Health Disparities Among Racial and Ethnic Minority Firefighters

ABSTRACT Background: Racial/ethnic minorities are substantially underrepresented in the fire service and this situation is unique when compared to similarly mentally and physically demanding and hazardous occupations such as the military and law enforcement. There is little systematic research to provide greater clarity about this significant disparity. The purpose of this study is to examine physical and behavioral health issues of racial/ethnic minority firefighters when compared to their white, non-Hispanic counterparts and potentially identify areas for future research that might assist in improving their substantial underrepresentation. Materials and Methods: We report the results of a secondary analysis of data combining the baseline evaluations of two different firefighter health studies, the Firefighter Injury and Risk Evaluation (FIRE) and Fuel 2 Fight (F2F) studies. Male career firefighters (N=1,404) were from 31 fire departments across the US and its territories. White, non-Hispanic firefighters comprised 72.5% of the sample (n=1,018) and 27.5% classified themselves as a racial/ethnic minority. Firefighters who agreed to participate comprised 94% (F2F) and 97% (FIRE) of those available and all underwent assessments including body composition, fitness, and general/behavioral health, and job satisfaction. Results: We examined differences in health and job status between minority and non-minority firefighters and between firefighters in minority- (MDCs) and white-dominated communities (WDCs). After adjusting for potential confounds, there were significant main effects for the individual minority status vs. non-minority status on both BMI and BF%, indicating that minority firefighters had significantly higher average BMI (28.8±0.3kg/m2) and BF% (24.7± 0.7%) when compared to their white, non-Hispanic colleagues (27.7±0.2kg/m2and 23.1±0.6% for BMI and BF%, respectively). Minority firefighters also were 59% more likely to be obese (adjusted [A]OR=1.59; 95% CI=1.16-2.18). Firefighters serving in MDCs reported significantly more poor health days (Mean±SE; 3.2±0.2 days) than firefighters serving in WDCs (2.8±0.2 days; p=0.038). In addition, minority firefighters reported significantly more poor health days (3.6±0.4 days) than their non-minority colleagues (2.8±0.2 days; p=0.003), while the interaction indicates that minority firefighters in MDCs reported more poor health days than the other groups (p Conclusions: Individual and community minority status (i.e., ethnic density effect) were both significantly associated with a number of important health status indicators, with racial/ethnic minority firefighters demonstrating greater risk for unfavorable body composition and more poor physical health days. In addition, minority firefighters in WDCs reported the highest prevalence of lifetime diagnosis of depression by a physician, while minority firefighters in MDCs had the lowest. Many of these health status indicators have recently been studied within the context of experiences with discrimination, demonstrating that racial discrimination is associated with greater risk for obesity, depression, and poor physical and mental health and could be contributing to health disparities and potentially negatively impacting racial/ethnic minority firefighter health, safety, and retention

A Positive Touch: C-tactile afferent targeted skin stimulation carries an appetitive motivational value.

The rewarding sensation of touch in affiliative interactions is hypothesised to be underpinned by an unmyelinated system of nerve fibres called C-tactile afferents (CTs). CTs are velocity tuned, responding optimally to slow, gentle touch, typical of a caress. Here we used evaluative conditioning to examine whether CT activation carries a positive affective value. A set of neutral faces were paired with robotically delivered touch to the forearm. With half the faces touch was delivered at a CT optimal velocity of 3cm/s (CT touch) and with the other half at a faster, Non-CT optimal velocity of 30cm/s (Control touch). Heart-rate and skin conductance responses (SCRs) were recorded throughout. Whilst rated equally approachable pre-conditioning, post-conditioning faces paired with CT touch were judged significantly more approachable than those paired with Control touch. CT touch also elicited significantly greater heart-rate deceleration and lower amplitude SCRs than Control touch. The results indicate CT touch carries a positive affective value, which can be acquired by socially relevant stimuli it is associated with

Vicarious ratings of social touch reflect the anatomical distribution & velocity tuning of C-tactile afferents: A Hedonic Homunculus?

A subclass of C-fibres, C-tactile afferents (CTs), have been discovered which respond preferentially to low force/velocity stroking touch, that is typically perceived as pleasant. Molecular genetic visualization of these low-threshold mechanosensitive C-fibres (CLTMs) in mice revealed a denser distribution in dorsal than ventral thoracic sites, scattered distal limb innervation and a complete absence from glabrous paw skin (Liu et al., 2007). Here we used third-party ratings to examine whether affective responses to social touch reflect the anatomical distribution and velocity tuning of CTs. Participants viewed and rated a sequence of video clips depicting one individual being touched by another at different skin sites and at 3 different velocities (static, 3 cm/s, 30 cm/s). Immediately after viewing each clip participants were asked to rate how pleasant they perceived the touch to be. Vicarious preferences matched the previously reported anatomical innervation density of rodent CLTMs, with touch on the back being rated significantly more pleasant than any other location. Furthermore, in contrast to all other skin sites, CT optimal (3 cm/s) touch on the palm of the hand was not preferred to static touch, consistent with the anatomical absence of CTs in glabrous skin. Our findings demonstrate that humans recognise the specific rewarding value of CT optimal caressing touch and their preferences reflect the hypothesised anatomical distribution of CTs

Practice Makes Imperfect: Restorative Effects of Sleep on Motor Learning

Emerging evidence suggests that sleep plays a key role in procedural learning, particularly in the continued development of motor skill learning following initial acquisition. We argue that a detailed examination of the time course of performance across sleep on the finger-tapping task, established as the paradigm for studying the effect of sleep on motor learning, will help distinguish a restorative role of sleep in motor skill learning from a proactive one. Healthy subjects rehearsed for 12 trials and, following a night of sleep, were tested. Early training rapidly improved speed as well as accuracy on pre-sleep training. Additional rehearsal caused a marked slow-down in further improvement or partial reversal in performance to observed levels below theoretical upper limits derived on the basis of early pre-sleep rehearsal. This decrement in learning efficacy does not occur always, but if and only if it does, overnight sleep has an effect in fully or partly restoring the efficacy and actual performance to the optimal theoretically achieveable level. Our findings re-interpret the sleep-dependent memory enhancement in motor learning reported in the literature as a restoration of fatigued circuitry specialized for the skill. In providing restitution to the fatigued brain, sleep eliminates the rehearsal-induced synaptic fatigue of the circuitry specialized for the task and restores the benefit of early pre-sleep rehearsal. The present findings lend support to the notion that latent sleep-dependent enhancement of performance is a behavioral expression of the brain's restitution in sleep

The role of gentle touch in perinatal osteopathic manual therapy.

Osteopathic medicine is a system of manual diagnosis and treatment. While there is growing evidence that osteopathy is effective in a range of clinical conditions, the underlying biological basis of its therapeutic effects remain largely unknown. Given that the sense of touch plays a critical role in osteopathy, in this perspective article, with a particular focus on perinatal care, we explore the potential mechanisms by which stimulation of the skin senses can exert beneficial physiological and psychological effects, aiding growth and development. We propose that a class of low threshold mechanosensitive c-fibre, named c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of manual therapies. A greater understanding of the impact the type and quality of touch plays in therapeutic tactile interventions and in particular the neuroscience underpinning these effects will aid the development of more targeted, population specific interventions

Linear normal mode analysis of baroclinic instability in a meridional channel

Submitted in partial fulfillment of the requirements for the degree of Master of Science at the Massachusetts Institute of Technology and the Woods Hole Oceanographic Institution March 2001Numerical solutions of the unstable, growing modes are found for the two-layer inviscid quasigeostrophic equations in a meridional channel. A steady mean flow in the N-S direction is imposed in the upper layer, and it is assumed that changes in planetary vorticity following this mean flow are balanced by the input of vorticity from an imposed wind stress curl. Thus in the two-layer system, the vertical shear, in thermal wind balance, is associated with an interface slope which provides a gradient of potential vorticity (PV) in the x-direction, of equal magnitude and opposite sign in the two layers. In the y-direction the PV gradient has the value of planetary beta, β in both layers. The unstable modes of this system exhibit a boundary-layer structure across the channel. They are intensified in the west. The growth rates of the unstable modes are of the same order as the zonal case, however the range of wavenumber and shear for which instability is possible is larger. Established cutoff criteria for the equal-layer zonal case are not applicable, and no analogous criteria has yet been found. Growing modes are found even for very weakly sheared flows, and this suggests that baroclinic instability may represent a more significant source of mid-ocean eddy energy than previously believed.This research was supported by the National Science Foundation under grant 9901654

A randomized, controlled trial comparing ganciclovir to ganciclovir plus foscarnet (each at half dose) for preemptive therapy of cytomegalovirus infection in transplant recipients

Forty-eight patients who provided 2 consecutive blood samples that tested positive for cytomegalovirus DNA by polymerase chain reaction (PCR) were randomized to receive either full-dose ganciclovir ( 5 mg/kg intravenously [iv] twice daily) or half-dose ganciclovir (5 mg/kg iv once daily) plus half-dose foscarnet (90 mg/kg iv once daily) for 14 days. In the ganciclovir arm, 17 (71%) of 24 patients reached the primary end point of being CMV negative by PCR within 14 days of initiation of therapy, compared with 12 (50%) of 24 patients in the ganciclovir-plus-foscarnet arm (P = .12). Toxicity was greater in the combination-therapy arm. In patients who failed to reach the primary end point, baseline virus load was 0.77 log(10) higher, the replication rate before therapy was faster (1.5 vs. 2.7 days), and the viral decay rate was slower (2.9 vs. 1.1 days) after therapy. Bivariable logistic regression models identified baseline virus load, bone-marrow transplantation, and doubling time and half-life of decay as the major factors affecting response to therapy within 14 days. This study did not support a synergistic effect of ganciclovir plus foscarnet in vivo

Eurasian Arctic greening reveals teleconnections and the potential for novel ecosystems

Arctic warming has been linked to observed increases in tundra shrub cover and growth in recent decades on the basis of significant relationships between deciduous shrub growth/biomass and temperature. These vegetation trends have been linked to Arctic sea ice decline and thus to the sea ice/albedo feedback known as Arctic amplification. However, the interactions between climate, sea ice and tundra vegetation remain poorly understood. Here we reveal a 50- year growth response over a >100,000 km2 area to a rise in summer temperature for alder (Alnus) and willow (Salix), the most abundant shrub genera respectively at and north of the continental treeline. We demonstrate that whereas plant productivity is related to sea ice in late spring, the growing season peak responds to persistent synoptic-scale air masses over West Siberia associated with Fennoscandian weather systems through the Rossby wave train. Substrate is important for biomass accumulation, yet a strong correlation between growth and temperature encompasses all observed soil types. Vegetation is especially responsive to temperature in early summer. These results have significant implications for modelling present and future Low Arctic vegetation responses to climate change, and emphasize the potential for structurally novel ecosystems to emerge fromwithin the tundra zone.Vertaisarviointia edeltävä käsikirjoitu

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

Superior identification of component odours in a mixture is linked to autistic traits in children and adults.

Most familiar odours are complex mixtures of volatile molecules which the olfactory system automatically synthesises into a perceptual whole. However, odours are rarely encountered in isolation, thus the brain must also separate distinct odour objects from complex and variable backgrounds. In vision, autistic traits are associated with superior performance in tasks that require focus on the local features of a perceptual scene. The aim of the present study was to determine whether the same advantage was observed in the analysis of olfactory scenes. To do this, we compared the ability of (i) Forty young adults (aged 16-35) with high (n=20) and low levels of autistic traits and, (ii) Twenty children (aged 7-11), with (n=10) and without an autism spectrum disorder diagnosis, to identify individual odour objects presented within odour mixtures. First, we used a 4-alternative forced choice task to confirm both adults and children were able to reliably identify eight blended fragrances, representing food related odours, when presented individually. We then used the same forced-choice format to test participants' ability to identify the odours when they were combined in either binary or ternary mixtures. Adults with high levels of autistic traits showed superior performance on binary but not ternary mixture trials. While children with an autism spectrum disorder diagnosis outperformed age matched neurotypical peers, irrespective of mixture complexity. These findings indicate, the local processing advantages associated with high levels of autistic traits in visual tasks are also apparent in a task requiring analytical processing of odour mixtures