If you build it, will they come? Is test site availability a root cause of geographic disparities in COVID-19 testing?

OBJECTIVES: The purpose of this study was to examine the relationship between test site availability and testing rate within the context of social determinants of health. STUDY DESIGN: A retrospective ecological investigation was conducted using statewide COVID-19 testing data between March 2020 and December 2021. METHODS: Ordinary least squares and geographically weighted regression were used to estimate state and ZIP code level associations between testing rate and testing sites per capita, adjusting for neighbourhood-level confounders. RESULTS: The findings indicate that site availability is positively associated with the ZIP code level testing rate and that this association is amplified in communities of greater economic deprivation. In addition, economic deprivation is a key factor for consideration when examining ethnic differences in testing in medically underserved states. CONCLUSION: The study findings could be used to guide the delivery of testing facilities in resource-constrained states.

Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms.

BACKGROUND AND PURPOSE: The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent. MATERIALS AND METHODS: On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up. RESULTS: Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03). CONCLUSIONS: This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.

Variance in disease risk: rural populations and genetic diversity.

Over 19% of the US population resides in rural areas, where studies of disease risk and disease outcomes are difficult to assess due to smaller populations and lower incidence. While some studies suggest rural disparities for different chronic diseases, the data are inconsistent across geography and definitions of rurality. We reviewed the literature to examine if local variations in population genomic diversity may plausibly explain inconsistencies in estimating disease risk. Many rural communities were founded over 150 years ago by small groups of ethnically and ancestrally similar families. These have since endured relative geographical isolation, similar to groups in other industrialized nations, perhaps resulting in founder effects impacting local disease susceptibility. Studies in Europe and Asia have found that observably different phenotypes may appear in isolated communities within 100 years, and that genomic variation can significantly vary over small geographical scales. Epidemiological studies utilizing common "rural" definitions may miss significant disease differences due to assumptions of risk homogeneity and misinterpretation of administrative definitions of rurality. Local genomic heterogeneity should be an important aspect of chronic disease epidemiology in rural areas, and it is important to consider for designing studies and interpreting results, enabling a better understanding of the heritable components of complex diseases.

Body schema, gender, and other correlates in nonclinical populations.

The link between body image and eating disorders has been extensively discussed, but investigations using nonclinical populations have not been systematically reviewed. In this article, a model to guide future researchers has been provided, and an attempt has been made to organize and synthesize the existing findings, with special attention to gender differences. Future researchers should more carefully delineate behavioral, emotional, cognitive, motivational, and evaluative components of body schema and should explore the relationship between body schema and outcomes other than eating disturbances. Conclusions in this review include the following: (a) Verbal measures of body schema are more successful than visual assessment tools; (b) measures of body distortion have been less successful than measures of dissatisfaction; (c) gender differences are prevalent; (d) behavioral outcomes can be successfully predicted; and (e) pubertal development plays a critical role in the gender differentiation of body schemas.

A comparison of Caucasian and Southeast Asian Hmong uterine fundal height during pregnancy.

BACKGROUND: Fundal height measurement is a standard clinical assessment tool used in prenatal care. This study compared the fundal heights growth curves of two ethnically distinct groups of pregnant women. We were motivated by our clinical experience with one group where fundal heights seemed 'small for date' and by the reluctance of this group to undergo further testing, especially ultrasound. METHODS: A prospective cohort study compared the fundal heights growth curve of 48 Caucasian and 40 Hmong women from two clinics in central Wisconsin (USA). RESULTS: Southeast Asian Hmong women were found to have a slower rate of fundal height growth than Caucasian women (significantly different average slopes of .88 vs. .95, respectively). An expectation of linear growth appeared more valid for Caucasian than Hmong women. At 40 weeks, regression based estimates overestimated the Caucasian sample by 1.3 weeks and the Hmong sample by 2.7 weeks. ANCOVA procedures remained significant while controlling for group differences in height. Fundal height measurements were moderately predictive of birth weight for the Hmong sample but not the Caucasian sample (multiple r=.39). CONCLUSIONS: Considerable differences emerged between fundal height measures for the Hmong and Caucasian samples. The improved ability to differentiate groups following control of variance due to height as well as the ability to predict birth weight from fundal height curve in the Hmong group argue for value of normative development using more homogeneous groups. Clinicians should consider the applicability of fundal height norms to their clinical populations and may be able to have more confidence in using fundal height as an evaluative tool with more appropriate norms.

Physicians' usefulness ratings of family-oriented clinical tools.

BACKGROUND: Family-oriented patient care is a cornerstone of family practice. Family practice educators have proposed various methods to help the physician to better assess and treat families. Little is known, however, of the usefulness of family-oriented clinical tools to practicing physicians. METHODS: On a mailed survey questionnaire, 595 members of the Wisconsin Academy of Family Physicians were asked to rate the usefulness of 10 family-oriented tools and indicate the frequency of use and level of training received for each item. In addition, physicians rated their current and desired level of competency for involving families in patient care. RESULTS: Two hundred ninety-nine (50%) physicians responded. Most of the tools were rated as useful but used infrequently. Identifying the effects of chemical dependency on the health of families and conducting family conferences were rated as highly useful and frequently used skills. Clinical tools rated as least useful were record keeping by family charts and folders and family function assessment by the Family APGAR: Physicians who had received training in the use of a tool rated it as more useful, except for the Family APGAR and family charts or folders. Physicians with busier practices rated some of the tools as less useful than did other physicians. Respondents indicated a desire to develop their family counseling skills. CONCLUSIONS: Most family-oriented tools were reported to be useful but used infrequently by practicing physicians. Residency programs should continue to provide training for assessing and treating families, particularly in the areas of family systems theory, self-awareness of the physician's own family background, and the effect of chemical dependency on families. Future research should target larger and more varied groups of family physicians.

A taxonomy of clinical research methods: comparisons of family practice and general medical journals.

Although an understanding of research methodology has been identified as an important skill for family practice researchers, the available literature contains confusing terminology and lacks agreement about research design classifications. A multidimensional taxonomy is presented to clarify and simplify the understanding of research designs, data collection methods, and research populations for family practice researchers. The taxonomy was used to classify 103 articles from five medical journals. Compared with general medical journals, reports in family practice journals used similar research designs but were more likely to rely on self-report data and to draw subjects from outpatient populations.