Challenging Pennsylvania's Firearm Preemption Law as a Public Health Danger: The Case of Philadelphia.

Firearm violence has soared in American cities, but most states statutorily preempt municipal firearm regulation. This article describes a unique collaboration in Philadelphia among elected officials, public health researchers, and attorneys that has led to litigation based on original quantitative analyses and grounded in innovative constitutional theories and statutory interpretation.

Socioeconomic status and disparities in COVID-19 vaccine uptake in Eastern Oslo, Norway.

Objective: The objective of this study was to assess whether socioeconomic status still remain a barrier to COVID-19 vaccination in eastern Oslo, Norway. Study design: A cross-section study. Methods: We conducted a web-based survey among the residents of six eastern parishes in Oslo, Norway. Text (SMS) messages were sent to 59978 potential participants. 5447 surveys were completed for a response rate of 9.1%. After removing participants who had not been offered the COVID-19 vaccine, we ended up with a valid sample of 4000. Results: We find a significant association between education and the likelihood of taking the COVID-19 vaccine in bivariate logistic regression. Further, we find a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group. However, when we add control variables to the regression, the significant results concerning both income and education are eliminated. In further analysis, we found that age worked as a moderator between socioeconomic status and vaccine uptake: In the youngest age group (18-29), we found a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group, and in the higher education group compared to the primary education group. Conclusion: Socioeconomic status remains a barrier to COVID-19 vaccination in the eastern parishes of Oslo, Norway. Indicating that Norwegians of lower socioeconomic status still disproportionately face barriers such as transportation, language, flexible work hours, and paid sick time. However, our analysis shows that this association is only found in the age group 18-29.

Identifying Patterns and Sources of Fine and Ultrafine Particulate Matter in London Using Mobile Measurements of Lung-Deposited Surface Area.

We performed more than a year of mobile, 1 Hz measurements of lung-deposited surface area (LDSA, the surface area of 20-400 nm diameter particles, deposited in alveolar regions of lungs) and optically assessed fine particulate matter (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) in central London. We spatially correlated these pollutants to two urban emission sources: major roadways and restaurants. We show that optical PM2.5 is an ineffective indicator of tailpipe emissions on major roadways, where we do observe statistically higher LDSA, BC, and NO2. Additionally, we find pollutant hot spots in commercial neighborhoods with more restaurants. A low LDSA (15 µm2 cm-3) occurs in areas with fewer major roadways and restaurants, while the highest LDSA (25 µm2 cm-3) occurs in areas with more of both sources. By isolating areas that are higher in one source than the other, we demonstrate the comparable impacts of traffic and restaurants on LDSA. Ratios of hyperlocal enhancements (ΔLDSA:ΔBC and ΔLDSA:ΔNO2) are higher in commercial neighborhoods than on major roadways, further demonstrating the influence of restaurant emissions on LDSA. We demonstrate the added value of using particle surface in identifying hyperlocal patterns of health-relevant PM components, especially in areas with strong vehicular emissions where the high LDSA does not translate to high PM2.5.

The association between warfarin usage and international normalized ratio increase: systematic analysis of FDA Adverse Event Reporting System (FAERS).

Introduction: Elevated international normalized ratio (INR) has been commonly reported as an adverse drug event (ADE) for patients taking warfarin for anticoagulant therapy. Aim: The purpose of this study was to determine the association between increased INR and the usage of warfarin by using the pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS). Methods: The ADEs in patients who took warfarin (N = 77,010) were analyzed using FAERS data. Association rule mining was applied to identify warfarin-related ADEs that were most associated with elevated INR (n = 15,091) as well as possible drug-drug interactions (DDIs) associated with increased INR. Lift values were used to identify ADEs that were most commonly reported alongside elevated INR based on the correlation between both item sets. In addition, this study sought to determine if the increased INR risk was influenced by sex, age, temporal distribution, and geographic distribution and were reported as reporting odds ratios (RORs). Results: The top 5 ADEs most associated with increased INR in patients taking warfarin were decreased hemoglobin (lift = 2.31), drug interactions (lift = 1.88), hematuria (lift = 1.58), asthenia (lift = 1.44), and fall (lift = 1.32). INR risk increased as age increased, with individuals older than 80 having a 63% greater likelihood of elevated INR compared to those younger than 50. Males were 9% more likely to report increased INR as an ADE compared to females. Individuals taking warfarin concomitantly with at least one other drug were 43% more likely to report increased INR. The top 5 most frequently identified DDIs in patients taking warfarin and presenting with elevated INR were acetaminophen (lift = 1.81), ramipril (lift = 1.71), furosemide (lift = 1.64), bisoprolol (lift = 1.58), and simvastatin (lift = 1.58). Conclusion: The risk of elevated INR increased as patient age increased, particularly among those older than 80. Elevated INR frequently co-presented with decreased hemoglobin, drug interactions, hematuria, asthenia, and fall in patients taking warfarin. This effect may be less pronounced in women due to the procoagulatory effects of estrogen signaling. Multiple possible DDIs were identified, including acetaminophen, ramipril, and furosemide.

Excess Mortality From Non-COVID-19 Causes During the COVID-19 Pandemic in Philadelphia, Pennsylvania, 2020-2021.

Objectives. To estimate excess mortality from non-COVID-19 causes during the COVID-19 pandemic in Philadelphia, Pennsylvania, and understand disparities by race/ethnicity, age, and sex. Methods. We used Poisson regression models of weekly deaths using data from Pennsylvania's vital registration system (2018-2021). Results. There was significant excess mortality as a result of heart disease, homicide, diabetes, drug overdoses, traffic crashes, and falls in 2020-2021; the burden of this excess non-COVID-19 mortality fell on non-Hispanic Black Philadelphians. Among younger non-Hispanic Black men, homicide and drug overdoses were responsible for 54% and 18% of excess deaths-more than COVID-19 (17%). For younger non-Hispanic Black women, drug overdoses accounted for 51% of excess deaths, whereas COVID-19 accounted for 40%. Conclusions. Excess mortality was not solely caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; the causative agent of COVID-19), particularly at younger ages. Indirect pandemic mortality exacerbated prepandemic disparities by race/ethnicity. Public Health Implications. Excess mortality as a result of non-COVID-19 causes may reflect indirect pandemic mortality. National cause-of-death data lag behind local cause-of-death data; local data should be examined as an early indication of trends and disparities. Public health practitioners must center health equity in pandemic response and planning. (Am J Public Health. 2022;112(12):1800-1803. https://doi.org/10.2105/AJPH.2022.307096).

Influenza risk groups in Norway by education and employment status.

AIMS: This study aimed to estimate the size of the risk group for severe influenza and to describe the social patterning of the influenza risk group in Norway, defined as everyone ⩾65 years of age and individuals of any age with certain chronic conditions (medical risk group). METHODS: Study data came from a nationally representative survey among 10,923 individuals aged 16-79 years. The medical risk group was defined as individuals reporting one or more relevant chronic conditions. The associations between educational attainment, employment status, age and risk of belonging to the medical risk group were studied with logistic regression. RESULTS: Nearly a fifth (19.0%) of respondents reported at least one chronic condition, while 29.4% belonged to the influenza risk group due to either age or chronic conditions. Being older, having a low educational level (comparing compulsory education to higher education, odds ratio (OR)=1.4, 95% confidence interval (CI) 1.2-1.8 among women, and OR=1.3, 95% CI 1.1-1.7 among men) and a weaker connection to working life (comparing disability pension to working full-time, OR=6.8, 95% CI 5.3-8.7 among women, and OR=6.5, 95% CI 4.9-8.5 among men) was associated with a higher risk of belonging to the medical risk group for severe influenza. CONCLUSIONS: This study indicates that the prevalence of medical risk factors for severe influenza is disproportionally distributed across the socio-economic spectrum in Norway. These results should influence both public funding decisions regarding influenza vaccination and communication strategies towards the public and health professionals.

Excess Mortality During the COVID-19 Pandemic in Philadelphia.

Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n = 2725) were attributed to COVID-19 on the death certificate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; official counts significantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups.

Darker days? Recent trends in depression disparities among U.S. adults.

Depression is the most prevalent mood disorder in the United States, and disparities in depressive symptoms and treatment by socioeconomic status have been well-documented. Recent evidence suggests the prevalence of depression is increasing, but less is known about time trends in disparities. Using nationally representative data from the National Health and Nutrition Examination Survey, we examined patterns of depressive symptoms (Patient Health Questionnaire-9) and treatment (self-reported psychotherapy and psychopharmacology). We assessed time trends in depression disparities by educational attainment among U.S. adults 2005-2014 using logistic regression models. Among the least educated groups, the odds of moderate to severe depressive symptoms increased; for the most educated, they remained stable (women) or decreased (men). At the same time, odds of receiving treatment, conditional on being depressed, declined (women) or remained stable (men) for the least educated group, whereas treatment rates stayed steady (women) or increased (men) for the most educated. Between 2005 and 2014, overall depression prevalence increased. Despite recent policies designed to improve mental health care coverage, depression treatment rates were unable to keep pace. The least educated consistently had the highest rates of moderate to severe depressive symptoms and the lowest rates of treatment. Disparities in depression by educational attainment have persisted or worsened. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Apolipoprotein E, cognitive function, and cognitive decline among older Taiwanese adults.

Apolipoprotein E (APOE) genotype is believed to play a role in the onset of dementia, though less is known about its relationship with non-pathogenic age-related cognitive decline. We assessed whether APOE was a risk factor for cognitive decline among older Taiwanese adults using nationally representative data. General cognition was measured longitudinally over eleven years; domain-specific cognitive assessments of working memory, declarative learning and three aspects of attention (executive function, alerting, and orientation) were performed once. Having at least one risky APOE allele was associated with more rapid longitudinal cognitive decline compared to those with no risky alleles. Some evidence from the cross-sectional analysis of domain-specific cognitive assessments suggested that APOE genotype may be more closely associated with working memory and declarative learning than with attention. Most genetic studies of cognition include only populations of European descent; extension is crucial. This study confirmed the association between APOE genotype and the rate of cognitive decline in a predominantly Han Chinese population. Additional studies on diverse populations are warranted.

Religious affiliation at time of death - Global estimates and projections.

AIMS: Religious affiliation influences societal practices regarding death and dying, including palliative care, religiously acceptable health service procedures, funeral rites and beliefs about an afterlife. We aimed to estimate and project religious affiliation at the time of death globally, as this information has been lacking. METHODS: We compiled data on demographic information and religious affiliation from more than 2500 surveys, registers and censuses covering 198 nations/territories. We present estimates of religious affiliation at the time of death as of 2010, projections up to and including 2060, taking into account trends in mortality, religious conversion, intergenerational transmission of religion, differential fertility, and gross migration flows, by age and sex. RESULTS: We find that Christianity continues to be the most common religion at death, although its share will fall from 37% to 31% of global deaths between 2010 and 2060. The share of individuals identifying as Muslim at the time of death increases from 21% to 24%. The share of religiously unaffiliated will peak at 17% in 2035 followed by a slight decline thereafter. In specific regions, such as Europe, the unaffiliated share will continue to rises from 14% to 21% throughout the period. CONCLUSIONS: Religious affiliation at the time of death is changing globally, with distinct regional patterns. This could affect spatial variation in healthcare and social customs relating to death and dying.

Inflammation and Cognition in Older Adults: Evidence from Taiwan.

Inflammation has been linked to clinical cognitive impairment, including Alzheimer's disease. Less is known, however, about the relationship between inflammation and normal, age-associated cognitive decline. An understanding of the determinants of all types of cognitive decline is important for improving quality of life in an aging world. This study investigated whether biomarkers of inflammation were associated with cognitive function and decline in older Taiwanese adults. Data were from the Taiwan Longitudinal Study of Aging and the Social Environment and Biomarkers of Aging Study. Inflammation was measured in 2000 and 2006 as C-reactive protein, interleukin-6, soluble e-selectin, soluble intercellular adhesion molecule-1, and white blood cell count. Cognition was assessed by 10 cognitive and memory tasks, measured in 2006, 2007, and 2011. Growth curve models were used to examine the relationship between inflammation and cognitive score over this time period. Higher levels of inflammation were associated with lower baseline cognitive scores, but not with longitudinal change in cognitive score. This study did not support a causal link between inflammation and cognitive decline among this older cohort. The observed cross-sectional relationship could reflect a causal relationship that arises earlier in life, or confounding; additional research across the life course is warranted.

Gender and the structure of self-rated health across the adult life span.

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002-2015 National Health Interview Survey data from US-born respondents aged 25-84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Correction of a Single Discolored Anterior Tooth Due to Internal Resorption: A Clinical Report.

For patients with a single discolored tooth who desire to have it lightened, a thorough examination and radiographic analysis need to be performed prior to initiating any bleaching treatment so that the cause of the discoloration can be determined. Underlying pathology, such as internal resorption, is often asymptomatic and difficult to diagnose and if left untreated could result in tooth loss. This article describes a case of a patient with a discolored maxillary central incisor resulting from internal resorption and the subsequent endodontic and bleaching therapy performed to resolve the pathology and achieve an acceptable esthetic result.

Combination of centripetal and successive layering techniques for a stress-reduced posterior direct composite restoration.

Due to the increased predictability of current bonding procedures and the improved properties of today's composite materials, large Class II and cuspal build-up direct composite resin restorations are routinely performed. Biological considerations and the stress associated with polymerization shrinkage are key factors that need to be considered during the treatment planning phase. This article demonstrates a combination of concepts and techniques to reduce the stress associated with polymerization shrinkage in large restorations, thus potentially improving the longevity of the restoration.

Restoration of a large class IV fracture using direct composite resin: A clinical report.

Restoration of anterior tooth fractures is a common dental procedure. Both direct and indirect options are clinically acceptable to repair fractured teeth. For a large class IV fracture, treatment planning is time consuming, and the artistic skills necessary to achieve optimal results can be daunting. This clinical report describes a step-by-step protocol for achieving highly esthetic direct anterior restorations.

Why are well-educated Muscovites more likely to survive? Understanding the biological pathways.

There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.

Do interviewer and physician health ratings predict mortality?: a comparison with self-rated health.

BACKGROUND: Despite the serious biases that characterize self-rated health, researchers rely heavily on these ratings to predict mortality. Using newly collected survey data, we examine whether simple ratings of participants' health provided by interviewers and physicians can markedly improve mortality prediction. METHODS: We use data from a prospective cohort study based on a nationally representative sample of older adults in Taiwan. We estimate proportional-hazard models of all-cause mortality between the 2006 interview and 30 June 2011 (mean 4.7 years' follow-up). RESULTS: Interviewer ratings were more strongly associated with mortality than physician or self-ratings, even after controlling for a wide range of covariates. Neither respondent nor physician ratings substantially improve mortality prediction in models that include interviewer ratings. The predictive power of interviewer ratings likely arises in part from interviewers' incorporation of information about the respondents' physical and mental health into their assessments. CONCLUSIONS: The findings of this study support the routine inclusion of a simple question at the end of face-to-face interviews, comparable to self-rated health, asking interviewers to provide an assessment of respondents' overall health. The costs of such an undertaking are minimal and the potential gains substantial for demographic and health researchers. Future work should explore the strength of the link between interviewer ratings and mortality in other countries and in surveys that collect less detailed information on respondent health, functioning, and well-being.

Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study.

OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression). METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points. RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity. DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

Urban growth, climate change, and freshwater availability.

Nearly 3 billion additional urban dwellers are forecasted by 2050, an unprecedented wave of urban growth. While cities struggle to provide water to these new residents, they will also face equally unprecedented hydrologic changes due to global climate change. Here we use a detailed hydrologic model, demographic projections, and climate change scenarios to estimate per-capita water availability for major cities in the developing world, where urban growth is the fastest. We estimate the amount of water physically available near cities and do not account for problems with adequate water delivery or quality. Modeled results show that currently 150 million people live in cities with perennial water shortage, defined as having less than 100 L per person per day of sustainable surface and groundwater flow within their urban extent. By 2050, demographic growth will increase this figure to almost 1 billion people. Climate change will cause water shortage for an additional 100 million urbanites. Freshwater ecosystems in river basins with large populations of urbanites with insufficient water will likely experience flows insufficient to maintain ecological process. Freshwater fish populations will likely be impacted, an issue of special importance in regions such as India's Western Ghats, where there is both rapid urbanization and high levels of fish endemism. Cities in certain regions will struggle to find enough water for the needs of their residents and will need significant investment if they are to secure adequate water supplies and safeguard functioning freshwater ecosystems for future generations.

The impact of bisphenol A and triclosan on immune parameters in the U.S. population, NHANES 2003-2006.

BACKGROUND: Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction. OBJECTIVES: To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function. METHODS: Using data from the 2003-2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine the association of BPA and triclosan with CMV antibody titers, and multivariate logistic regression models to investigate the association of these chemicals with allergy or hay fever diagnosis. Statistical models were stratified by age (< 18 years and ≥ 18 years). RESULTS: In analyses adjusted for age, sex, race, body mass index, creatinine levels, family income, and educational attainment, in the ≥ 18-year age group, higher urinary BPA levels were associated with higher CMV antibody titers (p < 0.001). In the < 18-year age group, lower levels of BPA were associated with higher CMV antibody titers (p < 0.05). However, triclosan, but not BPA, showed a positive association with allergy or hay fever diagnosis. In the < 18-year age group, higher levels of triclosan were associated with greater odds of having been diagnosed with allergies or hay fever (p < 0.01). CONCLUSIONS: EDCs such as BPA and triclosan may negatively affect human immune function as measured by CMV antibody levels and allergy or hay fever diagnosis, respectively, with differential consequences based on age. Additional studies should be done to investigate these findings.