Estimate of Increase in Colorectal Cancer Diagnoses with Expansion of Fecal Immunochemical Testing in an Urban Safety-Net Population.

BACKGROUND: Fecal immunochemical test (FIT) is less effective in detecting advanced adenomas (AA) than colonoscopy. Increase in FIT for colorectal cancer (CRC) screening may lead to an increased number of undetected AAs which may develop into future CRCs. AIM: We determined the potential impact of FIT expansion on missed AAs and future CRC diagnoses in an urban, tertiary-care, safety-net hospital. METHODS: CRC and AA diagnoses were identified in patients undergoing colonoscopy for average-risk CRC screening or positive FIT between 2017 and 2019 at Boston Medical Center. Poisson regression modeling was used to estimate the frequency of AAs per year by age group using data from 2017 to 2019, assuming average outpatient volume and proportion of screening colonoscopies. Total number of patients who received FIT was extrapolated from those who underwent colonoscopy for positive FIT. We estimated AAs per year if 'one-time' FIT was used for screening in 75% and 100% of the population and subtracted this from the estimated AAs per year under the Poisson model to determine missed AAs. We used previously described, age and gender specific estimates of the annual progression of AA to CRC. RESULTS: The estimated number of CRCs detected per year is 4.6/1785 males and 4.6/2086 females screened. With 75% FIT expansion, we estimate an additional 3.5 (95% CI 1.3, 9.5) and 2.2 (95% CI 0.64, 7.6) CRCs; with 100% FIT expansion, we estimate an additional 7.4 (95% CI 3.7, 14.9) and 4.2 (95% CI 1.7, 10.5) CRCs, in 5 years, in males and females, respectively. CONCLUSION: Expansion of FIT may substantially increase CRC incidence.

Time shifts: Place, belonging, and future orientation in pandemic everyday life.

The disruptions to everyday life wrought by the COVID-19 pandemic include distortions in the experience of time, as reported widely by ordinary citizens and observed by journalists and social scientists. But how does this temporal disruption play out in different time scales-in the individual day as opposed to the medium- and long-term futures? And how might place influence how individuals experience and understand the pandemic's temporal transformations? This essay examines a range of temporal disruptions reported in day diaries and surveys submitted to the Everyday Life in Middletown project, an online archive that has been documenting ordinary life in Muncie, Indiana, USA since 2016. Viewing these materials as instances of life writing, the essay probes the interactions between temporal disruptions and the local setting as they inflect the autobiographical selves our writers construct in their pandemic writings. It shows how living in Muncie-a postindustrial city with its particular combination of historical, demographic, economic, social, and political dynamics-structures the autobiographical stories available to our writers, and how the disruption of time produces new variations and problems for life writing. In the midst of a global crisis, we glimpse the pandemic's reshaping of a local structure of feeling in which a pervasive, local narrative of civic decline frames individual self-fashioning.

Under one canopy? Assessing the distributional environmental justice implications of street tree benefits in Barcelona.

Street trees are an important component of green infrastructure in cities, providing multiple ecosystem services (ES) and hence contributing to urban resilience, sustainability and livability. Still, access to these benefits may display an uneven distribution across the urban fabric, potentially leading to socio-environmental inequalities. Some studies have analyzed the distributional justice implications of street tree spatial patterns, but generally without quantifying the associated ES provision. This research estimated the amount of air purification, runoff mitigation and temperature regulation provided by circa 200,000 street trees in Barcelona, Spain, using the i-Tree Eco tool. Results were aggregated at neighborhood (n = 73) and census tract (n = 1068) levels to detect associations with the distribution of five demographic variables indicating social vulnerability, namely: income, residents from the Global South, residents with low educational attainment, elderly residents, and children. Associations were evaluated using bivariate, multivariate and cluster analyses, including a spatial autoregressive model. Unlike previous studies, we found no evidence of a significant and positive association between the distribution of low income or Global South residents and a lower amount of street tree benefits in Barcelona. Rather, higher ES provision by street trees was associated with certain types of vulnerable populations, especially elderly citizens. Our results also suggest that street trees can play an important redistributive role in relation to the local provision of regulating ES due to the generally uneven and patchy distribution of other urban green infrastructure components such as urban forests, parks or gardens in compact cities such as Barcelona. In the light of these findings, we contend that just green infrastructure planning should carefully consider the distributive implications associated with street tree benefits.

Your friends know how long you will live: a 75-year study of peer-rated personality traits.

Although self-rated personality traits predict mortality risk, no study has examined whether one's friends can perceive personality characteristics that predict one's mortality risk. Moreover, it is unclear whether observers' reports (compared with self-reports) provide better or unique information concerning the personal characteristics that result in longer and healthier lives. To test whether friends' reports of personality predict mortality risk, we used data from a 75-year longitudinal study (the Kelly/Connolly Longitudinal Study on Personality and Aging). In that study, 600 participants were observed beginning in 1935 through 1938, when they were in their mid-20s, and continuing through 2013. Male participants seen by their friends as more conscientious and open lived longer, whereas friend-rated emotional stability and agreeableness were protective for women. Friends' ratings were better predictors of longevity than were self-reports of personality, in part because friends' ratings could be aggregated to provide a more reliable assessment. Our findings demonstrate the utility of observers' reports in the study of health and provide insights concerning the pathways by which personality traits influence health.

Pulmonary hypertension in hypertensive patients: association with diastolic dysfunction and increased pulmonary vascular resistance.

BACKGROUND: Pulmonary hypertension (PH) in patients with systemic hypertension and preserved ejection fraction (PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH. METHODS: Echocardiograms and records of hypertensive patients with left ventricular (LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures. RESULTS: Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate (eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm(2) , P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e' 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e' showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively). CONCLUSIONS: Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro-BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy.

Green gentrification in European and North American cities.

Although urban greening is universally recognized as an essential part of sustainable and climate-responsive cities, a growing literature on green gentrification argues that new green infrastructure, and greenspace in particular, can contribute to gentrification, thus creating social and racial inequalities in access to the benefits of greenspace and further environmental and climate injustice. In response to limited quantitative evidence documenting the temporal relationship between new greenspaces and gentrification across entire cities, let alone across various international contexts, we employ a spatially weighted Bayesian model to test the green gentrification hypothesis across 28 cities in 9 countries in North America and Europe. Here we show a strong positive and relevant relationship for at least one decade between greening in the 1990s-2000s and gentrification that occurred between 2000-2016 in 17 of the 28 cities. Our results also determine whether greening plays a "lead", "integrated", or "subsidiary" role in explaining gentrification.

Adapting the environmental risk transition theory for urban health inequities: An observational study examining complex environmental riskscapes in seven neighborhoods in Global North cities.

Theories of epidemiologic transition analyze the shift in causes of mortality due to changes in risk factors over time, and through processes of urbanization and development by comparing risk factors between countries or over time. These theories do not account for health inequities such as those resulting from environmental injustice, in which minority and lower income residents are more likely to be exposed to environmental hazards or have less access to environmental goods. Neighborhoods with histories of environmental injustice are also at risk for gentrification as they undergo environmental improvements and new greening projects. We aimed to understand how environmental injustice, urban renewal and green gentrification could inform the understanding of epidemiologic risk transitions. We examined 7 case neighborhoods in cities in the United States and Western Europe which were representative in terms of city region and type, which 1) had experienced a history of environmental injustice and 2) exhibited evidence of recent processes of urban renewal and/or gentrification. In each city, we conducted semi-structured qualitative interviews (n = 172) with city representatives, activists, non-profits, developers and residents. Respondents reported health implications of traditional (heavy pollutants, poor social conditions), transitional (decontamination, new amenities), new (gentrification, access to amenities), and emerging (displacement, climate-related risks, re-emergence of traditional exposures) exposures. Respondents reported renewed, complexified and overlapping exposures leading to poor mental and physical health and to new patterns of health inequity. Our findings point to the need for theories of environmental and epidemiologic risk transitions to incorporate analysis of trends 1) on a city-scale, acknowledging that segregation and patterns of environmental injustice have created unequal conditions within cities and 2) over a shorter and more recent time period, taking into account worsening patterns of social inequity in cities.

Mental Health Outcomes in Barcelona: The Interplay between Gentrification and Greenspace.

Greenspace is widely related to mental health benefits, but this relationship may vary by social group. Gentrification, as linked to processes of unequal urban development and conflict, potentially impacts health outcomes. This study explores the relationships between greenspace and mental health and between gentrification and mental health associations. It also further examines gentrification as an effect modifier in the greenspace-mental health association and SES as an effect modifier in the gentrification-mental health association. We used cross-sectional Barcelona (Spain) data from 2006, which included perceived mental health status and self-reported depression/anxiety from the Barcelona Health Survey. Greenspace exposure was measured as residential access to (1) all greenspace, (2) greenways and (3) parks in 2006. Census-tract level gentrification was measured using an index including changes in sociodemographic indicators between 1991 and 2006. Logistic regression models revealed that only greenways were associated with better mental health outcomes, with no significant relationship between mental health and parks or all greenspace. Living in gentrifying neighborhoods was protective for depression/anxiety compared to living in non-gentrifying neighborhoods. However, only residents of gentrifiable census tracts benefited from the exposure to greenways. SES was not found to be an effect modifier in the association between gentrification and mental health. Future research should tackle this study's limitations by incorporating a direct measure of displacement in the gentrification status indicator, accounting for qualitative aspects of greenspace and user's perceptions. Gentrification may undermine the health benefits provided by greenspace interventions.

Natural outdoor environments' health effects in gentrifying neighborhoods: Disruptive green landscapes for underprivileged neighborhood residents.

BACKGROUND: Cities are restoring existing natural outdoor environments (NOE) or creating new ones to address diverse socio-environmental and health challenges. The idea that NOE provide health benefits is supported by the therapeutic landscapes concept. However, several scholars suggest that NOE interventions may not equitably serve all urban residents and may be affected by processes such as gentrification. Applying the therapeutic landscapes concept, this study assesses the impacts of gentrification processes on the associations between NOE and the health of underprivileged, often long-term, neighborhood residents. METHODS: We examined five neighborhoods in five cities in Canada, the United States and Western Europe. Our case studies were neighborhoods experiencing gentrification processes and NOE interventions. In each city, we conducted semi-structured qualitative interviews on NOE interventions, equity/justice, gentrification and health (n = 117) with case study neighborhood residents, community-based organizations, neighborhood resident leaders and other stakeholders such as public agencies staff. RESULTS: Respondents highlighted a variety of interconnected and overlapping factors: the insufficient benefits of NOE to counterbalance other factors detrimental to health, the use of NOE for city branding and housing marketing despite pollution, unwelcomeness, increase of conflicts, threats to physical displacement for themselves and their social networks, unattractiveness, deficient routes, inadequate NOE maintenance and lack of safety in NOE. CONCLUSIONS: Our study demonstrated that underprivileged neighborhood residents were perceived to experience new or improved NOE as what we call "disruptive green landscapes" (i.e. non-therapeutic landscapes with which they were not physically or emotionally engaged) instead of as therapeutic landscapes.

Determining the health benefits of green space: Does gentrification matter?

Urban green space is demonstrated to benefit human health. We evaluated whether neighborhood gentrification status matters when considering the health benefits of green space, and whether the benefits are received equitably across racial and socioeconomic groups. Greater exposure to active green space was significantly associated with lower odds of reporting fair or poor health, but only for those living in gentrifying neighborhoods. In gentrifying neighborhoods, only those with high education or high incomes benefited from neighborhood active green space. Structural interventions, such as new green space, should be planned and evaluated within the context of urban social inequity and change.

Future Pharmacotherapy for Non-alcoholic Steatohepatitis (NASH): Review of Phase 2 and 3 Trials.

Non-alcoholic steatohepatitis (NASH) results from inflammation and hepatocyte injury in the setting of hepatic steatosis. Non-alcoholic steatohepatitis increases the risk of progression to liver fibrosis and cirrhosis, and is the most rapidly growing etiology for liver failure and indication for liver transplantation in the USA. Weight loss and lifestyle modification remain the standard first-line treatment, as no USA Food and Drug Administration-approved pharmacotherapy currently exists. The past decade has seen an explosion of interest in drug development targeting pathologic pathways in non-alcoholic steatohepatitis, with numerous phase 2 and 3 trials currently in progress. Here, we concisely review the major targets and mechanisms of action by class, summarize results from completed pivotal phase 2 studies, and provide a detailed outline of key active studies with trial data for drugs in development, including obeticholic acid, elafibranor, cenicriviroc and selonsertib.

Are green cities healthy and equitable? Unpacking the relationship between health, green space and gentrification.

While access and exposure to green spaces has been shown to be beneficial for the health of urban residents, interventions focused on augmenting such access may also catalyse gentrification processes, also known as green gentrification. Drawing from the fields of public health, urban planning and environmental justice, we argue that public health and epidemiology researchers should rely on a more dynamic model of community that accounts for the potential unintended social consequences of upstream health interventions. In our example of green gentrification, the health benefits of greening can only be fully understood relative to the social and political environments in which inequities persist. We point to two key questions regarding the health benefits of newly added green space: Who benefits in the short and long term from greening interventions in lower income or minority neighbourhoods undergoing processes of revitalisation? And, can green cities be both healthy and just? We propose the Green Gentrification and Health Equity model which provides a framework for understanding and testing whether gentrification associated with green space may modify the effect of exposure to green space on health.

Adult human metapneumonovirus (hMPV) pneumonia mimicking Legionnaire's disease.

In adults hospitalized with viral pneumonias the main differential diagnostic consideration is influenza pneumonia. The respiratory viruses causing viral influenza like illnesses (ILIs), e.g., RSV may closely resemble influenza. Rarely, extrapulmonary findings of some ILIs may resemble Legionnaire's disease (LD), e.g., adenovirus, human parainfluenza virus (HPIV-3). We present a most unusual case of human metapneumonovirus pneumonia (hMPV) with some characteristic extrapulmonary findings characteristic of LD, e.g., relative bradycardia, as well as mildly elevated serum transaminases and hyphosphatemia. We believe this is the first reported case of hMPV pneumonia in a hospitalized adult that had some features of LD.

Herpes Simplex Virus (HSV-1) Encephalitis Mimicking Glioblastoma: Case Report and Review of the Literature.

Glioblastoma multiforme (GBM) often presents as a brain mass with encephalitis. In a patient with GBM, subsequent presentation with new onset encephalitis may be due to another GBM or Herpes simplex virus 1 (HSV-1) encephalitis. We present a case of HSV-1 encephalitis mimicking GBM in a patient with previous GBM.