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1.
J Natl Cancer Inst ; 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38588578

RESUMO

BACKGROUND: Lack of stable and affordable housing is an important social determinant of health. Federal housing assistance may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of SEER-Medicare and Housing and Urban Development (HUD) administrative data. METHODS: Individuals enrolled in HUD public and assisted housing programs 2006-2021 were linked with cancer diagnoses 2006-2019 identified in the SEER-Medicare data from 16 states using Match*Pro probabilistic linkage software. HUD administrative data include timing and type of housing assistance and verified household income. Medicare administrative data are available through 2020. RESULTS: A total of 335,490 unique individuals who received housing assistance matched to SEER-Medicare data at any point in time, including 156,794 that recieved housing assistance around the time of their diagnosis (at least 6 months prior to diagnosis until 6 months after diagnosis or death). A total of 63,251 persons with housing assistance at the time of their diagnosis were aged 66 years and older and continuously enrolled in Medicare Parts A and B fee-for-service, 12,035 with lung, 8,866 with breast, 7,261 with colorectal, and 4,703 with prostate cancer. CONCLUSIONS: This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis, care, and outcomes, including the role of housing assistance status in potentially reducing or contributing to inequities across racialized and ethnic groups.

2.
BMC Health Serv Res ; 23(1): 999, 2023 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-37718457

RESUMO

BACKGROUND: While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland's pilot program initiative - Assistance in Community Integration Services (ACIS). METHODS: The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity's administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers. RESULTS: A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs. CONCLUSIONS: The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing.


Assuntos
Habitação , Medicaid , Estados Unidos , Humanos , Maryland , Administração de Caso , Integração Comunitária
3.
bioRxiv ; 2023 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-37745341

RESUMO

Sensory cells often adopt specific morphologies that aid in the detection of external stimuli. Merkel cells encode gentle touch stimuli in vertebrate skin and adopt a reproducible shape characterized by spiky, actin-rich microvilli that emanate from the cell surface. The mechanism by which Merkel cells acquire this stereotyped morphology from basal keratinocyte progenitors is unknown. Here, we establish that dendritic Merkel cells (dMCs) express atonal homolog 1a (atoh1a), extend dynamic filopodial processes, and arise in transient waves during zebrafish skin development and regeneration. We find that dMCs share molecular similarities with both basal keratinocytes and Merkel cells, yet display mesenchymal-like behaviors, including local cell motility and proliferation within the epidermis. Furthermore, dMCs can directly adopt the mature, microvilliated Merkel cell morphology through substantial remodeling of the actin cytoskeleton. Loss of Ectodysplasin A signaling alters the morphology of dMCs and Merkel cells within specific skin regions. Our results show that dMCs represent an intermediate state in the Merkel cell maturation program and identify Ectodysplasin A signaling as a key regulator of Merkel cell morphology.

5.
JAMA ; 329(19): 1671-1681, 2023 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-37191703

RESUMO

Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors. Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores. Exposure: Moving to a low-poverty neighborhood. Main Outcomes: Caregiver-reported asthma exacerbations and symptoms. Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations. Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.


Assuntos
Asma , Habitação , Características de Residência , Determinantes Sociais da Saúde , Exacerbação dos Sintomas , Racismo Sistêmico , Criança , Feminino , Humanos , Masculino , Asma/diagnóstico , Asma/economia , Asma/epidemiologia , Asma/psicologia , Estudos de Coortes , Habitação/economia , Pobreza/economia , Pobreza/etnologia , Pobreza/psicologia , Pré-Escolar , Adolescente , Populações Vulneráveis/psicologia , População Urbana , Racismo Sistêmico/economia , Racismo Sistêmico/etnologia , Racismo Sistêmico/psicologia , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia
6.
Hous Policy Debate ; 33(1): 269-289, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36968643

RESUMO

We performed a secondary analysis of the Moving To Opportunity (MTO) social experiment to investigate the impact of different types of housing assistance and neighborhood environments on long-term patterns of health care use for specific conditions and across different types of health care services. MTO participants, who were randomized at baseline, were linked to up to 21 years of all-payer hospital discharge and Medicaid data. Among the 9,170 children at the time of randomization, those who received a voucher had subsequent hospital admissions rates that were 36% lower for asthma and 30% lower for mental health disorders compared to the control group; rates of psychiatric services, outpatient hospital services, clinic services and durable medical equipment were also lower among the voucher groups. Findings for adults were not statistically significant. The results suggest that housing policies that reduce neighborhood poverty exposure as a child are associated with lower subsequent healthcare use for specific clinical conditions and types of services.

7.
Elife ; 122023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36648063

RESUMO

Touch system function requires precise interactions between specialized skin cells and somatosensory axons, as exemplified by the vertebrate mechanosensory Merkel cell-neurite complex. Development and patterning of Merkel cells and associated neurites during skin organogenesis remain poorly understood, partly due to the in utero development of mammalian embryos. Here, we discover Merkel cells in the zebrafish epidermis and identify Atonal homolog 1a (Atoh1a) as a marker of zebrafish Merkel cells. We show that zebrafish Merkel cells derive from basal keratinocytes, express neurosecretory and mechanosensory machinery, extend actin-rich microvilli, and complex with somatosensory axons, all hallmarks of mammalian Merkel cells. Merkel cells populate all major adult skin compartments, with region-specific densities and distribution patterns. In vivo photoconversion reveals that Merkel cells undergo steady loss and replenishment during skin homeostasis. Merkel cells develop concomitant with dermal appendages along the trunk and loss of Ectodysplasin signaling, which prevents dermal appendage formation, reduces Merkel cell density by affecting cell differentiation. By contrast, altering dermal appendage morphology changes the distribution, but not density, of Merkel cells. Overall, our studies provide insights into touch system maturation during skin organogenesis and establish zebrafish as an experimentally accessible in vivo model for the study of Merkel cell biology.


Assuntos
Células de Merkel , Peixe-Zebra , Animais , Pele , Epiderme , Queratinócitos , Mamíferos
8.
J Urban Health ; 100(2): 389-397, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36689141

RESUMO

Community land trusts (CLTs) provide long-term affordable housing and offer a range of mechanisms that may improve the health and well-being of low-income households. We sought to elucidate these mechanisms through thematic analysis of semi-structured interviews with a diverse sample of CLT staff and residents across the USA. Stakeholders most frequently identified improvements in mental health that come through increased housing stability and affordability. Other factors-including the ways that CLTs promote wealth generation, improvements in housing quality and neighborhood amenities, services and partnerships with healthcare organizations, and democratic governance-were raised by respondents though less frequently tied to health benefits. CLTs represent a promising area for future research on housing's impact on health.


Assuntos
Habitação , Características de Residência , Humanos , Pobreza , Saúde Mental
9.
Prev Med ; 164: 107292, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36228876

RESUMO

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = -0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, -0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, -0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term.


Assuntos
Serviço Hospitalar de Emergência , Habitação , Criança , Adulto , Humanos , Baltimore , Crime
10.
JAMA Intern Med ; 182(11): 1229-1231, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36215046

RESUMO

This survey study assessed physicians' attitudes about the use of life expectancy as a guide in the decision to stop cancer screening in older adults.


Assuntos
Neoplasias , Médicos , Humanos , Idoso , Detecção Precoce de Câncer/métodos , Expectativa de Vida , Programas de Rastreamento/métodos , Atitude , Neoplasias/prevenção & controle
11.
Health Aff (Millwood) ; 41(6): 883-892, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35666971

RESUMO

Although stable, high-quality housing improves children's physical and social-emotional health, little is known about the health of children living in buildings financed by the federal government's primary tool for constructing and renovating affordable rental housing: the Low-Income Housing Tax Credit (LIHTC). Using data from the National Health Interview Survey (2004-16) linked to data on LIHTC properties (1987-2016), this study provides national estimates for health care access and health status among low-income children living in LIHTC properties compared with low-income children not living in LIHTC properties. Children living in LIHTC properties were more likely to have had a well-child visit in the past twelve months and a dental visit in the past six months. These children also had a higher likelihood of chronic school absenteeism and current asthma. These exploratory findings suggest that policy makers should consider features of LIHTC policy as possible mechanisms to improve low-income children's health care access and health status while addressing the shortage of affordable housing in the US.


Assuntos
Habitação , Pobreza , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Humanos , Impostos
12.
Artigo em Inglês | MEDLINE | ID: mdl-35701105

RESUMO

Housing may be at once the most powerful and underused tool at our disposal to improve population health. Using examples from the USA, we argue that current levels of housing insecurity are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class. Solutions to housing insecurity must, therefore, be structural. The COVID-19 pandemic has opened a window of opportunity for these structural housing policy reforms. Through justice- and action-oriented research, health researchers can inform the development and implementation of housing policies that advance health equity. We offer a series of recommendations to better position our field to achieve this goal.

13.
PLoS One ; 17(3): e0265188, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35290417

RESUMO

BACKGROUND: Despite no proven benefit in clinical outcomes, perioperative magnetic resonance imaging (MRI) was rapidly adopted into breast cancer care in the 2000's, offering a prime opportunity for assessing factors influencing overutilization of unproven technology. OBJECTIVES: To examine variation among physician patient-sharing networks in their trajectory of adopting perioperative MRI for breast cancer surgery and compare the characteristics of patients, providers, and mastectomy use in physician networks that had different adoption trajectories. METHODS AND FINDINGS: Using the Surveillance, Epidemiology, and End Results-Medicare database in 2004-2009, we identified 147 physician patient-sharing networks (caring for 26,886 patients with stage I-III breast cancer). After adjusting for patient clinical risk factors, we calculated risk-adjusted rate of perioperative MRI use for each physician network in 2004-2005, 2006-2007, and 2008-2009, respectively. Based on the risk-adjusted rate, we identified three distinct trajectories of adopting perioperative MRI among physician networks: 1) low adoption (risk-adjusted rate of perioperative MRI increased from 2.8% in 2004-2005 to 14.8% in 2008-2009), 2) medium adoption (8.8% to 45.1%), and 3) high adoption (33.0% to 71.7%). Physician networks in the higher adoption trajectory tended to have a larger proportion of cancer specialists, more patients with high income, and fewer patients who were Black. After adjusting for patients' clinical risk factors, the proportion of patients undergoing mastectomy decreased from 41.1% in 2004-2005 to 38.5% in 2008-2009 among those in physician networks with low MRI adoption, but increased from 27.0% to 31.4% among those in physician networks with high MRI adoption (p = 0.03 for the interaction term between trajectory group and time). CONCLUSIONS: Physician patient-sharing networks varied in their trajectory of adopting perioperative MRI. These distinct trajectories were associated with the composition of patients and providers in the networks, and had important implications for patterns of mastectomy use.


Assuntos
Neoplasias da Mama , Médicos , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Mastectomia , Medicare , Padrões de Prática Médica , Estados Unidos
15.
J Allergy Clin Immunol Pract ; 10(4): 1005-1012.e1, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34626856

RESUMO

BACKGROUND: Neighborhood and caregiver characteristics have each been linked to children's asthma outcomes, but less is known about how caregiver psychosocial functioning may explain the link between neighborhood characteristics and asthma outcomes. OBJECTIVE: To examine associations between neighborhood safety, caregiver stress and depressive symptoms, and children's asthma outcomes, and to evaluate whether caregiver stress and depressive symptoms mediate the relationship between neighborhood safety and asthma outcomes. METHODS: We analyzed baseline data from a prospective cohort study of the effects of a housing mobility program on children's asthma-related outcomes. Age- and sex-adjusted models evaluated associations of neighborhood safety, and caregiver stress and depressive symptoms, with children's asthma symptoms and exacerbations. RESULTS: Participants were 140 low-income children with persistent asthma (98% Black participants; 53% males; mean age, 9.0 years) with an average of 7.1 ± 5.3 maximum symptom days per 2 weeks. Lower neighborhood safety, and higher caregiver stress and depressive symptoms, were associated with higher asthma symptoms, but not exacerbations, in adjusted models (eg, for neighborhood safety, maximum symptom days: odds ratio, 1.41; 95% CI, 1.07-1.88; for caregiver stress, maximum symptom days: odds ratio, 1.08; 95% CI, 1.01-1.15; for depressive symptoms, maximum symptom days: odds ratio, 1.05; 95% CI, 1.00-1.11). Exploratory analyses suggested that caregiver stress partially mediated associations between neighborhood safety and asthma symptoms for children in unsafe neighborhoods. CONCLUSIONS: Neighborhood safety was associated with children's asthma symptoms independent from caregiver stress and depressive symptoms, although for children in unsafe neighborhoods, caregiver stress may partially mediate this association. Findings suggest the importance of targeting multiple systems to improve children's asthma outcomes.


Assuntos
Asma , Cuidadores , Asma/diagnóstico , Criança , Feminino , Humanos , Masculino , Pobreza , Estudos Prospectivos , Características de Residência
18.
Front Cell Infect Microbiol ; 11: 702676, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34490142

RESUMO

Clinical manifestations of leishmaniasis range from self-healing, cutaneous lesions to fatal infections of the viscera. With no preventative Leishmania vaccine available, the frontline option against leishmaniasis is chemotherapy. Unfortunately, currently available anti-Leishmania drugs face several obstacles, including toxicity that limits dosing and emergent drug resistant strains in endemic regions. It is, therefore, imperative that more effective drug formulations with decreased toxicity profiles are developed. Previous studies had shown that 2-(((5-Methyl-2-thienyl)methylene)amino)-N-phenylbenzamide (also called Retro-2) has efficacy against Leishmania infections. Structure-activity relationship (SAR) analogs of Retro-2, using the dihydroquinazolinone (DHQZ) base structure, were subsequently described that are more efficacious than Retro-2. However, considering the hydrophobic nature of these compounds that limits their solubility and uptake, the current studies were initiated to determine whether the solubility of Retro-2 and its SAR analogs could be enhanced through encapsulation in amphiphilic polymer nanoparticles. We evaluated encapsulation of these compounds in the amphiphilic, thermoresponsive oligo(ethylene glycol) methacrylate-co-pentafluorostyrene (PFG30) copolymer that forms nanoparticle aggregates upon heating past temperatures of 30°C. The hydrophobic tracer, coumarin 6, was used to evaluate uptake of a hydrophobic molecule into PFG30 aggregates. Mass spectrometry analysis showed considerably greater delivery of encapsulated DHQZ analogs into infected cells and more rapid shrinkage of L. amazonensis communal vacuoles. Moreover, encapsulation in PFG30 augmented the efficacy of Retro-2 and its SAR analogs to clear both L. amazonensis and L. donovani infections. These studies demonstrate that encapsulation of compounds in PFG30 is a viable approach to dramatically increase bioavailability and efficacy of anti-Leishmania compounds.


Assuntos
Leishmania , Leishmaniose , Animais , Disponibilidade Biológica , Leishmaniose/tratamento farmacológico , Camundongos , Camundongos Endogâmicos BALB C , Polímeros
19.
Am J Epidemiol ; 190(12): 2503-2510, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34309643

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic and associated economic crisis have placed millions of US households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals' ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in US states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 US states that instituted eviction moratoriums, followed from March 13 to September 3, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and expiration was associated with a doubling of COVID-19 incidence (incidence rate ratio = 2.1; 95% confidence interval (CI): 1.1, 3.9) and a 5-fold increase in COVID-19 mortality (mortality rate ratio = 5.4; CI: 3.1, 9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI: 365,200, 502,200) and 10,700 excess deaths (CI: 8,900, 12,500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.


Assuntos
COVID-19/prevenção & controle , Habitação , Mortalidade/tendências , Pandemias/prevenção & controle , Saúde Pública/normas , Política Pública , COVID-19/epidemiologia , Habitação/legislação & jurisprudência , Humanos , Incidência , Pobreza , SARS-CoV-2 , Estados Unidos/epidemiologia
20.
Am J Prev Med ; 61(6): 919-922, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34272137

RESUMO

INTRODUCTION: The COVID-19 pandemic has exacerbated longstanding housing precarity. This study measures the public support for policies designed to increase housing stability and gauges whether support levels are associated with views about the role of evictions in COVID-19 transmission and the existence of racial inequities in the housing market. METHODS: A cross-sectional survey with a representative sample of U.S. adults in November 2020 assessed support for 4 housing policies. Logistic regression models estimated the adjusted levels of support for each policy, with separate models testing the association with whether or not a respondent recognized the role of evictions in increased COVID-19 transmission or acknowledged racial inequities in the housing market. RESULTS: Most U.S. adults supported policies aimed to increase housing stability during the COVID-19 pandemic, including extending moratoriums on evictions (63%) and foreclosures (67%) and increasing emergency rental assistance (63%). In total, 54% supported increased government spending on housing vouchers. Adults who agreed that averting eviction would slow COVID-19 transmission had higher support for housing stability policies, as did those who agreed that it was easier for White families to find affordable, high-quality housing than Black families. CONCLUSIONS: Support for housing stability policies was strong among U.S. adults, particularly among those who agreed that preventing evictions slowed COVID-19 transmission and among those who acknowledged racial inequities in the housing market. Raising public awareness of the connections among unstable housing, infectious disease transmission, and racial inequity could broaden the support for policies to keep people in their homes through the pandemic.


Assuntos
COVID-19 , Pandemias , Adulto , Estudos Transversais , Habitação , Humanos , Pandemias/prevenção & controle , Políticas , SARS-CoV-2
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