Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health.

INTRODUCTION: Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities. METHODS: We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions. We calculated community health scores at the regional level, by using metrics similar to the Robert Wood Johnson Foundation (RWJF) County Health Rankings but with local data. We used descriptive analyses and multilevel linear modeling to explore relationships between community health and 3 outcome variables: emergency department (ED) use, hospital use, and paid claims. Business leaders reviewed findings and offered insights on preparedness to invest in community health improvement. RESULTS: Poorer community health was associated with high use of ED services, after controlling for age and sex. After including a summary measure of racial composition at the zip code region level, the relationship between community health and ED use became nonsignificant. No significant relationships between community health and hospitalizations or paid claims were identified. Business leaders expressed interest in further understanding health needs of communities where their employees live. CONCLUSION: The health of communities in which adult employees and dependents live was associated with ED use, but similar relationships were not seen for hospitalizations or paid claims. This finding suggests a need for more primary care access. Despite limited quantitative evidence, business leaders expressed interest in guidance on investing in community health improvement

Early T Cell Recognition of B Cells following Epstein-Barr Virus Infection: Identifying Potential Targets for Prophylactic Vaccination

Epstein-Barr virus, a B-lymphotropic herpesvirus, is the cause of infectious mononucleosis, has strong aetiologic links with several malignancies and has been implicated in certain autoimmune diseases. Efforts to develop a prophylactic vaccine to prevent or reduce EBV-associated disease have, to date, focused on the induction of neutralising antibody responses. However, such vaccines might be further improved by inducing T cell responses capable of recognising and killing recently-infected B cells. In that context, EBNA2, EBNA-LP and BHRF1 are the first viral antigens expressed during the initial stage of B cell growth transformation, yet have been poorly characterised as CD8+ T cell targets. Here we describe CD8+ T cell responses against each of these three "first wave" proteins, identifying target epitopes and HLA restricting alleles. While EBNA-LP and BHRF1 each contained one strong CD8 epitope, epitopes within EBNA2 induced immunodominant responses through several less common HLA class I alleles (e.g. B*3801 and B*5501), as well as subdominant responses through common class I alleles (e.g. B7 and C*0304). Importantly, such EBNA2-specific CD8+ T cells recognised B cells within the first day post-infection, prior to CD8+ T cells against well-characterised latent target antigens such as EBNA3B or LMP2, and effectively inhibited outgrowth of EBV-transformed B cell lines. We infer that "first wave" antigens of the growth-transforming infection, especially EBNA2, constitute potential CD8+ T cell immunogens for inclusion in prophylactic EBV vaccine design

Type 2 Diabetes Rates and Environmental and Socioeconomic Characteristics Among Philadelphia Commercial and Medicare Payer Populations: Analysis and Policy Considerations

Type 2 diabetes is a leading health issue for the population of Philadelphia. In 2012, adult diabetes prevalence in Philadelphia was 16%, which was a 50% increase from 2004 (Public Health Management Corporation Household Health Survey, 2012) and higher than the national average of 9.3% (Centers for Disease Control and Prevention, 2014). Traditionally, public health organizations use self-reported survey data to identify population-based associations between risk factors and health outcomes. Finding these relationships helps inform policies and interventions to address chronic health conditions, including Type 2 diabetes and related risk factors such as obesity. Because payer claims are based on actual individual diagnoses, these data serve as a rich source for finding associations between Type 2 diabetes rates and neighborhood-based risk factors. The objective of this study was to identify opportunities to positively impact population health in Philadelphia by analyzing rates of Type 2 diabetes prevalence in the 2010 and 2012 Independence Blue Cross commercial and Medicare populations relative to environmental and socioeconomic characteristics such as food site density, recreational facility density, unemployment rate, poverty rate, and crime rate. Multivariate regression analysis was used to identify the associations between Type 2 diabetes rates and all independent variables at the census tract level. Mapping software was used to illustrate all bivariate relationships. Associations were found between Type 2 diabetes prevalence and age, poverty, unemployment and crime rates. These results can be used to identify and monitor census tracts with high Type 2 diabetes prevalence and related environmental and socioeconomic risk factors, and to inform healthcare stakeholder policies and interventions for the work place and in the community to improve Type 2 diabetes prevention and management for the Philadelphia population. Presentation: 23 minute

Biosocial risk factors for academic dishonesty : testing a new mediation model in young adults

Researchers increasingly recognize that biological risk factors contribute to the development of antisocial behavior. Although academic dishonesty is a pervasive problem, this type of antisocial behavior has not been investigated in biosocial research. This article addresses this limitation by examining the relationship between academic dishonesty and resting heart rate in a sample of undergraduates (N = 149, 65.69% female, M age = 19.62 years). Subjects completed self-report academic dishonesty questionnaires, and heart rate was measured during a resting period. Low resting heart rate was associated with more frequent and varied academic dishonesty in females, but not in males. Self-control and sensation seeking, but not fearlessness, mediated this relationship in females. To our knowledge, this is the first study to examine a biological risk factor for academic dishonesty. This is also the first study to examine self-control as a possible mediator of the resting heart rate–antisocial behavior relationship in adults. Findings suggest a potential pathway in young adults through which low resting heart rate may affect antisocial behavior