A comparison of the frequencies of risk factors for depression in older black and white participants in a study of indicated prevention.

BACKGROUND: To compare the frequencies of risk factors, we describe risks for depression as a function of race among consecutively admitted participants in a randomized clinical trial of indicated depression prevention in later life. METHODS: Seventy-two black and 143 white participants were screened for risk factors for depression. RESULTS: Black participants were more likely to have fewer years of education and lower household income. They were more likely to be obese, live alone, experience functional disability, have a history of alcohol and drug abuse, and have lower scores on the Mini-mental State Examination and the Executive Interview (EXIT). White participants were not found to have greater prevalence or higher mean score on any risk factor. On average, black participants experienced approximately one more risk factor than white participants (t(213) = 3.32, p = 0.0011). CONCLUSIONS: In our sample, black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants.

Microfabricated thermal modulator for comprehensive two-dimensional micro gas chromatography: design, thermal modeling, and preliminary testing.

In comprehensive two-dimensional gas chromatography (GC x GC), a modulator is placed at the juncture between two separation columns to focus and re-inject eluting mixture components, thereby enhancing the resolution and the selectivity of analytes. As part of an effort to develop a microGC x microGC prototype, in this report we present the design, fabrication, thermal operation, and initial testing of a two-stage microscale thermal modulator (microTM). The microTM contains two sequential serpentine Pyrex-on-Si microchannels (stages) that cryogenically trap analytes eluting from the first-dimension column and thermally inject them into the second-dimension column in a rapid, programmable manner. For each modulation cycle (typically 5 s for cooling with refrigeration work of 200 J and 100 ms for heating at 10 W), the microTM is kept approximately at -50 degrees C by a solid-state thermoelectric cooling unit placed within a few tens of micrometres of the device, and heated to 250 degrees C at 2800 degrees C s(-1) by integrated resistive microheaters and then cooled back to -50 degrees C at 250 degrees C s(-1). Thermal crosstalk between the two stages is less than 9%. A lumped heat transfer model is used to analyze the device design with respect to the rates of heating and cooling, power dissipation, and inter-stage thermal crosstalk as a function of Pyrex-membrane thickness, air-gap depth, and stage separation distance. Experimental results are in agreement with trends predicted by the model. Preliminary tests using a conventional capillary column interfaced to the microTM demonstrate the capability for enhanced sensitivity and resolution as well as the modulation of a mixture of alkanes.

Creation of community-based research capabilities in the neighborhood cancer care cooperative: administrative infrastructure, program initiatives, and evaluation priorities.

The Radiation Oncology Community Outreach Group (ROCOG) and the Neighborhood Cancer Care Cooperative (NCCC) were developed to address oncology-related health disparities utilizing a community-based, collaborative organizational design. Funded in 2003 by the National Cancer Institute's Cancer Disparities Research Partnership program, ROCOG/NCCC has focused on reducing barriers to care and enhancing the health care system's responsiveness to minority and indigent populations within Southwestern Pennsylvania. This article will describe the component programs that have been developed under this umbrella, as well as the evolved administrative, governance, and evaluation infrastructure that supports these initiatives.

Electro-optic polymer cladding ring resonator modulators.

Compact, low capacitance optical modulators are vital for efficient, high-speed chip to chip optical interconnects. Electro-optic (EO) polymer cladding micro-ring resonator modulators have been fabricated and their performance is characterized. Optical modulators with ring diameters smaller than 50 microm have been demonstrated in a silicon nitride based waveguide system on silicon oxide with a top cladding of an electro-optic polymer. Optical modulation has been observed with clock signals up to 10 GHz.

Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers.

OBJECTIVES: To increase adult immunizations at inner-city health centers serving primarily minority patients. DESIGN: A before-after trial with a concurrent control. SETTING: Five inner-city health centers. PARTICIPANTS: All adult patients at the health centers eligible for influenza and pneumococcal vaccines. INTERVENTION: Four intervention sites chose from a menu of culturally appropriate interventions based on the unique features of their respective health centers. MEASUREMENTS: Immunization and demographic data from medical records of a random sample of 568 patients aged 50 and older who had been patients at their health centers since 2000. RESULTS: The preintervention influenza vaccination rate of 27.1% increased to 48.9% (P<.001) in intervention sites in Year 4, whereas the concurrent control rate remained low (19.7%). The pneumococcal polysaccharide vaccine (PPV) rate in subjects aged 65 and older increased from 48.3% to 81.3% (P<.001) in intervention sites in Year 4. Increase in PPV in the concurrent control was not significant. In logistic regression analysis, the likelihood of influenza vaccination was significantly associated with the intervention (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.77-2.41) and with age of 65 and older (OR=2.0, 95% CI=1.62-2.48) but not with race. Likelihood of receiving the pneumococcal vaccination was also associated with older age and, to a lesser degree, with intervention. CONCLUSION: Culturally appropriate, evidence-based interventions selected by intervention sites resulted in increased adult vaccinations in disadvantaged, racially diverse, inner-city populations over 2 to 4 years.

Breast cancer risk assessment in socioeconomically disadvantaged urban communities.

During 2005, a risk assessment tool based on the Gail model was used to calculate the five-year risk of developing breast cancer for 445 women who live in socioeconomically disadvantaged urban communities in western Pennsylvania and who attended health fairs and other community-sponsored activities. This tool allowed us to evaluate each woman and advise her of her risks in a process lasting 15-20 minutes. Of the 445 women, 71.7% were black and 21.6% had a higher than average risk. The proportion of white women at high risk was significantly greater than the proportion of black women at high risk (33.3% vs. 16.9%; P < 0.01). The Gail model assessment tool for use in low-income and minority populations holds promise because it is noninvasive, is easy to use and provides immediate data about risk. This risk communication may help encourage minority and low-income women to receive screening mammography. It has the potential to improve breast cancer screening rates.

Impact of the 2004 influenza vaccine shortage on patients from inner city health centers.

In the fall of 2004, the FDA and British authorities suspended the license of one of only two manufacturers that provided the US supply of inactivated influenza vaccine. With a 50% reduction in supply, a severe vaccine shortage resulted. This situation necessitated the development of priority groups for vaccination including those > or =65 years, when ordinarily, influenza vaccine is recommended for those > or =50 years old. A sample of patients > or =50 years old (n = 336), who had been seen at one of four inner-city health centers, was interviewed in summer 2005 using computer-assisted telephone interviewing. Associations of survey responses were examined for three groups: those vaccinated in the 2003-2004 and 2004-2005 influenza seasons (n = 142), those vaccinated in 2003-2004 but not vaccinated in 2004-2005 because of the shortage (n = 63), and those unvaccinated in both seasons (n = 83). Bivariate and multivariate logistic regression analyses were used to determine factors significantly influencing the likelihood of vaccination status. A significantly larger proportion of patients 50-64 years of age were unvaccinated due to the shortage (73%) compared to those who were vaccinated during both seasons (36%, P < 0.001), but there were no racial disparities in vaccination rates. Compared with patients who were vaccinated during both seasons, those who were unvaccinated due to the shortage were more frequently employed, self-reported their health positively, saw their physician less frequently, rated the US government's response to the shortage as "terrible," and blamed the US government for the shortage. Vaccination during the influenza vaccine shortage appears to have followed preferential vaccination of the CDC-established priority group (> or =65 years) and did not result in racial disparities in inner-city health centers.

Parental perspectives on influenza vaccination of children with chronic medical conditions.

BACKGROUND: Minorities and those living in the inner city have a higher respiratory disease burden than other groups. Yet, influenza vaccination rates among all children with chronic medical conditions remain low. METHODS: Parents of 2-13-year-old children with high-risk medical conditions from health centers in low-income urban neighborhoods completed a mailed survey. Immunization status from medical records was used to calculate validity measures. Survey data are presented for those whose vaccination status was concordant between parental report and the medical record (n=183). RESULTS: Parent-reported influenza vaccination versus medical record review showed 84.9% sensitivity, 68.7% specificity, 49.1% positive predictive value and 92.7% negative predictive value, with a kappa of 0.43. Vaccination rate was 30.6%. Medical record-verified influenza vaccination was associated with parental beliefs that the doctor recommends a flu shot (OR, 40.9; 95% Cl, 9.0-184.9) and that relatives recommend a flu shot (OR, 4.3; 95% Cl, 1.7-10.5), and was less likely if the parent believed that the child will get the flu if a household member is infected (OR, 0.2; 95% Cl, 0.1-0.6). CONCLUSIONS: The message that influenza vaccination is important to protect children with chronic medical conditions may be relayed through physician recommendation or a relative's suggestion and may be more effective if it addresses vaccine efficacy issues.

Interventions over 2 years to increase influenza vaccination of children aged 6-23 months in inner-city family health centers.

The purposes of this study were to test the ability of tailored interventions to raise influenza immunization rates and assess the effect on timely receipt of other vaccines. We conducted a before/after trial over 2 years to increase influenza vaccination rates of patients 6-23 months old in five inner-city family health centers serving low-income children with a sixth site as a concurrent control. Influenza vaccination rates improved significantly from a baseline of 4.7-24.7% in the first year and 36.6% in the second year, P < 0.001. The increase in rates was greater in intervention sites than the control site (31.9% versus 25.7%, P = 0.02). In regression analyses of influenza vaccination, intervention year was associated with an odds ratio (OR) of 9.4 (95% confidence interval (CI) = 4.4-20.0) for the first intervention year and OR = 13.4 (95% CI = 6.5-28.0) for the second intervention year. Children vaccinated against influenza were more likely to have received DTaP 3 and MMR within 2 months of the recommended age than children not vaccinated against influenza (P < 0.001).

Predictors of pneumococcal polysaccharide vaccination among patients at three inner-city neighborhood health centers.

BACKGROUND: Despite the availability of pneumococcal polysaccharide vaccine (PPV), vaccination rates are modest, and racial disparity in these rates is known to occur. OBJECTIVE: The purpose of this study was to identify determinants of patient-reported receipt of PPV among patients from 3 inner-city health centers that serve large numbers of minority and disadvantaged patients. METHODS: In 2003, a random sample of patients from 3 inner-city health centers was surveyed by computer-assisted telephone interview concerning their vaccination status and their attitudes and beliefs about PPV. The questionnaire was based on the theory of reasoned action, which emphasizes the contributions to behavioral intention of cognitive beliefs (including the likelihood of consequences), the value of those consequences, and normative beliefs. Factor analysis was conducted to examine whether survey items specific to attitudes about PPV would group together; the variance of the components resulting from the factor analysis was expressed in eigenvalues. Logistic regression analyses were conducted to determine which factors, demographic characteristics, and health habits were independently associated with PPV status. RESULTS: Of 674 patients sent introductory letters (13 of whom were ineligible), 325 (49%) completed the interview with usable data. These patients were primarily aged > or = 65 years (52% [168/325]), female (69% [223/325]), and white (57% [174/306]), and had an annual household income < 20,000 dollars (61% [174/287]). Vaccination status or intention to be vaccinated was unknown for 25 persons, reducing the sample to 300. Of these respondents, 59% (178) reported vaccination, 9% (26) intended to be vaccinated within 6 months, and 32% (96) had no intention of being vaccinated. Vaccination rates were 76% (119/157) for responders aged > or = 65 years and 41% (59/143) for responders aged 50 to 64 years (P < 0.001). Logistic regression analyses found 3 variables that were significantly associated with the likelihood of vaccination: age > or = 65 years; frequency of physician visits; and timing of the last complete physical examination. The factor analysis with varimax rotation identified 2 factors that increased the likelihood of reporting ever receiving PPV: attitudes about PPV and social influences (eigenvalue = 2.69), and beliefs about pneumonia risk and vaccine efficacy (eigenvalue = 1.24). When these factors were added to the model, the effects of age and frequency of seeing a physician became nonsignificant. Compared with those having a complete physical examination < 1 year ago, those having an examination 1 to 2 years ago (odds ratio [OR] = 0.16; 95% CI = 0.04-0.69) or > 2 years ago (OR = 0.10; 95% CI = 0.01-0.78) were less likely to be vaccinated. Those agreeing with the attitudes and social influence factor were more likely to be vaccinated (OR = 8.24; 95% CI = 3.97-17.12), as were those agreeing with the pneumonia risk and vaccine efficacy factor (OR = 2.63; 95% CI = 1.20-5.80). CONCLUSIONS: Attitudes about vaccination and a clinician's recommendation are the most powerful predictors of PPV status. Efforts to raise rates of vaccination and reduce racial disparities should emphasize communication of clinicians' recommendations to patients.

Ion neutral mass spectrometer results from the first flyby of Titan.

The Cassini Ion Neutral Mass Spectrometer (INMS) has obtained the first in situ composition measurements of the neutral densities of molecular nitrogen, methane, molecular hydrogen, argon, and a host of stable carbon-nitrile compounds in Titan's upper atmosphere. INMS in situ mass spectrometry has also provided evidence for atmospheric waves in the upper atmosphere and the first direct measurements of isotopes of nitrogen, carbon, and argon, which reveal interesting clues about the evolution of the atmosphere. The bulk composition and thermal structure of the moon's upper atmosphere do not appear to have changed considerably since the Voyager 1 flyby.

Feasibility of influenza immunization for inner-city children aged 6 to 23 months.

BACKGROUND: Annual influenza-related hospitalization rates of children aged < 2 years in the United States are second only to those of the elderly. Yet no recommendations existed for vaccinating healthy children aged 6 to 23 months until 2002, when the Advisory Committee on Immunization Practices encouraged influenza vaccination for them. This study tested the feasibility of vaccinating 6- to 23-month-old children against influenza and assessed the effect on timely receipt of other vaccines. METHODS: A pre-post trial was used in urban health centers serving low-income children. Sites selected interventions from strategies proven to increase vaccination rates. Targeted patients were aged 6 to 23 months by November 30, 2002 (N = 1534). RESULTS: Influenza vaccination rates for the 2002-2003 intervention season improved significantly from 6.5% to 38.5% for the first dose (p < 0.001). Second-dose rates were significantly improved over preintervention (1.9% preintervention, 13.2% intervention), but lower than first-dose rates. Mean ages at vaccination for other recommended childhood vaccines did not differ or were significantly younger (measles, mumps, and rubella vaccine [MMR] and varicella) for children who received influenza vaccine versus those who did not. Moreover, a higher percentage of influenza-vaccinated than unvaccinated children received MMR, diphtheria, tetanus, pertussis vaccine 3 (DTaP3), inactivated poliovirus vaccine 2 (IPV2), and Haemophilus influenzae b (Hib2) vaccines within a 2-month grace period of the recommended age (p < 0.039), with no differences between groups for Hib1, DTaP1, IPV1, and varicella. CONCLUSIONS: With directed effort, it is possible to increase influenza vaccination at health centers serving low-income children. The addition of a two-dose vaccine was not associated with delayed receipt of other vaccines among these children.