Homicide Mortality Inequities in the 30 Biggest Cities in the U.S.

INTRODUCTION: Homicide is a leading cause of death across the U.S., and it disproportionally affects Blacks in urban areas. This study fills a gap in the literature by examining homicide mortality and Black-White homicide disparities in the 30 biggest U.S. cities and for the entire U.S. across 2 time periods (2008-2012 and 2013-2017). METHODS: Using data from the National Vital Statistics System for 2008-2017, this study calculated age-adjusted homicide mortality rates (per 100,000) for the total, White, and Black populations in the 30 biggest cities, and the U.S. Black-to-White rate ratios were calculated to examine homicide mortality across the time periods. Data were analyzed in 2020. RESULTS: A total of 26 cities were included in the final analysis. Results show that U.S. homicides increased slightly but significantly across the time periods (p<0.05). A total of 6 cities saw significant increases in homicides and 5 saw significant decreases. Homicide mortality rates were 1.8 times to >20 times greater for Blacks than for Whites, and these disparities persisted across the time periods for most cities. Only 2 of 26 cities had mortality rates and racial inequities in rates that were lower than the national average. CONCLUSIONS: Homicide mortality increased slightly across the U.S. and most cities from 2008 to 2017. The majority of cities faced high homicide mortality rates and large inequities. Black-White disparities in homicide remain substantial at the national and city levels. These findings can inform city leaders in their efforts to address the homicide, violence, and racial inequities associated with them through the implementation of policies and programs.

Psychiatric disorders and treatment in low-income pregnant women.

AIMS: This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. METHOD: To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. RESULTS: The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. CONCLUSIONS: With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.

Trends in the prevalence of chronic medication use in children: 2002-2005.

OBJECTIVE: Our goal was to estimate the quarterly prevalence of and evaluate trends for chronic medication use in children. PATIENTS AND METHODS: A cross-sectional study of ambulatory prescription claims data from 2002 to 2005 was conducted for a nationally representative sample of >3.5 million commercially insured children who were 5 to 19 years old. Prevalence of chronic medication use was measured quarterly for antihypertensives, antihyperlipidemics, type 2 antidiabetics, antidepressants, attention-deficit disorder and attention-deficit/hyperactivity disorder medications, and asthma-controller therapy. RESULTS: First-quarter 2002 baseline prevalence of chronic medication use per 1000 child beneficiaries ranged from a high of 29.5 for antiasthmatics to a low of 0.27 for antihyperlipidemics. Except for asthma medication use, prevalence rates were higher for older teens aged 15 to 19 years. During the study period, the prevalence rate for type 2 antidiabetic agents doubled, driven by 166% and 135% increases in prevalence among females aged 10 to 14 and 15 to 19 years, respectively. Therapy classes with double-digit growth in prevalence of use were asthma medications (46.5%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (40.4%), and antihyperlipidemics (15%). Prevalence of use growth was more moderate for antihypertensives and antidepressants (1.8%). Rates of growth were dramatically higher among girls than boys for type 2 antidiabetics (147% vs 39%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (63% vs 33%), and antidepressants (7% vs -4%). CONCLUSIONS: Prevalence of chronic medication use in children increased across all therapy classes evaluated. Additional study is needed into the factors influencing these trends, including growth in chronic disease risk factors, greater awareness and screening, and greater affinity toward early use of drug therapy in children.

Associations between psychiatric disorders and menstrual cycle characteristics.

An understanding of the relationship between psychiatric disorders and menstrual characteristics is important to the assessment and care of women. Menstrual cycle regularity and length have significant associations with specific current and lifetime psychiatric disorders. The purpose of this study was to investigate whether psychiatric disorders are associated with menstrual cycle length or regularity. The sample included 628 pregnant Medicaid-eligible women from Women, Infants, and Children's Supplemental Nutrition Program sites in five counties in rural Missouri and the city of St. Louis. Women were assessed for current (12-month) and lifetime psychiatric disorders with the Diagnostic Interview Schedule IV. Menstrual length and regularity were assessed by self-report. Analyses consisted of logistic regression while controlling for race. Independent of the effects of race, (a) women who reported irregular cycles were less than half as likely to have a current anxiety disorder as those that reported regular cycles, and (b) women with shorter cycles (

There's no place like home: a preliminary study of toddler unintentional injury.

This household-based study of 100 parents documents the type and frequency of home toddler unintentional injury and describes parental supervision at the time of injury. Also included is a home assessment for injury-related hazards, parental report of the use of home safety measures, and an 8-week phone survey. The mean number of child injuries was 2.8 (SD = 2.69). Five percent of the injuries required medical attention. Overall, one fifth of the injuries occurred when children were unsupervised. Findings suggest that minor injury may have a developmental component that is different from that of serious injury.

Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders.

OBJECTIVES: We examined the association between psychiatric disorders and tobacco use during pregnancy. METHODS: Data were derived from a population-based cohort of 744 pregnant African American and White low-income women living in urban and rural areas. The Diagnostic Interview Schedule was used to assess women for 20 different psychiatric disorders. RESULTS: In comparison with nonusers, persistent tobacco users (women who had used tobacco after confirmation of their pregnancy) and nonpersistent users (women who had used tobacco but not after pregnancy confirmation) were 2.5 and 2 times as likely to have a psychiatric disorder. Twenty-five percent of persistent users had at least 1 of the following diagnoses: generalized anxiety disorder, bipolar I disorder, oppositional disorder, drug abuse or dependence, and attention deficit-hyperactivity disorder. CONCLUSIONS: In this cohort study, 5 diagnoses were more prevalent among persistent tobacco users than among nonusers, suggesting that several psychiatric disorders contribute to difficulty discontinuing tobacco use during pregnancy. Smoking cessation efforts focusing on pregnant women may need to address co-occurring psychiatric disorders if they are to be successful.

Intermediate term biochemical progression rates after radical prostatectomy and radiotherapy in patients with screen detected prostate cancer.

PURPOSE: We compared biochemical progression rates measured by increasing prostate specific antigen (PSA) levels using a standard definition of biochemical recurrence among patients with screen detected prostate cancer treated with radical prostatectomy (RP) or radiotherapy (RT). MATERIALS AND METHODS: A total of 1,939 patients diagnosed with clinically localized prostate cancer in a community based screening study from 1989 to 1998, followed through 2001, were treated with RP or RT and agreed to enroll in a followup study. This prospective cohort study (median followup 62 months, range 0.2 to 141) used adjusted Cox proportional hazards models to examine time to progression. Selection bias was addressed with propensity scores. Biochemical evidence of cancer progression was defined as PSA greater than 0.2 ng/ml in patients who underwent RP and 3 consecutive PSA increases as recommended by the American Society for Therapeutic Radiology and Oncology criteria for radiotherapy. RESULTS: Of the patients 17% had evidence of cancer progression. The percentage with progression-free survival at 5 and 9 years for RP was 84% and 76%, respectively, and for RT 80% and 70%, respectively. Cox proportional hazards models produced a hazard ratio of 1.63 (95% CI, 1.12, 2.38) for RT compared with RP, adjusting for clinical stage, Gleason grade, preoperative PSA, biopsy age, treatment year and propensity for treatment type. CONCLUSIONS: With intermediate term followup, patients treated with RT were more likely to have cancer progression than with RP adjusting for demographics, clinical factors, selection bias and treatment year.

Safety and immunogenicity of haemophilus influenzae type B polysaccharide or conjugate vaccines in an elderly adult population.

OBJECTIVES: To evaluate the safety and immunogenicity of unconjugated Haemophilus influenzae type b (Hib) polysaccharide (PRP) vaccine and two PRP-protein-conjugated vaccines as a model for the comparison of protein-conjugated versus plain polysaccharide vaccines in the elderly. DESIGN: Randomized, double-blind, prospective study. SETTING: University-based center for vaccine research and development. PARTICIPANTS: A total of 125 adults, aged 64 to 92, who were judged to be in general good health and lacking any significant underlying medical conditions. INTERVENTION: Subjects were randomized to receive one of three vaccines: Group 1 (n=39), PRP; Group 2 (n=44), PRP conjugated to an outer-membrane protein complex of Neisseria meningitidis (PRP-OMP); and Group 3 (n=42), PRP conjugated to diphtheria toxoid (PRP-D). Sera were obtained before immunization and 1 and 12 months later. MEASUREMENTS: Subjects maintained a diary of injection site and systemic reactions for 3 days after immunization. A radioantigen-binding assay was used to measure total concentrations of serum anticapsular antibody, and an enzyme-linked immunosorbent assay was used to measure immunoglobulin (Ig) G1 and IgG2 anticapsular antibody responses. Antibody functional activity was assessed using a complement-mediated bactericidal assay. RESULTS: Before vaccination, the geometric mean serum anticapsular antibody concentration was 0.8 microg/mL, but fewer than 10% of subjects had detectable bactericidal activity (titer>1:4). The magnitude, subclass distribution, and bactericidal activity of antibody responses to unconjugated PRP vaccine were similar to those observed in previous studies of younger adults immunized with PRP. The OMP conjugate, which is highly immunogenic after one dose in 2-month old infants, did not elicit anticapsular antibody responses in the elderly greater than those elicited by PRP vaccine (P=.43). In contrast, the D conjugate, which is poorly immunogenic in 2-month old infants, elicited higher anticapsular antibody responses than PRP vaccine in the elderly (P=.01) and higher levels than the OMP-conjugate 1 year after vaccination (P<.006). CONCLUSION: Elderly adults develop protective anticapsular antibody responses to unconjugated and conjugated PRP vaccine. The higher anticapsular antibody responses to the D conjugate but not to the OMP conjugate in the elderly, which is the reverse of that observed in immunized infants, implies fundamental differences in the immunological mechanisms by which the two age groups respond to PRP and by which the OMP and D conjugates elicit anticapsular antibody responses.

Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment.

OBJECTIVE: To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvantaged pregnant women. METHODS: The sample included 744 pregnant Medicaid-eligible women from Women, Infants and Children Supplemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmental stressors, and pregnancy characteristics. Logistic regression identified risk factors associated with posttraumatic stress disorder. RESULTS: Posttraumatic stress disorder prevalence was 7.7% (n = 57/744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.61, 10.26) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported moderate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months. CONCLUSIONS: The prevalence of posttraumatic stress disorder in pregnancy and low treatment rates suggest that screening for this disorder should be considered in clinical practice. LEVEL OF EVIDENCE: II-2

Evidence for probable sexual transmission of the hepatitis g virus.

A cross-sectional epidemiology study evaluated the role of sexual activity and sexually transmitted diseases (STDs) in the transmission of hepatitis G virus (HGV/GBV-C) and other hepatitis virus infections in 944 subjects. There was a statistically significant higher prevalence of HGV/GBV-C, hepatitis B virus, and hepatitis C virus exposure in the STD clinic group (i.e., subjects who were currently seeking treatment for an STD) compared with the group who never had received treatment for an STD. In a comparison of the subjects with an STD versus those without an STD, the prevalence of HGV/GBV-C was 11.3% versus 4.9%, on the basis of polymerase chain reaction (PCR) results alone, and 36.6% versus 8.8%, when results of PCR and enzyme-linked immunosorbent assay were combined. Sexual activity and, possibly, the presence of an STD increases the risk of HGB/GBV-C transmission.

Effects of hemoglobin concentration and temperature on the in vitro release of cyanide from sodium nitroprusside.

PURPOSE: This in vitro study was performed to determine whether changes in hemoglobin (Hb) concentration and temperature influenced the amount of cyanide (CN-) released from sodium nitroprusside (SNP). METHODS: Canine whole blood with a Hb concentration of 8.5 to 18.9 g·dl (5.3 to 18.9 mM) was equilibrated with SNP at either 37°C or 25°C, and CN- levels in plasma and red blood cells (RBC) were measured using the microdiffusion method. RESULTS: Changes in Hb concentration and temperature did not have any statistically significant effect on the CN- released from SNP in plasma. On the other hand, CN- levels in RBC decreased with increasing Hb concentrations. CN- levels in RBC were significantly lower at 25°C than at 37°C. CONCLUSION: Though the Hb concentration and temperature changed the amount of CN- released from SNP in RBC, the change observed was not clinically significant.