Chronic disease and county economic status: Does it matter where you live?

Chronic disease is a major health burden in the United States, affecting about half of adults, and leading to poor health, disability, and death. However, the burden of chronic disease is not shared equally among Americans, with some groups (created by determinants such as race/ethnicity and socioeconomic resources) experiencing higher rates of morbidity and mortality. When measures of health and socioeconomic resources are examined together, a stepwise gradient pattern emerges. This social gradient has been established for individual measures, such as household income and social class, and several measures of morbidity and mortality. However, nationally, little research has been conducted using area-level measures, such as county economics, to examine its relationship with chronic disease. Three studies were completed using data from the Behavioral Risk Factor Surveillance System (BRFSS). County economic status was determined using unemployment, per capita market income, and poverty. The first study examined the relationship between county economic status and chronic disease and risk factors, both nationally and by metropolitan classification, using data from BRFSS 2013. Further, the social gradient was explored. The second study also used data from BRFSS 2013 to examine county economic status and prevalence of hypertension, arthritis, and poor health, after controlling for known risk factors. This study also examined results by US region. Finally, the third study assessed changes in disparities between persistently poor and persistently affluent counties for heart disease, hypertension, arthritis, and diabetes using data from BRFSS 2001-2010

How do caregivers know when to take their child for immunizations?

BACKGROUND: Childhood vaccinations help reduce and eliminate many causes of morbidity and mortality among children. The objective of this study was to compare 4:3:1:3:3 (4+ doses of diphtheria and tetanus toxoids and pertussis vaccine, 3+ doses of poliovirus vaccine, 1+ doses of measles-containing vaccine, 3+ doses of Haemophilus influenzae type b vaccine, and 3+ doses of hepatitis B vaccine) coverage among children whose caregivers learned by different methods when their child's most recent immunization was needed. METHODS: Between July 2001 and December 2002, a portion of households receiving the National Immunization Survey were asked how they knew when to take the child in for his/her most recent immunization. Responses were post-coded into several categories: 'Doctor/nurse reminder at previous immunization visit', 'Shot card/record', 'Reminder/recall', and 'Other'. Respondents could give more than one answer. Children who did not receive any vaccines, had ≤ 1 visits for vaccinations, or whose caregiver did not provide an answer to the question were excluded from analyses. Chi-square analyses were used to compare 4:3:1:3:3 coverage among 19–35 month old children. RESULTS: Children whose caregivers indicated that a doctor/nurse told them at a previous immunization visit when to return for the next immunization had significantly greater 4:3:1:3:3 coverage than those who did not choose the response (77.2% vs. 70.1%, p < 0.01). However, no significant difference in coverage was found between households that did/did not indicate that reminder/recalls (71.0% vs. 75.5%, p = 0.24) helped them remember when to take their child for their most recent immunization visit; only borderline significance was found between those that did/did not choose shot cards (70.6% vs. 76.2%, p = 0.07). CONCLUSION: A doctor or nurse's reminder during an immunization visit of the next scheduled immunization visit effectively encourages caregivers to bring children in for immunizations, providing an inexpensive and easy way to effectively increase immunization coverage

Impact of methodological "shortcuts" in conducting public health surveys: Results from a vaccination coverage survey

Abstract Background Lack of methodological rigor can cause survey error, leading to biased results and suboptimal public health response. This study focused on the potential impact of 3 methodological "shortcuts" pertaining to field surveys: relying on a single source for critical data, failing to repeatedly visit households to improve response rates, and excluding remote areas. Methods In a vaccination coverage survey of young children conducted in the Commonwealth of the Northern Mariana Islands in July 2005, 3 sources of vaccination information were used, multiple follow-up visits were made, and all inhabited areas were included in the sampling frame. Results are calculated with and without these strategies. Results Most children had at least 2 sources of data; vaccination coverage estimated from any single source was substantially lower than from all sources combined. Eligibility was ascertained for 79% of households after the initial visit and for 94% of households after follow-up visits; vaccination coverage rates were similar with and without follow-up. Coverage among children on remote islands differed substantially from that of their counterparts on the main island indicating a programmatic need for locality-specific information; excluding remote islands from the survey would have had little effect on overall estimates due to small populations and divergent results. Conclusion Strategies to reduce sources of survey error should be maximized in public health surveys. The impact of the 3 strategies illustrated here will vary depending on the primary outcomes of interest and local situations. Survey limitations such as potential for error should be well-documented, and the likely direction and magnitude of bias should be considered.</p

Hypertension in Women of Reproductive Age in the United States: NHANES 1999-2008

Objective: To examine the epidemiology of hypertension in women of reproductive age. Methods: Using NHANES from 1999–2008, we identified 5,521 women age 20–44 years old. Hypertension status was determined using blood pressure measurements and/or self-reported medication use. Results: The estimated prevalence of hypertension in women of reproductive age was 7.7% (95% confidence interval (CI): 6.9%–8.5%). The prevalence of anti-hypertensive pharmacologic therapy was 4.2% (95% CI 3.5%–4.9%). The prevalence of hypertension was relatively stable across the study period; the age and race adjusted odds of hypertension in 2007–2008 did not differ significantly from 1999–2000 (odds ratio 1.2, CI 0.8 to 1.7, p = 0.45). Significant independent risk factors associated with hypertension included older age, non-Hispanic black race (compared to non-Hispanic whites), diabetes mellitus, chronic kidney disease, and higher body mass index. The most commonly used antihypertensive medications included diuretics, angiotensin-converting enzyme inhibitors (ACE), and beta blockers. Conclusion: Hypertension occurs in about 8% of women of reproductive age. There are remarkable differences in the prevalence of hypertension between racial/ethnic groups. Obesity is a risk factor of particular importance in this population because it affects over 30% of young women in the U.S., is associated with more than 4 fold increased risk of hypertension, and is potentially modifiable

LoCATE - Local Community Archaeological Training & Equipment Project

The Local Community Archaeological Training and Equipment (LoCATE) Project is a partnership between archaeologists at BU and the New Forest National Park Authority (NFNPA). Working with archaeological societies and community groups from across Dorset and Hampshire, the project provides access, training, and support for the use of advanced survey equipment that would otherwise be hard to get access to. LoCATE aims to support the research that local groups already do by extending the range of techniques and skills they can use. Our goal is to enable an even greater contribution to the understanding of the rich archaeological heritage of our region

Budding yeast Rif1 binds to replication origins and protects DNA at blocked replication forks

We thank Javier Garzon and Vamsi Krishna Gali for discussion and advice on methods, and Takashi Kubota for helpful comments on the manuscript. This work was supported by Cancer Research UK Programme Award A19059 to ADD and SH. KS was supported by Grant‐in‐Aid for Scientific Research on Priority Areas (15H05970 and 15K21761) from Ministry of Education, Culture, Sports, Science and Technology, Japan. Funding Cancer Research UK (CRUK) A19059 Ministry of Education, Culture, Sports, Science and Technology (MEXT) 15H0597015K21761 Data availability ChIP‐Seq data and corresponding input data were submitted to ArrayExpress under accession number E‐MTAB‐6736.Peer reviewedPublisher PD

Co-creation and archaeological prospection: LoCATE – The Local Community Archaeological Training and Equipment Project.

This paper is based on the co-creation of research through an innovative partnership focused around archaeological prospection techniques. LoCATE (Local Community Archaeological Training and Equipment) is a project that brings together archaeologists at Bournemouth University and the New Forest National Park Authority (NFNPA) with archaeological societies and community groups from across Dorset and Hampshire. LoCATE provides access, training, and support for the use of advanced survey equipment that can otherwise be hard to get hold of. It supports the work that all partners already do by extending the range of techniques and skills they can use, and expanding their capacity to undertake research. The idea for LoCATE was first instigated in 2015 when member of the Avon Valley Archaeological Society approached the University and asked them to consider providing access to older, but serviceable geophysical equipment that was not being used regularly for teaching and other activities. Working with the New Forest National Park Authority LoCATE was developed, and the first instrument made available was a Geoscan Research FM36 followed a year later by a Geoscan Research RM15. Most recently a total station has been added to the equipment pool, funded through the Heritage Lottery Funding (Our Past and Our Future, Landscape Partnership Scheme) and the Hampshire Field Club and Archaeological Society. Access to the equipment is managed through the New Forest’s volunteer equipment loan system. LoCATE members are given access to free training on these techniques using a variety of expertise situated across the partnership, and LoCATE members sign up to a code of responsible survey and data sharing. Open data is a core value, and LoCATE also encourages members to use open access materials and software, for example Snuffler freeware geophysics software (Staveley 2018). Inter-partner support is fostered through a variety of means including shared prospection activities, and project social media channels. Now in its fourth year, LoCATE has become well established, enabling relationships that support the research agendas of all partners. It has developed both capacity and expertise in the use of archaeological prospection activities in the local region. Example of the success of the project can be seen through the diversity of the outcomes from the work of LoCATE members from prehistoric monuments, including previously understudied Neolithic long and oval barrows and Bronze Age double ring ditches, to extensive Romano-British sites along the Avon Valley and on Cranborne Chase (Hampshire) (Gill 2019a, b). Through these surveys LoCATE members have achieved their own research aims, but also contributed to the collective goal of the project in enabling an improved understanding of the rich archaeological heritage of our region. In conclusion, LoCATE provides a new model for community engagement in archaeological prospection projects. In an era where the integration of techniques and data are central themes, it is perhaps timely to also consider the integration of people, and how we best work with a variety of different communities to create a shared understanding of our collective past. Bibliography Gill, M. 2019a. New long barrow discoveries in the vicinity of the middle Avon Valley and Cranborne Chase. PAST 91, 5-7. Gill, M. 2019b. Putting old kit to good use, the LoCATE geophysical project. British Archaeology, March/April 2019, 30-5. Staveley, D 2018. Snuffler - Freeware Geophysics Software. Available from: http://www.sussexarch.org.uk/geophys/snuffler.htm

Megalith quarries for Stonehenge’s bluestones. Review

Geologists and archaeologists have long known that the bluestones of Stonehenge came from the Preseli Hills of west Wales, 230km away, but only recently have some of their exact geological sources been identified. Two of these quarries - Carn Goedog and Craig Rhos-y-felin - have now been excavated to reveal evidence of megalith quarrying around 3000 BC - the same period as the first stage of the construction of Stonehenge. The authors present evidence for the extraction of the stone pillars and consider how they were transported, including the possibility that they were erected in a temporary monument close to the quarries, before completing their journey to Stonehenge

Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.&lt;/p&gt

Effective Mitigation of Anchoring Bias, Projection Bias, and Representativeness Bias from Serious Game-based Training

AbstractAlthough human use of heuristics can result in ‘fast and frugal’ decision-making, those prepotent tendencies can also impair our ability to make optimal choices. Previous work had suggested such cognitive biases are resistant to mitigation training. Serious games offer a method to incorporate desirable elements into a training experience, and allow the use of mechanisms that enhance learning and retention. We developed a game to train recognition and mitigation of three forms of cognitive bias: anchoring, a tendency to be inordinately influenced by one piece of information; projection, an implicit assumption that others think or know what you do; and representativeness, judging the likelihood of a hypothesis by how much the available data resembles it. Participants were randomly assigned to play the training game once, twice spaced by 10 to 12 days, or a control condition that used a training video. External questionnaire-based assessments were given immediately post-training and 12 weeks later. Superior training was seen from the game. An independent group using our training game with their own novel bias assessment instruments (to which the researchers and game-developers had no access or content information) validated the key finding. These results demonstrate the viability and high value of using serious computer games to train mitigation of cognitive biases