Health, wealth, and air pollution: advancing theory and methods.

The effects of both ambient air pollution and socioeconomic position (SEP) on health are well documented. A limited number of recent studies suggest that SEP may itself play a role in the epidemiology of disease and death associated with exposure to air pollution. Together with evidence that poor and working-class communities are often more exposed to air pollution, these studies have stimulated discussion among scientists, policy makers, and the public about the differential distribution of the health impacts from air pollution. Science and public policy would benefit from additional research that integrates the theory and practice from both air pollution and social epidemiologies to gain a better understanding of this issue. In this article we aim to promote such research by introducing readers to methodologic and conceptual approaches in the fields of air pollution and social epidemiology; by proposing theories and hypotheses about how air pollution and socioeconomic factors may interact to influence health, drawing on studies conducted worldwide; by discussing methodologic issues in the design and analysis of studies to determine whether health effects of exposure to ambient air pollution are modified by SEP; and by proposing specific steps that will advance knowledge in this field, fill information gaps, and apply research results to improve public health in collaboration with affected communities

Post Hysterectomy Discharge Destination and Risk of Hospital Readmission in Elderly Women

In elderly women, discharge after gynecologic surgery is often associated with increased morbidity. Little information exists about elderly women\u27s discharge destination after gynecologic surgery and the outcome of early hospital readmission. The purpose of this study, conceptualized using the quality health outcomes model, was to examine whether post hysterectomy discharge destination is an independent predictor of 30-day hospital readmission in women age 65 and older. Examination of covariates included patient age, race, medical comorbidity and complications of care, as well as surgical anatomic approach and operative technique. This study involved use of a retrospective cohort design and data from 10,598 cases contained in the Healthcare Cost and Utilization Project 2010 and 2011 California State Inpatient Databases. Results of the bivariate analysis showed a statistically significant association between discharge destination after hysterectomy and 30-day hospital readmission. Additionally, the results of multivariate logistic regression revealed the odds of readmission after discharge with home care were 2.99, p \u3c .001, 95% CI [2.29, 3.67] times greater when compared with discharge home for self-care and 5.99, p \u3c .001, 95% CI [4.68, 7.43] times greater with discharge to continuing inpatient care versus home for self-care. This study may lead to positive social change for elderly women by informing health care providers about the odds of early hospital readmission associated with discharge destination after hysterectomy. Further, this information may stimulate development of interventions to improve health care practices for elderly women preparing for hospital discharge after hysterectomy

Why Does the Importance of Education for Health Differ across the United States?

The positive association between educational attainment and adult health (“the gradient”) is stronger in some areas of the United States than in others. Explanations for the geographic pattern have not been rigorously investigated. Grounded in a contextual and life-course perspective, the aim of this study is to assess childhood circumstances (e.g., childhood health, compulsory schooling laws) and adult circumstances (e.g., wealth, lifestyles, economic policies) as potential explanations. Using data on U.S.-born adults aged 50 to 59 years at baseline (n = 13,095) and followed for up to 16 years across the 1998 to 2014 waves of the Health and Retirement Study, the authors examined how and why educational gradients in morbidity, functioning, and mortality vary across nine U.S. regions. The findings indicate that the gradient is stronger in some areas than others partly because of geographic differences in childhood socioeconomic conditions and health, but mostly because of geographic differences in adult circumstances such as wealth, lifestyles, and economic and tobacco policies

Use of Medicinal Cannabis and Synthetic Cannabinoids in Posttraumatic Stress Disorder (PTSD): a systematic review

Background and Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric disorder resulting from a traumatic event, is manifested through hyperarousal, anxiety, depressive symptoms, and sleep disturbances. Despite several therapeutic approaches being available, both pharmacological and psychological, recently a growing interest has developed in using cannabis and synthetic cannabinoids stems from their consideration as more efficient and better tolerated alternatives for the treatment of this condition. The present paper aims to evaluate the clinical and therapeutic potentials of medical cannabis and synthetic cannabinoids in treating PTSD patients. Methods: A systematic electronic search was performed, including all papers published up to May 2019, using the following keywords (((cannabis[Title/Abstract]) OR (synthetic cannabinoids [Title/Abstract])) AND ((PTSD[Title/Abstract]) OR (Posttraumatic stress disorder[Title/Abstract]))) for the topics ‘Cannabis’, ‘Synthetic Cannabinoids’, ‘PTSD’, and MESH terms, on the PubMed, Cochrane Library, and Web of Science online databases. For data gathering purposes, PRISMA guidelines were followed. Results were organized into two groups, considering cannabis and synthetic cannabinoids as different therapeutic approaches for PTSD. Results: Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory-related processes, and improving sleep. Conclusions: Even though the current literature suggests that cannabis and synthetic cannabinoids may have a role in the treatment of PTSD, there is currently limited evidence regarding their safety and efficacy. Therefore, additional research is needed in order to better understand the effectiveness and therapeutic usage of these drug classes and monitor their safety.Peer reviewe

Personalized Exposure Assessment: Promising Approaches for Human Environmental Health Research

New technologies and methods for assessing human exposure to chemicals, dietary and lifestyle factors, infectious agents, and other stressors provide an opportunity to extend the range of human health investigations and advance our understanding of the relationship between environmental exposure and disease. An ad hoc Committee on Environmental Exposure Technology Development was convened to identify new technologies and methods for deriving personalized exposure measurements for application to environmental health studies. The committee identified a “toolbox” of methods for measuring external (environmental) and internal (biologic) exposure and assessing human behaviors that influence the likelihood of exposure to environmental agents. The methods use environmental sensors, geographic information systems, biologic sensors, toxicogenomics, and body burden (biologic) measurements. We discuss each of the methods in relation to current use in human health research; specific gaps in the development, validation, and application of the methods are highlighted. We also present a conceptual framework for moving these technologies into use and acceptance by the scientific community. The framework focuses on understanding complex human diseases using an integrated approach to exposure assessment to define particular exposure–disease relationships and the interaction of genetic and environmental factors in disease occurrence. Improved methods for exposure assessment will result in better means of monitoring and targeting intervention and prevention programs

Exploring the Concept of Self-Creativity Through the Validation of a New Survey Measure

The purpose of this investigation was to validate a newly constructed instrument, the Creativity Assessment for the Malleability of Possible Selves (CAMPS) and, through that process, operationally define the newly developed construct of self-creativity. This dissertation utilizes three separate studies to validate the CAMPS and operationally define self-creativity, including samples intended to represent the general population (n = 199), professional counselors (n = 133), and exemplars of self-creativity (n = 13). Study 1 utilized an exploratory factor analysis for the initial item reduction and factor structure exploration, followed by testing convergent and discriminant validity utilizing established assessments of creativity, personality, and depression. Through this process, 16 items and six factors emerged, as did the initial parameters for the self-creativity operational definition. Study 2 utilized a confirmatory factor analysis to confirm this 16-item, six factor model, the results of which supported a good model fit. Study 3 utilized semi-structured interviews with exemplars of self-creativity for the purpose of determining face validity of both the CAMPS and the conceptual definition of self-creativity, as well as to provide feedback on the overall experience of completing the assessment. Hypothetical and practical implications of these results and recommendations for future research are discussed

Geographic Biases in Human Lyme disease Surveillance and Utility of Companion Animal Sentinel Programs: Exploratory Spatial Analysis

Background and Objectives: Mapping and exploratory spatial data analyses are ideal tools for characterizing spread and occurrence of human Lyme disease infection. Unfortunately, many mapped displays utilizing Lyme disease surveillance data are prone to bias due to a lack of consideration for geographical confounders. The objectives of our study were to 1) characterize the geographic effects that boundary and travel related biases have on visualization of human Lyme disease occurrence and 2) apply these findings to develop a more precise methodology for evaluating efficacy of animal sentinel surveillance programs in predicting incidence of human Lyme disease infection.;Methods: County-level human Lyme disease and companion animal tick surveillance data were obtained from relevant state health departments. Data were organized within Microsoft Excel spreadsheets, and sorted by relevant reporting year and county. In Study 1, boundary effects were evaluated for the region containing Kentucky, Maryland, Ohio, Pennsylvania, Virginia, and West Virginia 2010-2014, utilizing a combination of rate smoothing and local indicators of spatial autocorrelation. Trends in disease clustering over time within our multistate region were evaluated utilizing logistic generalized estimating equations. In Study 2, travel associated biases were evaluated only for West Virginia confirmed Lyme disease cases 2011-2015, utilizing a combination of paired t-test, Wilcoxon Rank Signed test, and local indicators of spatial autocorrelation. In Study 3, the efficacy of the companion animal (dog and cat) sentinel surveillance program in West Virginia 2014-2016, was evaluated utilizing a combination of ordinary least squares and spatial regression techniques as well as local indicators of spatial autocorrelation on regression residuals.;Results: Study 1. Analyses indicated statistically significant ( P = 0.05) clustering of human Lyme disease incidence over time. High-high clusters aggregated near counties bordering high incidence states, while low-low clusters aggregated near shared county borders in non-high incidence states. Study 2. Analyses indicated statistical non-equivalency using paired t-test (t = 3.99, df = 54, P = 0.0002) and the non-parametric Wilcoxon Signed Rank test (S=264, P \u3c 0.001) between total overall cases and those obtained within patient\u27s home county, suggesting significant travel-associated bias. Additionally, local indicators of spatial autocorrelation detected statistically significant ( P = 0.05) patterns of clustering in the county level proportion of cases attributable to travel. Study 3. Regression analyses identified significant associations between confirmed cases of human Lyme disease and average number of Ixodes scapularis removed from dogs (ordinary least squares (beta=0.20 P \u3c 0.001) and spatial lag (beta = 0.12, P = 0.002) models) but not cats for the period 2014-2016. Local indicators of spatial autocorrelation produced for spatial lag regression residuals indicated a decrease in model over and underestimation, but identified a higher number of statistically significant outliers than ordinary least squares regression.;Conclusions: Results of spatial and regression analyses 1) indicate significant differential clustering of incident human Lyme disease within WV and surrounding states over time; 2) suggest substantial travel-associated bias in Lyme disease case visualization within WV; and 3) strongly support the use of companion animal, and specially dog sentinel surveillance programs for estimation of human Lyme disease risk within WV. These findings suggest that geographic biases significantly affect visualization of human Lyme disease incidence and support the effectiveness of utilizing dogs as sentinel populations to estimate human risk. Findings of these three studies highlight the importance of using statistical methodologies that can accommodate the spatial structure imbedded within public health surveillance data