parents' personal and psychological resources (parenting self-efficacy, centrality, private regard, and depression), and contextual sources of stress and support (stress: economic hardship, family stress, neighborhood disadvantage and support: marital status, family cohesion, family organization) were correlated with profile membership. Findings suggest that variability in African American PARs is shaped by an extensive set of individual and contextual factors related to adolescents and the family and neighborhood context. These findings have important implications for future research and how to target multiple potential levers for change in African American parenting practice.