Projecting the COVID-19 Weekly Deaths and Hospitalizations for Jefferson County, Kentucky

Introduction: The trends in the numbers of active hospitalizations and fatalities caused by the COVID-19 in Jefferson County, Kentucky, were projected over the period May 7 to August 20, 2020. Methods: The projections provided in this report are from a susceptible-exposed-infectious-recovered (SEIR) model. The model was calibrated using the COVID-19 transmission dynamics parameters from relevant literature and clinical dynamics parameters from the county’s data. The model was used for measuring the impact of public health policy interventions designed to contain the infection. The policy was modeled by its intervention day and impact on the transmission of the virus such that the resulted fatalities resembled those observed in Jefferson County. Results: By May 6, 2020, there were 1,557 cases and 109 COVID-19 deaths in Jefferson County. The average age of deceased individuals was 76.5 years―76% of them had a previous medical condition, and 28% were African American. Among the hospitalized, 53% were admitted to the ICU, and 43% used a ventilator. The model’s status quo scenario, which produced the observed fatalities in the county, was identified assuming that the transmission of the virus was reduced by 70% with a policy intervention on April 7. Projections based on the status quo showed 91 active hospitalizations and 147 total fatalities, on average, on May 14. By June 4, the average number of active hospitalizations were projected to decrease to 61, but total fatalities to increase to 195, assuming a 70% reduction in transmission of the virus was maintained since the implementation of the policy intervention. By late August, the average number of active hospitalizations and total fatalities were projected to be 12 and 269, respectively. Conclusion: Had the county practiced weaker containment strategies, it would have been on an upward path with increased hospitalization and fatality trends. Therefore, decreasing the current social distancing measures without efforts regarding testing, isolating, and contact tracing can move the county to an unstable status. Had Jefferson County practiced stronger containment strategies, it could more safely plan open in early June. Still taking newer and even more effective measures can make a manageable early-June opening more likely

Residential particulate matter and distance to roadways in relation to mammographic density: results from the Nurses’ Health Studies

Background: High mammographic density is a strong, well-established breast cancer risk factor. Three studies conducted in various smaller geographic settings reported inconsistent findings between air pollution and mammographic density. We assessed whether particulate matter (PM) exposures (PM2.5, PM2.5–10, and PM10) and distance to roadways were associated with mammographic density among women residing across the United States. Methods: The Nurses’ Health Studies are prospective cohorts for whom a subset has screening mammograms from the 1990s (interquartile range 1990–1999). PM was estimated using spatio-temporal models linked to residential addresses. Among 3258 women (average age at mammogram 52.7 years), we performed multivariable linear regression to assess associations between square-root-transformed mammographic density and PM within 1 and 3 years before the mammogram. For linear regression estimates of PM in relation to untransformed mammographic density outcomes, bootstrapped robust standard errors are used to calculate 95% confidence intervals (CIs). Analyses were stratified by menopausal status and region of residence. Results: Recent PM and distance to roadways were not associated with mammographic density in premenopausal women (PM2.5 within 3 years before mammogram β = 0.05, 95% CI –0.16, 0.27; PM2.5–10 β = 0, 95%, CI –0.15, 0.16; PM10 β = 0.02, 95% CI –0.10, 0.13) and postmenopausal women (PM2.5 within 3 years before mammogram β = –0.05, 95% CI –0.27, 0.17; PM2.5–10 β = –0.01, 95% CI –0.16, 0.14; PM10 β = –0.02, 95% CI –0.13, 0.09). Largely null associations were observed within regions. Suggestive associations were observed among postmenopausal women in the Northeast (n = 745), where a 10-μg/m3 increase in PM2.5 within 3 years before the mammogram was associated with 3.4 percentage points higher percent mammographic density (95% CI –0.5, 7.3). Conclusions: These findings do not support that recent PM or roadway exposures influence mammographic density. Although PM was largely not associated with mammographic density, we cannot rule out the role of PM during earlier exposure time windows and possible associations among northeastern postmenopausal women. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0915-5) contains supplementary material, which is available to authorized users

Facial Mask Use and COVID-19 Protection Measures in Jefferson County, Kentucky: Results from an Observational Survey, November 5−11, 2020

Introduction: The transmission of respiratory infectious diseases such as COVID-19 can significantly decrease by mask-wearing. However, accurate information about the extent and proper use of the facial mask is scarce. This study’s main objective was to observe and analyze mask-wearing behavior and the level of COVID-19 protection measures in indoor public areas (PAs) of Jefferson County, Kentucky. Methods: For conducting the observational survey study, targets were indoor PAs, and zip codes were defined as surveying clusters. The number of selected PAs in each zip code was proportional to the population and the total number of PAs in that zip code. The PA pool in a zip code was divided into four groups, followed by random selection without replacement from each group. Results: A total of 191 PAs were surveyed: 50 of them were grocery stores, 56 were convenience stores or pharmacies, 39 were wine and liquor stores, and 46 were other stores. At least one unmasked and one incorrectly masked staff were observed in 26% and 40% of the sampled PAs, respectively. Also, in 29% and 35% of the PAs, at least one unmasked and one incorrectly masked visitor were observed, respectively. The rates varied by PA size and county district. Eighty percent of unmasked staff and 75% of the unmasked visitors were male. The rate of unmasked males varied from 50% to 100% across districts. About 66% of unmasked staff among all Jefferson County districts were young adults. More than one-fourth of all the PAs provided hand sanitizer for visitors’ use, and only 2% of the PAs provided masks to their visitors. Conclusion: Messaging about mask use and correct usage may need to particularly target the 19-44-year-old male population, as these individuals were the most prevalent among those unmasked and masked incorrectly. Additionally, businesses’ protective measures may depend on their resources to operate in such a manner. Hand sanitizer is easier to offer visitors, while staffing to regularly sanitize carts or funds to provide a sufficient number of wipes, gloves, or masks may present further opportunities for government assistance

Selenium Supplementation and Prostate Cancer Mortality

BackgroundFew studies have evaluated the relation between selenium supplementation after diagnosis and prostate cancer outcomes.MethodsWe prospectively followed 4459 men initially diagnosed with nonmetastatic prostate cancer in the Health Professionals Follow-Up Study from 1988 through 2010 and examined whether selenium supplement use (from selenium-specific supplements and multivitamins) after diagnosis was associated with risk of biochemical recurrence, prostate cancer mortality, and, secondarily, cardiovascular disease mortality and overall mortality, using Cox proportional hazards models. All P values were from two-sided tests.ResultsWe documented 965 deaths, 226 (23.4%) because of prostate cancer and 267 (27.7%) because of cardiovascular disease, during a median follow-up of 8.9 years. In the biochemical recurrence analysis, we documented 762 recurrences during a median follow-up of 7.8 years. Crude rates per 1000 person-years for prostate cancer death were 5.6 among selenium nonusers and 10.5 among men who consumed 140 or more μg/day. Crude rates per 1000 person-years were 28.2 vs 23.5 for all-cause mortality and 28.4 vs 29.3 for biochemical recurrence, for nonuse vs highest-dose categories, respectively. In multivariable analyses, men who consumed 1 to 24 μg/day, 25 to 139 μg/day, and 140 or more μg/day of supplemental selenium had a 1.18 (95% confidence interval [CI] = 0.73 to 1.91), 1.33 (95% CI = 0.77 to 2.30), and 2.60-fold (95% CI = 1.44 to 4.70) greater risk of prostate cancer mortality compared with nonusers, respectively, P trend = .001. There was no statistically significant association between selenium supplement use and biochemical recurrence, cardiovascular disease mortality, or overall mortality.ConclusionSelenium supplementation of 140 or more μg/day after diagnosis of nonmetastatic prostate cancer may increase risk of prostate cancer mortality. Caution is warranted regarding usage of such supplements among men with prostate cancer

Long-term Particulate Matter Exposures during Adulthood and Risk of Breast Cancer Incidence in the Nurses' Health Study II Prospective Cohort

BackgroundThere is increasing concern that environmental exposures, such as air pollution, may be related to increasing rates of breast cancer; however, results from cohort studies have been mixed. We examined the association between particulate matter (PM) and measures of distance to roadway with the risk of incident breast cancer in the prospective nationwide Nurses' Health Study II (NHSII) cohort.MethodsIncident invasive breast cancer from 1993 to 2011 (N = 3,416) was assessed among 115,921 women in the NHSII cohort. Time-varying Cox proportional hazards models were used to calculate HRs and 95% confidence intervals (95% CI) for increases in ambient exposures to PM10, PM2.5-10, and PM2.5 and residential roadway proximity categories.ResultsIn multivariable adjusted models, there was little evidence of an increased risk of breast cancer (or any of the receptor-specific subtypes) overall or by menopausal status with PM exposure. There was, however, a suggestion of increased risks among women living <50 m of the largest road type (HR = 1.60; 95% CI, 0.80-3.21) or within <50 m of the two largest road types (1.14; 95% CI, 0.84-1.54) compared with women living farther (≥200 m) away.ConclusionsAmong women in the NHSII, we found no statistically significant associations between particulate matter exposures and incidence of breast cancer overall, by menopausal status, or by hormone receptor subtype. There was, however, a suggestion that residential proximity to major roadways may be associated with increased risk.ImpactThese results suggest no elevated breast cancer risk with increasing exposures to particulate matter air pollution, but that other traffic-related exposures may be important. Cancer Epidemiol Biomarkers Prev; 25(8); 1274-6. ©2016 AACR

Interprofessional education for complex neurological cases

There is a growing necessity for healthcare professionals to collaborate across disciplines in order to adequately treat patients. Interprofessional education (IPE) is one strategy that can be used to strengthen student attitudes, skill mastery, and preparedness toward working in interprofessional teams prior to joining the healthcare workforce. The current study evaluated the effects of a four-session IPE training program for students from four New England universities across nine different health professions. Participants (N = 46) were placed into teams to create an assessment plan, evaluated their patient volunteer, developed a treatment plan, and presented treatment plan decisions to the group. Students reported attitudes, skills and readiness to work on interprofessional teams before and after the training; additionally, students completed a free-response posttest questionnaire. Paired samples t-tests, repeated measures ANCOVA, and thematic analysis were conducted to analyze the data. Results showed that following program completion, participants expressed more positive attitudes toward team collaboration and demonstrated higher skill mastery to function within healthcare teams. The presence of prior IPE experience did not positively or negatively influence changes in attitudes, skills, or readiness from pretest to posttest. Results suggest that this IPE program demonstrated preliminary feasibility and effectiveness by actively improving the attitudes and skills of healthcare students to engage in interprofessional teamwork

Empathy, better patient care, and how interprofessional education can help

Interprofessional education (IPE) has been promoted as one way to prepare healthcare students for interprofessional encounters they might experience in the workplace. However, the link between IPE, interprofessional care in the workforce, and better patient outcomes is tenuous, perhaps in part due to the inability of IPE programs to adequately address barriers associated with interprofessional care (e.g., power differentials, role disputes). Empathy, or understanding the experiences of others, has emerged as a critical tool to breaking down barriers inherent to working in teams. Given the evidence connecting empathy to stronger team collaboration and better patient care, researchers significantly revamped programming from a prior training called Interprofessional Education for Complex Neurological Cases (IPE Neuro) to enhance empathy, foster stronger team collaboration, and improve information integration among participants. In this improved three-session program, participants from seven different professions were grouped into teams, assessed a patient volunteer with neurological disorder, and created and presented an integrated, patient-centric treatment plan. Students (N = 31) were asked to report general empathy levels, as well as attitudes, team skills, and readiness toward interprofessional care, before and after the program. We conducted paired samples t-tests and thematic analysis to analyze the data. Results showed that participants reported higher empathy levels, more positive attitudes, and greater team skills pre- to posttest with moderate to large effects. Results bolster IPE Neuro programming as one approach to prepare students for interprofessional care while underscoring the potential implications of IPE to improve empathy levels of healthcare professionals

Additional file 1: Table S1. of Residential particulate matter and distance to roadways in relation to mammographic density: results from the Nurses’ Health Studies

Presenting adjusted estimates (95% CI) of the difference in square-root-transformed mammographic dense area and nondense area for a 10-Îźg/m3 increase in PM among premenopausal and postmenopausal women residing across the United States and within regions, and Table S2. presenting adjusted estimates (95% CI) of the difference in untransformed mammographic density measures for a 10-Îźg/m3 increase in PM using bootstrapped robust standard errors (DOCX 33 kb

Exposure to natural vegetation in relation to mammographic density in a Massachusetts-based clinical cohort.

UNLABELLED: Inverse associations between natural vegetation exposure (i.e., greenness) and breast cancer risk have been reported; however, it remains unknown whether greenness affects breast tissue development or operates through other mechanisms (e.g., body mass index [BMI] or physical activity). We examined the association between greenness and mammographic density-a strong breast cancer risk factor-to determine whether greenness influences breast tissue composition independent of lifestyle factors. METHODS: Women (n = 2,318) without a history of breast cancer underwent mammographic screening at Brigham and Womens Hospital in Boston, Massachusetts, from 2006 to 2014. Normalized Difference Vegetation Index (NDVI) satellite data at 1-km2 resolution were used to estimate greenness at participants residential address 1, 3, and 5 years before mammogram. We used multivariable linear regression to estimate differences in log-transformed volumetric mammographic density measures and 95% confidence intervals (CIs) for each 0.1 unit increase in NDVI. RESULTS: Five-year annual average NDVI was not associated with percent mammographic density in premenopausal (β = -0.01; 95% CI = -0.03, 0.02; P = 0.58) and postmenopausal women (β = -0.02; 95% CI = -0.04, 0.01; P = 0.18). Results were similar for 1-year and 3-year NDVI measures and in models including potential mediators of BMI and physical activity. There were also no associations between greenness and dense volume and nondense volume. CONCLUSIONS: Greenness exposures were not associated with mammographic density. IMPACT: Prior observations of a protective association between greenness and breast cancer may not be driven by differences in breast tissue composition, as measured by mammographic density, but rather other mechanisms