How Are HOPE VI Families Faring? Income and Employment

While the primary goal of the HOPE VI program is to improve the living environment of public housing residents, it also aims to help residents move toward self-sufficiency by helping them find new or better jobs (see page 6). The program's Community Support Services (CSS) component can help identify what residents need, such as job training or placement, to make them more likely to find employment. Relocation itself might help residents find employment if they move to less poor neighborhoods with more job opportunities and better job information networks. Residents who move back to new mixed-income developments on the HOPE VI sites could experience similar improved job networks. However, whether these expectations of increased employment and self-sufficiency are realistic for HOPE VI residents is unclear. For both employed and nonemployed residents, the gap between household income and the income needed for housing and other costs of living is wide. The HOPE VI Panel Study is tracking the well-being of residents from five HOPE VI sites (see page 7). These respondents, mostly African American women, were extremely poor at baseline.[1] The vast majority reported household incomes below the poverty level, and over a third (35 percent) reported annual incomes of less than $5,000. Less than half (45 percent) of respondents were employed, and those who were working earned low wages (Popkin et al. 2002). This brief discusses income and employment findings for working-age adults under 62 years old two years after relocation started at the five HOPE VI Panel Study sites.[2] It examines various barriers to employment for respondents, and considers both expectations for future employment and the services and support systems that might best mitigate those barriers. Future research will examine how residents' employment experiences are affected as relocation is completed and some residents return to the revitalized developments. Notes from this section 1. Among respondents under 62 years old, 82 percent were non-Hispanic African American women and 9 percent were Hispanic women. 2. A future brief in the "A Roof Over Their Heads" series will examine income and employment findings for adults over 62 years old

Lightning-induced ventricular fibrillation

We present a case of a previously healthy 17 year-old white male boy scout who collapsed after a lightning strike, and was found to be in ventricular fibrillation when emergency medical services arrived. The ventricular fibrillation was defibrillated into sinus rhythm after a single direct current (DC) countershock. However, the patient has remained in coma. Commotio cordis, sudden cardiac death from low-energy chest wall impact, is a phenomenon in which an exactly timed and located blow on the chest during the cardiac cycle results in ventricular fibrillation. Commotio cordis and electrical shock can both result in ventricular arrhythmias. We speculate that in this patient, ventricular fibrillation began immediately after the lightning, which probably struck at the peak of the T wave. (Cardiol J 2007; 14: 91–94

Wyładowanie atmosferyczne jako przyczyna migotania komór

W niniejszej pracy zaprezentowano przypadek 17-letniego harcerza, uprzednio zdrowego, który po uderzeniu pioruna stracił przytomność. Po przybyciu zespołu pogotowia ratunkowego w badaniu elektrokardiograficznym stwierdzono migotanie komór (VF). Wykonano defibrylację (1 impuls, prąd stały), która przywróciła rytm zatokowy, jednak mimo skutecznej interwencji pacjent pozostał w śpiączce. Angielski termin commotio cordis, który oznacza wystąpienie nagłej śmierci sercowej w wyniku działania niskiej energii na ścianę klatki piersiowej, jest fenomenem polegającym na pojawieniu się VF wskutek uderzenia ściśle określonej okolicy klatki piersiowej w danym okresie podczas cyklu serca. Zarówno energia fizyczna (uraz serca wskutek uderzenia - commotio cordis), jak i elektryczna (uderzenie pioruna) mogą wywołać VF. Autorzy pracy spekulują, że u omawianego chorego VF pojawiło się natychmiast po rażeniu piorunem, którego uderzenie prawdopodobnie nastąpiło podczas szczytu załamka T

Changes in Beliefs Identify Unblinding in Randomized Controlled Trials: A Method to Meet CONSORT Guidelines

Double-blinded trials are often considered the gold standard for research, but significant bias may result from unblinding of participants and investigators. Although the CONSORT guidelines discuss the importance of reporting evidence that blinding was successful , it is unclear what constitutes appropriate evidence. Among studies reporting methods to evaluate blinding effectiveness, many have compared groups with respect to the proportions correctly identifying their intervention at the end of the trial. Instead, we reasoned that participants\u27 beliefs, and not their correctness, are more directly associated with potential bias, especially in relation to self-reported health outcomes. During the Water Evaluation Trial performed in northern California in 1999, we investigated blinding effectiveness by sequential interrogation of participants about their blinded intervention assignment (active or placebo). Irrespective of group, participants showed a strong tendency to believe they had been assigned to the active intervention; this translated into a statistically significant intergroup difference in the correctness of participants\u27 beliefs, even at the start of the trial before unblinding had a chance to occur. In addition, many participants (31%) changed their belief during the trial, suggesting that assessment of belief at a single time does not capture unblinding. Sequential measures based on either two or all eight questionnaires identified significant group-related differences in belief patterns that were not identified by the single, cross-sectional measure. In view of the relative insensitivity of cross-sectional measures, the minimal additional information in more than two assessments of beliefs and the risk of modifying participants\u27 beliefs by repeated questioning, we conclude that the optimal means of assessing unblinding is an intergroup comparison of the change in beliefs (and not their correctness) between the start and end of a randomized controlled trial

Timing of primary tooth emergence among U.S. racial and ethnic groups

ObjectivesTo compare timing of tooth emergence among groups of American Indian (AI), Black and White children in the United States at 12 months of age.MethodsData were from two sources – a longitudinal study of a Northern Plains tribal community and a study with sites in Indiana, Iowa and North Carolina. For the Northern Plains study, all children (n = 223) were American Indian, while for the multisite study, children (n = 320) were from diverse racial groups. Analyses were limited to data from examinations conducted within 30 days of the child’s first birthday.ResultsAI children had significantly more teeth present (Mean: 7.8, Median: 8.0) than did Whites (4.4, 4.0, P < 0.001) or Blacks (4.5, 4.0, P < 0.001). No significant differences were detected between Black and White children (P = 0.58). There was no significant sex difference overall or within any of the racial groups.ConclusionsTooth emergence occurs at a younger age for AI children than it does for contemporary White or Black children in the United States.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135387/1/jphd12154.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135387/2/jphd12154_am.pd

Recent Diarrhea is Associated with Elevated Salivary IgG Responses to Cryptosporidium in Residents of an Eastern Massachusetts Community

BACKGROUND: Serological data suggest that Cryptosporidium infections are common but underreported. The invasiveness of blood sampling limits the application of serology in epidemiological surveillance. We pilot-tested a non-invasive salivary anti-Cryptosporidium antibody assay in a community survey involving children and adults. MATERIALS AND METHODS: Families with children were recruited in a Massachusetts community in July; symptoms data were collected at 3 monthly follow-up mail surveys. One saliva sample per person (n = 349) was collected via mail, with the last survey in October. Samples were analyzed for IgG and IgA responses to a recombinant C. hominis gp15 sporozoite protein using a time-resolved fluorometric immunoassay. Log-transformed assay results were regressed on age using penalized B-splines to account for the strong age-dependence of antibody reactions. Positive responses were defined as fluorescence values above the upper 99% prediction limit. RESULTS: Forty-seven (13.5%) individuals had diarrhea without concurrent respiratory symptoms during the 3-month-long follow-up; eight of them had these symptoms during the month prior to saliva sampling. Two individuals had positive IgG responses: an adult who had diarrhea during the prior month and a child who had episodes of diarrhea during each survey month (Fisher\u27s exact test for an association between diarrhea and IgG response: p = 0.0005 for symptoms during the prior month and p = 0.02 for symptoms during the entire follow-up period). The child also had a positive IgA response, along with two asymptomatic individuals (an association between diarrhea and IgA was not significant). CONCLUSION: These results suggest that the salivary IgG specific to Cryptosporidium antigens warrants further evaluation as a potential indicator of recent infections

A Pilot Randomized, Controlled Trial of an In-Home Drinking Water Intervention Among HIV + Persons

Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. Forty-five (90%) of the participants completed the study and were successfully blinded. Illness was measured using \u27highly credible gastrointestinal illness\u27 (HCGI), a previously published measure. There were 31 episodes of HCGI during 1,797 person-days in the sham group and 16 episodes during 1,478 person-days in the active group. The adjusted relative risk was 3.34 (95% CI: 0.99-11.21) times greater in those with the sham device. The magnitude of the point estimate of the risk, its consistency with recently published observational data, and its relevance for drinking water choices by immunocompromised individuals support the need for larger trials

Sulfa or Sulfone Prophylaxis and Geographic Region Predict Mutations in the Pneumocystis carinii Dihydropteroate Synthase Gene

To determine factors associated with mutations in the Pneumocystis carinii dihydropteroate synthase (DHPS) gene, a prospective study of human immunodeficiency virus (HIV)-infected patients with confirmed P. carinii pneumonia was conducted in Atlanta, Seattle, and San Francisco. Clinical information was obtained from patient interview and chart abstraction. DHPS genotype was determined from DNA sequencing. Overall, 76 (68.5%) of 111 patients had a mutant DHPS genotype, including 22 (81.5%) of 27 patients from San Francisco. In multivariate analysis, sulfa or sulfone prophylaxis and study site were independent predictors of a mutant genotype. Fourteen (53.8%) of 26 patients who were newly diagnosed with HIV infection and had never taken prophylaxis had a mutant genotype. The significance of geographic location as a risk factor for mutant genotype and the high proportion of mutant genotypes among persons never prescribed prophylaxis, including those newly diagnosed with HIV infection, provide indirect evidence that these mutations are transmitted from person to person either directly or through a common environmental source

Identifying and addressing barriers to implementing core electronic health record use metrics for ambulatory care: Virtual consensus conference proceedings

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. PROCESS:  We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care. CONCLUSION:  Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop\u27s outputs offers promise for overcoming barriers to implementing EHR use metrics