Flu Vaccine Uptake in Caregivers and Noncaregivers: Implications for Policy and Practice.

INTRODUCTION: Caregivers are a critical and highly used health care resource. Caregivers may experience adverse health outcomes and practice less self-care, including obtaining vaccinations, while serving in their roles. Influenza (flu) is a common infectious disease responsible for millions of doctor visits, hospitalizations, and approximately 43,000 US deaths annually that can largely be prevented by receiving seasonal vaccinations. We aimed to estimate and compare the prevalence of flu vaccination among caregivers and noncaregivers. We hypothesized that caregivers would have a lower prevalence of flu vaccination than noncaregivers and that sociodemographic variables, health-related variables, and caregiving-specific characteristics would be associated with vaccine uptake. METHODS: We analyzed Behavioral Risk Factor Surveillance System data from 2016 through 2018 on 154,170 respondents from 27 US states and the District of Columbia. We used bivariate analysis to estimate the difference in flu vaccination uptake among caregivers and noncaregivers and logistic regression to estimate differences after adjusting for individuals' characteristics. RESULTS: Logistic regression indicated no significant difference in flu vaccine uptake between caregivers and noncaregivers. Caregiving characteristics such as years in a caregiver role, weekly time spent caregiving, relationship to care recipient, and recipient's risk for flu complications were also nonsignificant. Sociodemographic factors such as marital status, income, health insurance coverage, and race had a significant impact on flu vaccine uptake. CONCLUSION: Although no significant differences in flu vaccine uptake were found between caregivers and noncaregivers, flu vaccine coverage remains low in both groups. Evidence-based programs and policies to improve vaccine coverage in the caregiver and general populations remains a public health priority.

Prevalence and Characteristics of Subjective Cognitive Decline Among Unpaid Caregivers Aged ≥45 Years - 22 States, 2015-2019.

Approximately 20% of U.S. adults are unpaid caregivers (caregivers) (1) who provide support to a family member or friend with a health condition or disability. Although there are benefits to caregiving, it can negatively affect caregivers' physical and mental health (2-4). Much of the assistance caregivers provide, such as administering medications or financial management, relies on cognitive ability, but little is known about caregivers' cognitive functioning. Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss over the past year (5), could affect caregivers' risk for adverse health outcomes and affect the quality of care they provide. CDC analyzed SCD among caregivers aged ≥45 years through a cross-sectional analysis of data from 22 states in the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). Among adults aged ≥45 years, SCD was reported by 12.6% of caregivers who provided care to a family member or friend with a health condition or disability in the past 30 days compared with 10.2% of noncaregivers (p<0.001). Caregivers with SCD were more likely to be employed, men, aged 45-64 years, and have chronic health conditions than were noncaregivers with SCD. Caregivers with SCD were more likely to report frequent mental distress, a history of depression, and frequent activity limitations than were caregivers without SCD. SCD among caregivers could adversely affect the quality of care provided to care recipients. Understanding caregivers' cognitive health and the types of care provided is critical to maintaining the health, well-being, and independence of the caregiving dyad. Health care professionals can support patients and their patients' caregivers by increasing awareness among caregivers of the need to monitor their own health. The health care team can work with caregivers to identify potential treatments and access supports that might help them in their caregiving role and compensate for SCD.

Female genital cutting in the Gambia: can education of women bring change?

BACKGROUND: In the Gambia, three out of four women of reproductive age have undergone Female Genital Cutting (FGC). Many studies and policy advocates suggest that for such a practice that is deeply rooted in culture, a more holistic approach focusing on educating the population will have sustainable impact. This research examined whether educational level of women has an association with their attitude towards the practice of FGC. METHODS: Data from the 2013 Gambia Demographic Health Survey (GDHS) were analyzed. The sample included 6217 households: 10,233 females aged between 15 to 49 years and 3831 males between 15-59 years. This study focused only on women participants. The outcome variable was the attitude of women toward the practice of FGC. RESULTS: In multivariate regression model, women who were circumcised are found to have 80 times higher odds of supporting FGC [Odds Ratio = 80 (95% CI 50.93-124.4)] compared to uncircumcised women. Women with primary and secondary level education have lower odds of supporting FGC [OR = 0.73 (95% CI 0.915-0.007)) and those with higher education had the lowest odds [OR = 0.28 (95% CI 0.147-0.543)) of supporting FGC relative to women with no education at all. CONCLUSIONS: Education and awareness programs targeting women who are married and older, those with less education and those who are already circumcised can help change attitudes towards the practice of FGC.

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life.

OBJECTIVES: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN: Cross-sectional. SETTING: US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

Global increase in major tropical cyclone exceedance probability over the past four decades.

Theoretical understanding of the thermodynamic controls on tropical cyclone (TC) wind intensity, as well as numerical simulations, implies a positive trend in TC intensity in a warming world. The global instrumental record of TC intensity, however, is known to be heterogeneous in both space and time and is generally unsuitable for global trend analysis. To address this, a homogenized data record based on satellite data was previously created for the period 1982-2009. The 28-y homogenized record exhibited increasing global TC intensity trends, but they were not statistically significant at the 95% confidence level. Based on observed trends in the thermodynamic mean state of the tropical environment during this period, however, it was argued that the 28-y period was likely close to, but shorter than, the time required for a statistically significant positive global TC intensity trend to appear. Here the homogenized global TC intensity record is extended to the 39-y period 1979-2017, and statistically significant (at the 95% confidence level) increases are identified. Increases and trends are found in the exceedance probability and proportion of major (Saffir-Simpson categories 3 to 5) TC intensities, which is consistent with expectations based on theoretical understanding and trends identified in numerical simulations in warming scenarios. Major TCs pose, by far, the greatest threat to lives and property. Between the early and latter halves of the time period, the major TC exceedance probability increases by about 8% per decade, with a 95% CI of 2 to 15% per decade.

Thunderstorms Increase Mercury Wet Deposition.

Mercury (Hg) wet deposition, transfer from the atmosphere to Earth's surface by precipitation, in the United States is highest in locations and seasons with frequent deep convective thunderstorms, but it has never been demonstrated whether the connection is causal or simple coincidence. We use rainwater samples from over 800 individual precipitation events to show that thunderstorms increase Hg concentrations by 50% relative to weak convective or stratiform events of equal precipitation depth. Radar and satellite observations reveal that strong convection reaching the upper troposphere (where high atmospheric concentrations of soluble, oxidized mercury species (Hg(II)) are known to reside) produces the highest Hg concentrations in rain. As a result, precipitation meteorology, especially thunderstorm frequency and total rainfall, explains differences in Hg deposition between study sites located in the eastern United States. Assessing the fate of atmospheric mercury thus requires bridging the scales of global transport and convective precipitation.

A profile of solo/two-physician practices.

Understanding practice behaviors of solo/dual physician ownership and associated factors at the national level is important information for policymakers and clinicians in response to the Affordable Care Act (ACA) of 2010, but poorly understood in the literature. We analyzed nationally representative data (n = 4,720). The study results reveal nearly 33% of the sample reported solo/two-physician practices. Male/minority/older physicians, psychiatrists, favor small practices. Greater market competition was perceived and less charity care was given among solo/two-physician practitioners. The South region was favored by small physician practitioners. Physicians in solo or two-person practices provided fewer services to chronic patients and were dissatisfied with their overall career in medicine. Small practices were favored by international medical graduates (IMGs) and primary care physicians (PCPs). Overall our data suggest that the role of solo/dual physician practices is fading away in the delivery of medicine. Our findings shed light on varied characteristics and practice behaviors of solo/two-physician practitioners, but more research may be needed to reevaluate the potential role of small physician practitioners and find a way to foster a private physician practice model in the context of the newly passed ACA of 2010.

Determining a patient's comfort in inquiring about healthcare providers' hand-washing behavior.

OBJECTIVES: To determine whether a patient's level of assertiveness and other factors influences her comfort level in asking her provider to wash his or her hands. METHODS: In this pilot study, we developed a survey to gather cross-sectional information on a variety of factors that might explain patient willingness to ask her health-care provider to wash his or her hands. Three primary predictor variables are analyzed: (1) patient assertiveness; (2) patient familiarity with her healthcare provider; and (3) whether the patient has observed hand-washing behavior. Fifty patients participated from the Obstetrics and Gynecology Department of Metropolitan Hospital Center. RESULTS: Less assertive patients are much less likely than assertive patients to ask physicians to wash hands (25% versus 68%; Fisher's exact test P = 0.0427). Among the 3 assertiveness questions included in the survey, the ability to ask physicians questions during visits is most strongly indicative of willingness to ask about hand washing. Familiarity with the names of regular health-care providers has a statistically significant impact on willingness to ask about hand washing. Evidence suggests that observing hand washing behavior affects willingness to ask, but differences are not statistically significant. Results by socioeconomic status such as age, education, income, and race/ethnicity are inconclusive. CONCLUSIONS: A patient's level of assertiveness alone is not sufficient to determine her willingness to inquire about the hand-washing behavior of her provider. A high percentage of patients did not see their provider engaging in adequate hand washing behavior. If patients feel comfortable with their provider to inquire about their care and request hand-washing behavior, health outcomes are affected by reducing the rates of health care-associated infections.

Competing interests in healthcare: a conflict of quality. Part II: regulations, transparency, and policy implications.

This research explores the association of physician conflicts of interest with quality of care. Specifically, we discuss the role of some government regulations as policy alternatives. The need for further regulation has become more apparent as improprieties in the healthcare industry have come to light. The dominating theme in current and proposed legislation, as well as institutional policies, is the idea of ensuring that conflicts of interest are transparent, thereby increasing the likelihood that appropriate relationships will be maintained between healthcare providers and industry representatives. Much of the difficulty that organizations are going to have in implementing effective policies is the resistance that will be initiated by physicians. In order to decrease the frequency of negative effects from conflicts of interest, we suggest that each organization establish a committee to create and oversee strict policies governing expectations regarding conflicts of interest.

Competing interests in healthcare: a conflict of quality. Part I: definition, background, and evidence.

This policy paper investigates whether physician conflicts of interest have an effect on physicians' quality of care and whether implementation of conflict-of-interest policies will ameliorate any negative effects of divergent interests. Some government regulations are discussed in a policymaking perspective. We also suggest that healthcare organizations establish specific policies guarding against potential negative outcomes related to conflicts of interest. At the pinnacle of the conflict-of-interest debate resides the patient. One of the most important effects of disclosure is providing patients with the opportunity to make informed decisions regarding their healthcare. Research supports that conflicts of interest are inherent and oftentimes unavoidable in the healthcare setting.

Light-Duty Motor Vehicle Exhaust Particulate Matter Measurement in the Denver, Colorado, Area.

A study of particulate matter (PM) emissions from in-use, light-duty vehicles was conducted during the summer of 1996 and the winter of 1997 in the Denver, CO, region. Vehicles were tested as received on chassis dynamometers on the Federal Test Procedure Urban Dynamometer Driving Schedule (UDDS) and the IM240 driving schedule. Both PM10 and regulated emissions were measured for each phase of the UDDS. For the summer portion of the study, 92 gasoline vehicles, 10 diesel vehicles, and 9 gasoline vehicles with visible smoke emissions were tested once. For the winter, 56 gasoline vehicles, 12 diesel vehicles, and 15 gasoline vehicles with visible smoke were tested twice, once indoors at 60 °F and once outdoors at the prevailing temperature. Vehicle model year ranged from 1966 to 1996. Impactor particle size distributions were obtained on a subset of vehicles. Continuous estimates of the particle number emissions were obtained with an electrical aerosol analyzer. This data set is being provided to the Northern Front Range Air Quality Study program and to the State of Colorado and the U.S. Environmental Protection Agency for use in updating emissions inventories.

The Effect of Ethanol Fuel on the Emissions of Vehicles over a Wide Range of Temperatures.

The emissions from a fleet of 11 vehicles, including three from the State of Alaska, were tested at 75, 0, and -20 °F with base gasolines and E10 gasolines, that is, gasolines with 10% by volume ethanol added. The data for the changes in emissions for the test run at 75 °F are included, since most other studies on the effects of E10 gasoline on emissions were run at that temperature. The three Alaskan vehicles were also tested at 20 °F. The testing followed the Federal Test Procedure, and regulated emissions-CO, total hydrocarbons (THC), and nitrogen oxides (NOx)-CO2, speciated organics, and fuel economy were measured. A total of 490 FTP tests were run. The data obtained indicated that with most vehicles, at the temperatures tested, improvements in both CO and THC emissions were obtained with the use of E10 fuel. At the lowest temperature used, -20 °F, most vehicles had an increase in NO emissions with the use of E10 fuel. At the other temperatures, however, more vehicles showed a decrease in NOx emissions with the use of E10. With all vehicles at all temperatures tested, the emissions of acetaldehyde increased significantly when E10 fuel was used. The highest increase was about 8 to 1. Benzene, formaldehyde, and 1,3 butadiene showed both increases and decreases in the emissions when using E10 fuel. Unexpected results were obtained with the fuel economy, with about half of the tests showing an increase in fuel economy with the use of E10 fuel.

Influence of Ethanol-Blended Fuels on the Emissions from Three Pre-1985 Light-Duty Passenger Vehicles.

Tailpipe and evaporative emissions from three pre-1985 passenger motor vehicles operating on an ethanol oxygenated and on a nonoxygenated (base) fuel were characterized. Emission data were collected for vehicles operating over the Federal Test Procedure at 90 °F, 75 °F, and 40 °F to simulate ambient driving conditions. The two fuels tested were a commercial summer-grade regular gasoline (the nonoxygenated base fuel) and an oxygenated fuel containing 8.8% ethanol, more paraffins and olefins, and less aromatics than the base fuel. The Reid vapor pressure (RVP) was adjusted to correspond to that of the base fuel. The emissions measured were total hydrocarbons (THCs), speciated hydrocarbons, spedated aldehydes, carbon monoxide (CO), and oxides of nitrogen (NOX). This study showed a general reduction in tailpipe emissions of THC, CO, benzene, and 1,3-butadiene when tested with the ethanol fuel. The ethanol fuel significantly reduced these emissions from the high emitting vehicle, MU098, at 90 °F, 75 °F, and 40 °F test temperatures. Additionally, the ethanol fuel reduced CO emissions from vehicle BU950, with and without catalyst, and from vehicle CI415 at 40 °F. Both formaldehyde and acetaldehyde emissions generally increased when tested with the oxygenated fuel. The acetaldehyde emissions were about double with this fuel. The limited data indicate that most emissions, including toxics, occur during the first 124 seconds of vehicle start-up. Diurnal evaporative emissions were less from the oxygenated fuel, while hot-soak evaporative emissions were greater from the oxygenated fuel (for all vehicles except MU098). Evaporative emissions were generally greatest at the 90 °F test temperature.

An Experimental Evaluation of Remote Sensing-Based Hydrocarbon Measurements: A Comparison to FID Measurements.

The purpose of this study was to intercompare hydrocarbon (HC) measurements performed by a number of different instruments: a gas chromatograph (GC), a flame ionization detector (FID), a fourier transform infrared spectrometer (FTIR), a commercially produced non-dispersive infrared analyzer (NDIR), and two remote sensors. These instruments were used to measure total HC concentrations in a variety of samples, including (1) ten different individual HC species, (2) 12 different vehicle exhaust samples, and (3) three different volatilized fuel samples. The 12 exhaust samples were generated by operating two different vehicles on a dynamometer. Each vehicle was operated at different times with three different fuels. The vehicles were operated fuel rich, i.e., with low air/fuel ratios to encourage elevated exhaust HC levels. Some of the exhaust samples were obtained while operating each vehicle at a stoichiometric air/fuel ratio with one spark plug wire disconnected. To quantify the degree to which the various instruments agreed with the FID, a parameter called the response factor was used, where the response factor was defined as the HC/CO2 ratio measured by each instrument divided by the HC/CO2 ratio measured by the dynamometer bench. Of the various instruments, only the GC yielded response factors that were consistently at or close to one. The other instruments typically had values at or below one. For the ten individual HC species studied, the NDIR and remote sensors obtained response factors between 0.05 and 1.0, with the highest response factors being obtained for the alkanes and the lowest response factors obtained for toluene and ethylene. For the exhaust samples, the NDIR and remote sensors obtained response factors between 0.23 and 0.68. For raw fuel samples, the response factors were between 0.44 and 0.68. NDIR and remote sensor measurements correlated very poorly with total HC in exhaust.