Covid-19 patterns among adults with intellectual and developmental disability and the general population in New York state during the first year of the pandemic.

BACKGROUND: People with intellectual and developmental disabilities (IDD) in the US, especially those living in group homes, experienced comparatively higher Covid-19 case/case fatality rates than the general population during the first year of the pandemic. There is no information about the patterns of case/case fatality rates during this time. OBJECTIVE: This study compared Covid-19 case/case fatality rates among people with IDD living in residential group homes to the general population across the first year of the pandemic in New York State (NYS). METHODS: Covid-19 positive cases and deaths collected from New York Disability Advocates (NYDA), a coalition of organizations serving individuals with IDD, was compared to data for the NYS general population from the first pandemic year. Case rates/100,000 and case fatality rates were calculated for the study period. Joinpoint Trend Analysis Software was used to analyze patterns in weekly case/case fatality rates. RESULTS: Case fatality rates for people with IDD were higher than for the overall state population throughout the pandemic's first year. Case rates were higher among people with IDD across most of this year. Although the patterns in rates were similar, there was a sharp increase in cases for those with IDD during Fall 2020 beginning eight weeks before the general NYS population and a significant decrease in fatalities in late December 2020 into January 2021. CONCLUSIONS: Consistently higher case fatality rates and significant differences in case/case fatality rates for people with IDD living in group homes require further consideration. Planning for future emergencies will require an enhanced federal/state understanding of the needs of people with IDD and a responsive surveillance system.

Pediatric Injury Trends in Rhode Island During the COVID-19 Pandemic.

BACKGROUND: Pediatric Emergency Department (PED) visits nationally decreased while the proportion of injury-related PED visits increased during the COVID-19 pandemic. Little is known about the trends in Rhode Island (RI). METHODS: This is a planned sub-analysis of RI data from a retrospective study of pediatric injury-related visits to 40 PEDs for children <18 years old from January 2019-December 2020. We calculated frequencies and compared patient demographics, injury types, severity, and mechanisms for 3/17/2019-12/31/2019 (pre-COVID-19) versus 3/15/2020-12/31/2020 (study period). RESULTS: Despite a 31.4% decrease in total injury-related PED visits from 2019 to 2020, the proportion of injury-related PED visits increased by 8.1% (p<0.001) in 2020. The mean age of patients decreased from 8.3 (SD 5.4) to 7.7 (SD 5.4) years old (p<0.0001), with a higher proportion of female (p=0.0018), privately insured (p=0.0274), and non-Hispanic White children (p<0.001) in 2020. There was a higher proportion of trauma activations, admissions, and injuries caused by intentional self-harm (all p<0.0001). CONCLUSIONS: In RI, the total number of injury-related PED visits decreased while the proportion of injury-related PED visits increased during the COVID-19 pandemic, similar to national trends. There were significant demographic, mechanism, and intent shifts among injured patients, highlighting epidemiologic changes during the pandemic and identifying high-risk groups that would benefit from targeted education and interventions.

The Daily Patterns of Emergency Medical Events.

This study examines population-level daily patterns of time-stamped emergency medical service (EMS) dispatches to establish their situational predictability. Using visualization, sinusoidal regression, and statistical tests to compare empirical cumulative distributions, we analyzed 311,848,450 emergency medical call records from the US National Emergency Medical Services Information System (NEMSIS) for years 2010 through 2022. The analysis revealed a robust daily pattern in the hourly distribution of distress calls across 33 major categories of medical emergency dispatch types. Sinusoidal regression coefficients for all types were statistically significant, mostly at the p < 0.0001 level. The coefficient of determination (R2) ranged from 0.84 and 0.99 for all models, with most falling in the 0.94 to 0.99 range. The common sinusoidal pattern, peaking in mid-afternoon, demonstrates that all major categories of medical emergency dispatch types appear to be influenced by an underlying daily rhythm that is aligned with daylight hours and common sleep/wake cycles. A comparison of results with previous landmark studies revealed new and contrasting EMS patterns for several long-established peak occurrence hours-specifically for chest pain, heart problems, stroke, convulsions and seizures, and sudden cardiac arrest/death. Upon closer examination, we also found that heart attacks, diagnosed by paramedics in the field via 12-lead cardiac monitoring, followed the identified common daily pattern of a mid-afternoon peak, departing from prior generally accepted morning tendencies. Extended analysis revealed that the normative pattern prevailed across the NEMSIS data when reorganized to consider monthly, seasonal, daylight-savings versus civil time, and pre-/post-COVID-19 periods. The predictable daily EMS patterns provide impetus for more research that links daily variation with causal risk and protective factors. Our methods are straightforward and presented with detail to provide accessible and replicable implementation for researchers and practitioners.

Defining pre-existing disability among adults captured by the National Trauma Data Bank: A descriptive assessment of patient characteristics and details of injury.

BACKGROUND: There is limited research on trauma in people with disability (PWD), despite potentially increased risk for trauma and negative outcomes following injury. OBJECTIVE: This study describes characteristics of trauma among both narrow and broad subsamples of PWD. METHODS: Data from the 2016 National Trauma Data Bank was used to identify two Disability Comparison Groups (DCGs). DCG-1 included adult patients with a functionally dependent health status, and DCG-2 included DCG-1 plus other adult patients with disability-associated diagnoses. Trauma characteristics (e.g., signs of life, intent of injury, mechanism of injury, and injury severity score [ISS]) were compared via logistic regression. RESULTS: Among the 782,241 reported trauma events, 39,011 belonged to DCG-1 and 193,513 to DCG-2. Falls caused most instances of trauma across both groups (DCG-1: 88.7 %; DCG-2: 67.3 %). Both DCGs were less likely than patients without disability to arrive at the facility without signs of life (DCG-1:aOR = 0.22, 95%CI 0.15-0.31; DCG-2:aOR = 0.40, 95%CI 0.36-0.45) or to have an ISS greater than 15 (DCG-1:aOR = 0.81, 95%CI 0.79-0.84; DCG-2:aOR = 0.92, 95%CI:0.91-0.94). They were, however, more likely to have an ISS greater than or equal to 8 (DCG-1:aOR = 1.14, 95%CI 1.11-1.16; DCG-2:aOR = 1.06, 95%CI 1.05-1.07). CONCLUSION: PWD have greater odds for moderately scored injuries and presenting with signs of life at U.S. trauma centers compared to patients without disability. However, they can be more likely to have certain intents and mechanisms of trauma depending on their functional status and the nature of their impairment. Differences warrant further and continued assessment of trauma experiences among patients with pre-existing disability.

A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic.

BACKGROUND: Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS: The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS: The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.

Engaging East Harlem, New York youth in action gun violence prevention research and child rights: a preliminary study.

BACKGROUND: The aim of the study was to have youth participate in the design and implementation of a research project set within a child rights framework to better understand high schoolers' perceptions of safety in their school and community. RESULTS: Between June 2020 and March 2021, a team of East Harlem, New York high school students, participated as co-researchers to modify the United Nations Children's Fund Child Friendly Cities Initiative Survey to suit their needs. Due to the COVID-19 pandemic, the final survey was conducted through an online remote classes system during advisory school classes, accompanied by brief focused group discussions. The novel process of conducting an interactive qualitative and quantitative virtual survey during a pandemic via youth participatory action research is outlined in this paper. CONCLUSIONS: Our results demonstrate that youth participatory action research can be utilized as part of a child rights framework approach to assess the views of youth regarding community safety and violence prevention.

Attitudes towards HPV Vaccination Policy Strategies to Improve Adolescent Vaccination Coverage among Pediatric Providers in New York State.

Pediatric providers' stances on HPV vaccination-related policies are largely unknown. To gain insight into pediatric providers' perspectives and potential recommendations for directed policy, we conducted a cross-sectional survey of the American Academy of Pediatrics members in New York. Almost all providers expressed confidence in discussing the HPV vaccine with patients (98.6%, n = 72). Among common barriers to vaccination, providers listed parental safety concerns (n = 60, 82.2%), vaccination not being required for school entry (n = 59, 80.8%), and moral opposition to vaccination (n = 48, 65.8%). Among all respondents, 29 (39.7%), 13 (17.8%), and 2 (2.7%) agreed the vaccine should be required for middle, high, and tertiary school entry, respectively. Support for pharmacist-provision of the vaccine varied, with 31 (42.5%) providers expressing support. Most providers supported adolescent self-consent to vaccination, (n = 67, 91.8%). Providers continued to encounter barriers to HPV vaccination and indicated support of HPV vaccination mandates for school entry, pharmacist provision of the vaccine, and adolescent self-consent to vaccination.

Gun violence and the voices of youth on community safety in the time of COVID-19 in East Harlem, NY: a youth participatory action research cross-sectional study.

BACKGROUND: The USA has failed to codify the protection of children from gun violence (GV) as a human right. This study employs a youth participatory action research methodology, within the framework of the United Nations Convention on the Rights of the Child (UNCRC), to investigate the relationships between GV exposure, self-identified gender and perceptions of children's rights and safety. METHODS: An anonymous survey based on UNICEF USA's Child Friendly Cities Initiative interactive survey tool targeting adolescents was modified by East Harlem, New York high school student co-researchers in collaboration with near-peer graduate students. The 61-question survey was administered at an East Harlem high school. Analysis consisted of univariate, bivariate and logistic regression using SPSS®. RESULTS: A total of 153 students completed the survey: 48.4% self-identified as male and 45.8% as female. Thirty-five percent reported witnessing GV. Most (79.1%) were aware of child rights regardless of gender or GV exposure but there were differences in perceptions of safety. Fifteen percent of females reported never feeling safe at school compared to 3% of males (p = 0.01). Females were 2.2 times as likely as males to report transportation waiting areas as never safe (p = 0.008). Almost a third of females reported never feeling safe from sexual harassment in public, compared to 10% of males (p = 0.004). In multivariable logistic regression adjusted for gender, race/ethnicity and grade level, students who witnessed GV were 4.6 times more likely to report never feeling safe from violence (95% CI 1.7-12.4). Thirty percent of students who witnessed GV reported not attending school because of safety concerns. Students who witnessed GV had 2.2 times the odds of carrying a weapon to school (95% CI 1.1-4.5). These patterns continued for other perceptions of safety. CONCLUSIONS: The students in this study affirmed their rights to participate and express their views on matters that may affect them, as articulated in the UNCRC. The study revealed differences in perceptions of safety by self-identified gender and identified gun violence as a major contributor of youth's perception of lack of safety. The study evinces the efficacy of employing YPAR methodology to identify and answer youth concerns of community safety and prioritize honoring child rights.

Refugee Births and the Migrant Health Effect in Syracuse NY.

OBJECTIVES: In Syracuse, NY among 5998 births in a 3-year period (2017-2019), 24% were to foreign-born women, among whom nearly 5% were refugees from the Democratic Republic of the Congo and Somalia. The impetus for the study was to identify potential risk factors and birth outcomes of refugee women, other foreign-born women, and US born women to inform care. METHODS: This study reviewed 3 years of births (2017-2019) in a secondary database of births in Syracuse, New York. Data reviewed included maternal demographics, natality, behavioral risk factors (e.g., drug use, tobacco use), employment, health insurance, and education. RESULTS: In a logistic regression model controlling for race, education, insurance status, employment status, tobacco use and illicit drug use, compared to US born mothers, refugees (OR 0.45, 95% CI 0.24-0.83) and other foreign born (OR 0.63, 95% CI 0.47-0.85) had significantly fewer low birth weight births. CONCLUSION: The results of this study supported the "healthy migrant effect," a concept that refugees have fewer low birth weight (LBW) births, premature births, and cesarean section deliveries than US born women. This study adds to the literature on refugee births and the healthy migrant effect.

Sources of coronavirus disease 2019 (COVID-19) exposure among healthcare personnel (HCP) in a large tertiary-care medical center.

Objectives: To describe the burden and sources of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP), such as occupational role, work setting, vaccination status, and patient contact between March 2020 through May 2022. Design: Active prospective surveillance. Setting: Large tertiary-care teaching institution with inpatient and ambulatory care services. Results: We identified 4,430 cases among HCPs between March 1, 2020, through May 31, 2022. The median age of this cohort was 37 years (range, 18-89); 2,840 (64.1%) were female; and 2,907 (65.6%) were white. Most of the infected HCP were in the general medicine department, followed by ancillary departments and support staff. Less than 10% of HCP SARS-CoV-2-positive cases worked on a COVID-19 unit. Of the reported SARS-CoV-2 exposures, 2,571 (58.0%) were from an unknown source, 1,185 (26.8%) were from a household source, 458 (10.3%) were from a community source, and 211 (4.8%) were healthcare exposures. A higher proportion of cases with reported healthcare exposures was vaccinated with only 1 or 2 doses, whereas a higher proportion of cases with reported household exposure was vaccinated and boosted, and a higher proportion of community cases with reported and unknown exposures were unvaccinated (P < .0001). HCP exposure to SARS-CoV-2 correlated with community-level transmission regardless of type of reported exposure. Conclusions: The healthcare setting was not an important source of perceived COVID-19 exposure among our HCPs. Most HCPs were not able to definitively identify the source of their COVID-19, followed by suspected household and community exposures. HCP with community or unknown exposure were more likely to be unvaccinated.

Systematic review and meta-analysis of 90-day and 30-day mortality after liver resection in the elderly.

BACKGROUND: With the aging population worldwide, the number of elderly patients presenting for liver resection because of liver malignancies is increasing. Data on the perioperative mortality in this population are limited and contradictory. We performed a systematic review and meta-analysis to determine the mortality of elderly patients after hepatectomy. METHODS: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, we searched 3 databases to identify studies that investigated 30-day and 90-day mortality after hepatectomy for patients ≥65 years of age. We categorized the patients by age into 4 groups (≥65, ≥70, ≥75, and ≥80 years), which were analyzed separately for mortality. All analyses were conducted with IBM SPSS Statistics for Windows version 28. RESULTS: Using PubMed, Embase, and Scopus, we identified 441 articles. After study selection and quality assessment, we included 66 studies consisting of 29,998 patients in the final meta-analysis. The pooled estimates for 30-day and 90-day mortality in the ≥65, ≥70, ≥75, and ≥80 age groups years were 1.3% (95% confidence interval 0.59%-2.06%), 2.8% (95% confidence interval 1.80%-3.69%), 3.0% (95% confidence interval 1.68%-4.30%), and 1.7% (95% confidence interval 1.22%-2.20%) and 2.7% (95% confidence interval 1.45%-3.87%), 2.8% (95% confidence interval 1.49%-4.02%), 5.1% (95% confidence interval 2.76%-7.42%), and 2.4% (95% confidence interval 0.60%-4.16%), respectively. CONCLUSION: This meta-analysis summarizes the 30-day and 90-day mortality rates after liver resection in the elderly patients. Liver resection in this population selected for surgery appears to be relatively safe. Advanced age alone may not be a sufficient exclusion criterion for surgery. These age-specific mortality data can be used to educate patients at the time of preoperative counseling.

Quick and Clean: LCME Scientific Method Training Without a Teaching Laboratory.

This exercise satisfies the Liaison Committee on Medical Education Standard 7.3 for medical student training in the scientific method. The students are challenged, individually and in small groups, to state and test hypotheses based on real patient data concerning risk factors for the development of hepatocellular carcinoma.

An Eye on Disparities, Health Equity, and Racism-The Case of Firearm Injuries in Urban Youth in the United States and Globally.

Firearm violence is a significant public health problem, particularly among youth in the United States. Regardless of the data source or setting, young Black men have consistently been found to be disproportionately affected by firearm injuries and deaths. Public health research indicates that racial segregation likely increases racial disparities in firearm violence. To minimize deaths and injuries due to firearms and their cascading health consequences and to ultimately achieve health equity, preventive efforts will need to address the social determinants of health, including racism.

Community-Engaged and Informed Violence Prevention Interventions.

Strategies for the prevention of violence against children have evolved over the last 3 decades to incorporate community-engaged approaches. These promising approaches involve mobilizing key stakeholders within communities from a variety of different sectors, and engaging adult bystanders to take action when violence is suspected. However, there are many challenges associated with funding and evaluating such programs, which are often barriers in the development of an evidence base that includes metrics of effectiveness and cost benefits. This article discusses specific interventions developed to target physical abuse and neglect, sexual violence, community and gang violence, and bullying within the community setting.

Anatomical distribution and autopsy features of gunshot injuries to support the manner of death.

The autopsy features of gunshot wounds can be useful in understanding the manner of death. This research aims to provide concrete data to help to discriminate between homicide and suicide based on specific autopsy findings. A search of the database of the Cook County Medical Examiner's Office from August 2014 through April 2019 identified 3491 deaths due to gunshot wounds. Deaths due to complication from delayed fatal gunshot wounds, subjects who received hospital care prior to death, and decomposed bodies were identified and excluded. The following data were recorded: manner of death, demographic data, firearm and bullet type, number and location of gunshot wounds, range of fire, toxicology, and additional injuries. The study primary focused on the analysis of the bullet trajectory. A course leftward-upward-backward was the most frequent observed trajectory in suicides; a course rightward-upward-frontward was the most frequent observed trajectory in homicides. When the internal trajectory of a bullet is interpreted in the light of all available evidence it can impeach or corroborate witness statements and highlight consistencies as well inconsistencies in investigative reports and scene examinations.

COVID-19 outcomes among people with intellectual and developmental disability living in residential group homes in New York State.

BACKGROUND: People with intellectual and developmental disabilities (IDD) may be at higher risk of severe outcomes from COVID-19. OBJECTIVE: To describe COVID-19 outcomes among people with IDD living in residential groups homes in the state of New York and the general population of New York State. METHODS: Data for people with IDD are from a coalition of organizations providing over half of the residential services for the state of New York, and from the New York State Department of Health. Analysis describes COVID-19 case rates, case-fatality, and mortality among people with IDD living in residential group homes and New York State through May 28, 2020. RESULTS: People with IDD living in residential group homes were at greater risk of severe COVID-19 outcomes: case rates - 7,841 per 100,000 for people with IDD compared to 1,910 for New York State; case-fatality - 15.0% for people with IDD compared to 7.9% for New York State; and mortality rate - 1,175 per 100,000 for people with IDD compared to 151 per 100,000 for New York State. Differences in cases and mortality rate were confirmed across regions of the state, but case-fatality rate was only higher for people with IDD in and around the New York City region. CONCLUSIONS: COVID-19 appears to present a greater risk to people with IDD, especially those living in congregate settings. A full understanding of the severity of this risk will not be possible until US states begin publicly sharing all relevant data they have on COVID-19 outcomes among this population.

Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis.

BACKGROUND: Despite possibly higher risk of severe outcomes from COVID-19 among people with intellectual and developmental disabilities (IDD), there has been limited reporting of COVID-19 trends for this population. OBJECTIVE: To compare COVID-19 trends among people with and without IDD, overall and stratified by age. METHODS: Data from the TriNetX COVID-19 Research Network platform was used to identify COVID-19 patients. Analysis focused on trends in comorbidities, number of cases, number of deaths, and case-fatality rate among patients with and without IDD who had a positive diagnosis for COVID-19 through May 14, 2020. RESULTS: People with IDD had higher prevalence of specific comorbidities associated with poorer COVID-19 outcomes. Distinct age-related differences in COVID-19 trends were present among those with IDD, with a higher concentration of COVID-19 cases at younger ages. In addition, while the overall case-fatality rate was similar for those with IDD (5.1%) and without IDD (5.4%), these rates differed by age: ages ≤17 - IDD 1.6%, without IDD <0.01%; ages 18-74 - IDD 4.5%, without IDD 2.7%; ages ≥75- IDD 21.1%, without IDD, 20.7%. CONCLUSIONS: Though of concern for all individuals, COVID-19 appears to present a greater risk to people with IDD, especially at younger ages. Future research should seek to document COVID-19 trends among people with IDD, with particular attention to age related trends.

Survey of U.S. adults with spina bifida.

BACKGROUND: Spina Bifida (SB) is one of the most common birth defects and causes of permanent disability in the United States (US), with approximately 3.5 cases per 10,000 live births. OBJECTIVE: To identify complications associated with SB related to skin breakdown, pain, and urinary tract infections (UTIs), and to examine socio-demographic differences related to these complications. METHODS: Exploratory cross-sectional study via online of a national US convenience sample of adults with SB. RESULTS: We collected 1485 survey responses, of which 852 had complete, useable data. Skin breakdown in one or more locations during the past year was reported by 43.1%. After controlling for socio-demographic characteristics, only mobility variables remained significant predictors of skin breakdown (assistive device use OR = 3.119, 95% CI: 1.749, 5.564; using a wheelchair OR = 6.336, 95% CI: 3.442, 11.662). Pain in past seven days was reported by 46.9%. Single respondents (OR = 0.621; 95% CI: 0.419, 0.921) and those with at least a Bachelor's degree (vs high school degree or less, OR = 0.468; 95% CI: 0.283, 0.774) were less likely, and those using assistive devices were significantly more likely (OR = 1.960; 95% CI: 1.163, 3.303), to report pain. About one-third (32.7%) reported having a UTI within the past 12 months. Notably, almost half (49.6%) of respondents did not answer this question. The presence of UTIs was not significantly related to any socio-demographic characteristics assessed. CONCLUSIONS: Adults with SB in the US live with a wide range of complications which are potentially under-monitored, with predictors of complications that require further research.

Nonparametric Interval Estimators for the Coefficient of Variation.

The coefficient of variation (CV) is a widely used scaleless measure of variability in many disciplines. However the inference for the CV is limited to parametric methods or standard bootstrap. In this paper we propose two nonparametric methods aiming to construct confidence intervals for the coefficient of variation. The first one is to apply the empirical likelihood after transforming the original data. The second one is a modified jackknife empirical likelihood method. We also propose bootstrap procedures for calibrating the test statistics. Results from our simulation studies suggest that the proposed methods, particularly the empirical likelihood method with bootstrap calibration, are comparable to existing methods for normal data and yield better coverage probabilities for nonnormal data. We illustrate our methods by applying them to two real-life datasets.