Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health

Multilevel interventions are those that affect at least two levels of influence—for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health’s Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions

Access to Care and Cardiovascular Disease Prevention: A Cross-Sectional Study in 2 Latino Communities.

Cardiovascular disease (CVD) is the leading killer of Americans. CVD is understudied among Latinos, who have high levels of CVD risk factors. This study aimed to determine whether access to health care (ie, insurance status and having a usual source of care) is associated with 4 CVD prevention factors (ie, health care utilization, CVD screening, information received from health care providers, and lifestyle factors) among Latino adults and to evaluate whether the associations depended on CVD clinical risk/disease.Data were collected as part of a community-engaged food environment intervention study in East Los Angeles and Boyle Heights, CA. Logistic regressions were fitted with insurance status and usual source of care as predictors of the 4 CVD prevention factors while controlling for demographics. Analyses were repeated with interactions between self-reported CVD clinical risk/disease and access to care measures.Access to health care significantly increased the odds of CVD prevention. Having a usual source of care was associated with all factors of prevention, whereas being insured was only associated with some factors of prevention. CVD clinical risk/disease did not moderate any associations.Although efforts to reduce CVD risk among Latinos through the Affordable Care Act could be impactful, they might have limited impact in curbing CVD among Latinos, via the law's expansion of insurance coverage. CVD prevention efforts must expand beyond the provision of insurance to effectively lower CVD rates

Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps.

BackgroundThe effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.MethodsHousehold data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.ResultsImprovements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.ConclusionsResults suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity

A companion candidate in the gap of the T Cha transitional disk

T Cha is a young star surrounded by a cold disk. The presence of a gap within its disk, inferred from fitting to the spectral energy distribution, has suggested on-going planetary formation. We observed T Cha in L' and K_s with NAOS-CONICA, the adaptive optics system at the VLT, using sparse aperture masking. We detected a source in the L' data at a separation of 62+-7 mas, position angle of 78+-1 degrees, and a contrast of delta L' = 5.1+-0.2 mag. The object is not detected in the Ks band data, which show a 3-sigma contrast limit of 5.2 mag at the position of the detected L' source. For a distance of 108 pc, the detected companion candidate is located at 6.7 AU from the primary, well within the disk gap. If T Cha and the companion candidate are bound, the comparison of the L' and Ks photometry with evolutionary tracks shows that the photometry is inconsistent with any unextincted photosphere at the age and distance of T Cha. The detected object shows a very red Ks-L' color for which a possible explanation would be a significant amount of dust around it. This would imply that the companion candidate is young, which would strengthen the case for a physical companion, and moreover that the object would be in the substellar regime, according to the Ks upper limit. Another exciting possibility would be that this companion is a recently formed planet within the disk. Additional observations are mandatory to confirm that the object is bound and to properly characterize it.Comment: 4 pages, 4 figures; accepted for publication by A&

The time evolution of aerosol composition over the Mexico City plateau

International audienceThe time evolution of aerosol concentration and chemical composition in a megacity urban plume was determined based on 8 flights of the DOE G-1 aircraft in and downwind of Mexico City during the March 2006 MILAGRO field campaign. A series of selection criteria are imposed to eliminate data points with non-urban emission influences. Biomass burning has urban and non-urban sources that are distinguished on the basis of CH3CN and CO. In order to account for dilution in the urban plume, aerosol concentrations are normalized to CO which is taken as an inert tracer of urban emission, proportional to the emissions of aerosol precursors. Time evolution is determined with respect to photochemical age defined as ?Log10 (NOx/NOy). The geographic distribution of photochemical age and CO is examined, confirming the picture that Mexico City is a source region and that pollutants become more dilute and aged as they are advected towards T1 and T2, surface sites that are located at the fringe of the City and 35 km to the NE, respectively. Organic aerosol (OA) per ppm CO is found to increase 7 fold over the range of photochemical ages studied, corresponding to a change in NOx/NOy from nearly 100% to 10%. In the older samples the nitrate/CO ratio has leveled off suggesting that evaporation and formation of aerosol nitrate are in balance. In contrast, OA/CO increases with age in older samples, indicating that OA is still being formed. The amount of carbon equivalent to the deduced change in OA/CO with age is 56 ppbC per ppm CO. At an aerosol yield of 5% and 8% for low and high yield aromatic compounds, it is estimated from surface hydrocarbon observations that only ~9% of the OA formation can be accounted for. A comparison of OA/CO in Mexico City and the eastern U.S. gives no evidence that aerosol yields are higher in a more polluted environment

Complementary analysis of Mueller-matrix images of optically anisotropic highly scattering biological tissues

Background: Using optical techniques for tissue diagnostics (so-called ‘optical biopsy’) has been a subject of extensive research for many years. Various groups have been exploring different spectral and/or imaging modalities (e.g. diffuse reflectance spectroscopy, autofluorescence, Raman spectroscopy, optical coherence tomography (OCT), polarized light microscopy, etc.) for biomedical applications. In this paper, we report on using multi-wavelength imaging Mueller polarimetry combined with an appropriated image post-processing for the detection of tissue malignancy. Methods: We investigate a possibility of complementary analysis of Mueller matrix images obtained for turbid tissue-like scattering phantoms and excised human normal and cancerous colorectal tissue samples embedded in paraffin. Combined application of correlation, fractal and statistical analysis was employed to assess quantitatively the polarization-inhomogeneous scattered fields observed at the surface of tissue samples. Results: The combined analysis of the polarimetric images of paraffin-embedded tissue blocks has proved to be an efficient tool for the unambiguous detection of tissue malignant transformation. A fractal structure was clearly observed at spatial distributions of depolarization of light scattered in healthy tissues in a visible range of spectrum, while corresponding distributions for cancerous tissues did not show such dependence. We demonstrate that paraffin does not destroy a fractal structure of spatial distribution of depolarization. Thus, the loss of fractality in spatial distributions of depolarization for cancerous tissue is related to the structural changes in the tissue sample induced by cancer itself and, therefore, may serve as a marker of the disease. Conclusion: The obtained results emphasize that a combined use of statistical, correlation and fractal analysis for the Mueller-matrix image post-processing is an effective approach for an assessment of variations of optical properties in turbid tissue-like scattering media and biological tissues, with a high potential to be transferred to clinical practice for screening cancerous tissue samples

Heterogeneity in Health Insurance Coverage Among US Latino Adults

We sought to determine the differences in observed and unobserved factors affecting rates of health insurance coverage between US Latino adults and US Latino adults of Mexican ancestry. Our hypothesis was that Latinos of Mexican ancestry have worse health insurance coverage than their non-Mexican Latino counterparts. The National Health Interview Survey (NHIS) database from 1999–2007 consists of 33,847 Latinos. We compared Latinos of Mexican ancestry to non-Mexican Latinos in the initial descriptive analysis of health insurance coverage. Disparities in health insurance coverage across Latino categories were later analyzed in a multivariable logistic regression framework, which adjusts for confounding variables. The Blinder-Oaxaca technique was applied to parse out differences in health insurance coverage into observed and unobserved components. US Latinos of Mexican ancestry consistently had lower rates of health insurance coverage than did US non-Mexican Latinos. Approximately 65% of these disparities can be attributed to differences in observed characteristics of the Mexican ancestry population in the US (e.g., age, sex, income, employment status, education, citizenship, language and health condition). The remaining disparities may be attributed to unobserved heterogeneity that may include unobserved employment-related information (e.g., type of employment and firm size) and behavioral and idiosyncratic factors (e.g., risk aversion and cultural differences). This study confirmed that Latinos of Mexican ancestry were less likely to have health insurance than were non-Mexican Latinos. Moreover, while differences in observed socioeconomic and demographic factors accounted for most of these disparities, the share of unobserved heterogeneity accounted for 35% of these differences

Towards neuroscience of the everyday world (NEW) using functional near infrared spectroscopy

Published in final edited form as: Curr Opin Biomed Eng. 2021 June ; 18: doi:10.1016/j.cobme.2021.100272.Functional near-infrared spectroscopy (fNIRS) assesses human brain activity by noninvasively measuring changes of cerebral hemoglobin concentrations caused by modulation of neuronal activity. Recent progress in signal processing and advances in system design, such as miniaturization, wearability, and system sensitivity, have strengthened fNIRS as a viable and cost-effective complement to functional magnetic resonance imaging, expanding the repertoire of experimental studies that can be performed by the neuroscience community. The availability of fNIRS and electroencephalography for routine, increasingly unconstrained, and mobile brain imaging is leading toward a new domain that we term “Neuroscience of the Everyday World” (NEW). In this light, we review recent advances in hardware, study design, and signal processing, and discuss challenges and future directions.U01EB029856 - National Institutes of HealthAccepted manuscrip

Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status