Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, ...have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods.
This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews.
The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden.
The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.
Amidst the COVID-19 pandemic, interest in using telehealth to increase access to health and mental health care has grown, and school transitions to remote learning have heightened awareness of ...broadband inequities. The purpose of this study was to examine access and barriers to technology and broadband Internet service ("broadband") among rural and urban youth. Washington State public school districts were surveyed about youth's access to technology (ie, a device adequate for online learning) and broadband availability in spring 2020. Availability of and barriers to broadband (ie, geography, affordability, and smartphone-only connectivity) were assessed across rurality. Among responding districts, 64.2% (n = 172) were rural and 35.8% (n = 96) were urban. Rural districts reported significantly fewer students with access to an Internet-enabled device adequate for online learning (80.0% vs 90.1%, P < .01). Access to reliable broadband varied significantly across geography (P < .01). Compared with their urban peers, rural youth face more challenges in accessing the technology and connectivity needed for remote learning and telehealth. Given that inadequate broadband infrastructure is a critical barrier to the provision of telehealth services and remote learning in rural areas, efforts to improve policies and advance technology must consider geographical disparities to ensure health and education equity.
Introduction
Neighborhoods are often overlooked as a determinant of health. Among recent research, the focus on “place‐based effects,” due to prolonged residential environmental exposure, has been of ...particular interest. These studies' purpose is to identify and examine how a healthy neighborhood is intentionally created to describe a transferable process‐driven theory.
Method
A classic grounded theory approach was used in these studies. Data sources include individual in‐depth interviews, historical documents, and a member‐checking focus group, collected over 3‐years.
Results
Analysis generated the Four Stages of Neighborhood Trust Model, which is nested within the context of perceived neighborhood safety. The theory outlines a social process of four stages of neighborhood trust: (a) rules‐based agreements, (b) shared values, (c) cooperation, and (d) neighborhood belonging.
Conclusions
We present the development of a process‐driven theory that may be useful for public health nurses as they engage neighborhoods in health promotion activities. The stage of trust development will aid the nurse in identifying what is needed to move to the next stage in a healthy neighborhood process.
This study sought to estimate total health care costs for mild, moderate, and severe pediatric traumatic brain injury (TBI) and to compare individual- and population-level costs across levels of TBI ...severity.
Using 2007 to 2010 MarketScan Commercial Claims and Encounters data, we estimated total quarterly health care costs 1 year after TBI among enrollees (aged < 18 years). We compared costs across levels of TBI severity using generalized linear models.
Mild TBI accounted for 96.6% of the 319 103 enrollees with TBI; moderate and severe TBI accounted for 1.7% and 1.6%, respectively. Adjusted individual health care costs for moderate and severe TBI were significantly higher than mild TBI in the year after injury (P < .01). At the population level, moderate and severe TBI costs were 88% and 75% less than mild TBI, respectively.
Individually, moderate and severe TBI initially generated costs that were markedly higher than those of mild TBI. At the population level, costs following mild TBI far exceeded those of more severe cases, a result of the extremely high population burden of mild TBI.
Traumatic brain injury (TBI) disproportionately affects marginalized populations social workers serve. Current practices and training needs of social workers who serve clients with TBI are not ...well-understood. An online survey was administered to all licensed social workers in Washington (N=5,032) to assess the following for clients with TBI: interactions, challenges, knowledge, beliefs, confidence, and training recommendations. Analyses involved descriptive statistics, logistic regression, and content analysis of open-ended responses. Respondents (n=834, 16.6% response rate) endorsed serving clients with TBI, heterogeneous confidence and practices, limited training, and high learning needs. New training approaches are needed to prepare social workers to better provide services to these clients. Training on diagnosis, understanding comorbidities, treating behavioral symptoms, disparities, and advocacy tools are recommended.
Medical interpreters play a vital role in fostering understanding and ensuring safety and transparency in healthcare for patients with non-English language preference. Limited research describes ...work-related experiences of medical interpreters. The purpose of this research was to explore perceptions of occupational health and safety among medical interpreters. A structured, online survey was administered to all certified medical interpreters in Hawaii, New York, New Jersey, California, and Texas. Participants described occupational experiences as an interpreter via an open-ended question. Responses were coded using qualitative thematic analysis. Response text was reviewed, a codebook of descriptive themes developed, and data thematically coded and summarized. Of 981 potential participants, 199 responded (20.3% response rate). Four main themes were identified: Professionalism and Role, Work-Related Challenges, Approaches to Mitigate Vicarious Trauma, and The Rewarding Nature of the Job. Respondents described compassion fatigue, vicarious trauma, intentional emotional distancing from clients, and loneliness. Respondents identified needs for workplace support to ensure professionalism and safeguard interpreter safety. Medical interpreters appreciate their work, yet face challenges, including compassion fatigue and vicarious trauma. Employers and healthcare institutions should support the occupational and emotional needs of medical interpreters as a vital member of the healthcare team.
Modernization of SNAP mirrors efforts spurred on by the pandemic, including national vendors’ investments in online grocery delivery infrastructure and expanded delivery services (2). Because of the ...rapid responses on behalf of private and governmental entities, evaluation of access to delivery services and beneficiary awareness of new online delivery services availability was needed. Census tract–level SNAP household data were obtained from the 2015 American Community Survey (ACS), accessed from the US Department of Agriculture Food Environment Atlas website (8). According to Washington State Economic Services Administration reporting, the number of people on food assistance increased by 16% from September 2019 to July 2020, as reported through management accountability and performance statistics (Economic Services Administration, Management Accountability and Performance Statistics ESA/EMAPS, the state SNAP client eligibility system). Accessed April 27, 2022. https://www.census.gov/data/datasets/time-series/demo/popest/2010s-total-housing-units.html US Department of Agriculture Food Atlas. 2015 Food Access Research Atlas published April 27, 2021. https://www.ers.usda.gov/data-products/food-access-research-atlas/download-the-data/.
Background
Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to ...describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs.
Methods
Annual injury claims data covered under Washington State workers’ compensation (WC) fund were analyzed over a 13-year period (2007–2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications.
Results
Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio IRR: 0.99, 95% confidence interval CI = 0.94, 1.05). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts.
Discussion
To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.
PDF
