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PubMed2005

Playground safety and access in Boston neighborhoods.

BACKGROUND: Youth physical activity is partly influenced by access to playgrounds and recreational opportunities. Playgrounds in disadvantaged areas may be less safe. METHODS: Investigators assessed safety at 154 playgrounds in Boston between July 2000 and July 2001. Playgrounds were geocoded and safety scores assigned to census block groups (CBGs). For each of Boston's 591 CBGs, investigators calculated the total number youth and proportions of black residents, adults without a high school degree, and youth living in poverty. Investigators assigned each CBG a safety score, and calculated distance from the CBG centroid to the nearest playground and nearest "safe" playground (top safety quartile). Statistical analyses were completed using SAS PROC GENMOD by October 2002. RESULTS: In bivariate analysis, playground safety was inversely associated with total CBG youth population (p =0.001) and proportions of black residents (p <0.001), youth in poverty (p =0.003) and residents with no high school degree (p <0.002). The proportion of black residents in the CBG was inversely associated with safety (p =0.013), independent of CBG educational attainment and numbers of youth. The average distance was 417 meters to the nearest playground and 1133 meters to the nearest "safe" playground. Distance to the nearest playground was inversely associated with the proportion of residents with no high school degree (p <0.0001) after controlling for numbers of youth and proportion of black residents. CBGs with more youth had greater distances to the safest playgrounds (p =0.04). CONCLUSIONS: In Boston, playground safety and access to playgrounds varied according to indicators of small-area socioeconomic and racial/ethnic composition.

Adolescent↗

PubMed2006

Results from the multicenter Boston Type 1 Keratoprosthesis Study.

PURPOSE: To report indications, practices, complications, and outcomes from the first multicenter study on the Boston Type 1 keratoprosthesis. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: We analyzed 141 Boston Type 1 keratoprosthesis surgical procedures, from 17 surgical sites, done from January 2003 through September 2005 in 136 eyes of 133 patients. METHODS: Forms reporting 70 preoperative, intraoperative, and postoperative parameters were collected and analyzed at a central data collection site (Cornea Consultants of Albany, Albany Medical College, Albany, New York). MAIN OUTCOME MEASURES: Visual acuity (VA) and keratoprosthesis survival. RESULTS: Common preoperative diagnoses were graft rejection, in 73 eyes (54%) (average prior grafts, 2.24); chemical injury (20 eyes [15%]); bullous keratopathy (19 eyes [14%]); and herpes simplex virus keratitis (9 eyes [7%]). Additionally, 82 eyes (60%) had preoperative glaucoma. Preoperative best-corrected VA ranged from 20/100 to light perception, and was <20/200 in 96% of eyes. At an average follow-up of 8.5 months (range, 0.03-24; standard deviation, 6.1; median, 12), postoperative vision improved to > or =20/200 in 57%. Among eyes at least 1 year after the operation (62 eyes), vision was > or =20/200 in 56% of eyes and > or =20/40 in 23%. At an average follow-up of 8.5 months, graft retention was 95%. Severe visual loss or failure to improve from keratoprosthesis was usually secondary to comorbidities such as advanced glaucoma, macular degeneration, or retinal detachment. CONCLUSIONS: The Boston Type 1 keratoprosthesis seems, based on early follow-up, to be a viable option after multiple failed corneal grafts or in some situations of a poor prognosis for primary penetrating keratoplasty.

Cornea↗

PubMed1998

Bicycle safety behavior in Paris and Boston.

Concerns about bicycle-related deaths and injuries have led to extensive injury prevention efforts in the United States, yet these concerns are not universal. For instance, in France attitudes toward bicycle safety are quite different. To understand more about variation in urban bicycle safety behavior, we observed passing bicyclists in Paris and Boston. In addition to helmet use, we looked at use of lights at night. Among 5,808 passing bicyclists, there were large differences in helmet and light use: only 2.2% of Paris bicyclists wore helmets compared to 31.5% in Boston. In contrast, 46.8% of nighttime Paris bicyclists had working head or tail lights compared to only 14.8% in Boston. These large and seemingly contradictory percentages are the result of different laws and public health priorities, types of bicycle riding, and perceived risks. Suggestions for further research and practical ways to improve U.S. bicycle safety behavior are discussed.

Accidents, Traffic↗

PubMed1998

Boston HAPPENS Program: a model of health care for HIV-positive, homeless, and at-risk youth. Human immunodeficiency virus (HIV) Adolescent Provider and Peer Education Network for Services.

The Boston HAPPENS [Human immunodeficiency virus (HIV) Adolescent Provider and Peer Education Network for Services] Program is a project supported by Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration, which provides a network of care for homeless, at-risk, and HIV-positive youth (ages 12-24 years), involving eight agencies. The program has provided services to 1301 youth, including 46 who are HIV-positive. Boston HAPPENS provides a citywide network of culturally and developmentally appropriate adolescent-specific care, including: (a) outreach and risk-reduction counseling through professional and adult-supervised peer staff, (b) access to appropriate HIV counseling and testing support services, (c) life management counseling (mental health intake and visits as part of health care and at times of crisis), (d) health status screening and services needs assessment, (e) client-focused, comprehensive, multidisciplinary care and support, (f) follow-up and outreach to ensure continuing care, and (g) integrated care and communication among providers in the metropolitan Boston area. This innovative network of youth-specific care offers a continuum from street outreach to referral and HIV specialty care that crosses institutional barriers.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Importance of black carbon to sorption of native PAHs, PCBs, and PCDDs in Boston and New York harbor sediments.

The solid-water distribution ratios (Kd values) of "native" PAHs, PCBs, and PCDDs in Boston and New York Harbor sediments were determined using small passive polyethylene samplers incubated for extended times in sediment-water suspensions. Observed solid-water distribution coefficients exceeded the corresponding f(oc)Koc products by 1-2 orders of magnitude. It was hypothesized that black carbon (fBC), measured in the Boston harbor sediment at about 0.6% and in the New York harbor sediment at about 0.3%, was responsible for the additional sorption. The overall partitioning was then attributed to absorption into the organic carbon and to adsorption onto the black carbon via Kd = f(oc)Koc + f(BC)K(BC)C(w)n-1 with Cw in microg/L. Predictions based on published Koc, K(BC), and n values for phenanthrene and pyrene showed good agreement with observed Kd,obs values. Thus, assuming this dual sorption model applied to the other native PAHs, PCBs, and PCDDs, black carbon-normalized adsorption coefficients, K(BC)S, were deduced forthese contaminants. Log K(BC) values correlated with sorbate hydrophobicity for PAHs in Boston harbor (log K(BC) approximately 0.83 log gamma w(sat) - 1.6; R2 = 0.99, N= 8). The inferred sorption to the sedimentary BC phase dominated the solid-water partitioning of these compound classes, and its inclusion in these sediments is necessary to make accurate estimates of the mobility and bioavailability of PAHs, PCBs, and PCDDs.

Adsorption↗

PubMedDate not supplied

Smoking in Boston bars before and after a 100% smoke-free regulation: an assessment of early compliance.

The objective of this study was to assess compliance with Boston's 100% smoke-free bar regulation within the first 3 months of implementation. An observational survey was conducted of a random sample of 102 bars in Boston before and after the smoking ban went into effect. Forty bars were observed both pre- and postban, serving as a true comparison group; 62 additional bars were observed postban only. From preban to postban, highly significant decreases were found in the mean proportion of patrons smoking inside (22.5% to 0.19%, p < 0.0001), in the proportion of bars with smoking patrons (100% to 2.5%, p < 0.0001), and in the average number of ashtrays present in each bar (24 to 0, p < 0.0001). A highly significant increase was found in the average number of "no smoking" signs posted in each bar (0 to 3.3, p < 0.0001). Within the 3 months immediately following the 100% smoke-free bar regulation in Boston, bars were highly compliant with the ban, including not allowing patrons and employees to smoke, removing ashtrays, and posting signs indicating that smoking is prohibited. Therefore, with proper time and preparation, public health practitioners can change social norms before a ban goes into effect and can implement smoke-free policies smoothly and with immediate compliance.

Boston↗

PubMedDate not supplied

A public health approach to reducing morbidity and mortality among homeless people in Boston.

Urban homeless populations suffer disproportionately high rates of premature death. In response to a wave of highly publicized deaths on the streets of Boston during the winter of 1998-1999, the Massachusetts Department of Public Health (MDPH) convened a task force to investigate these deaths and implement an integrated response to this public health crisis. Comprised of a broad coalition of public and private agencies as well as homeless persons and advocacy groups, the MDPH Task Force reviewed the circumstances surrounding the 13 deaths, monitored subsequent deaths among homeless persons in Boston, and implemented a comprehensive plan to address critical needs and prevent further deaths. Contrary to the task force's initial assumption, the 13 decedents had multiple recent contacts with the medical, psychiatric, and substance abuse systems. In response to this finding, the MDPH Task Force sought to improve continuity of care and prevent future deaths among Boston's street population. Coordination of needed services was achieved through the creation of new, and often unconventional, partnerships. This case study exemplifies a public health practice response to the vexing health care challenges confronting homeless people who must struggle to survive on the streets and in shelters.

Boston↗

PubMed1985

Occupation and bladder cancer in Boston, USA, Manchester, UK, and Nagoya, Japan.

Relations between occupational history and the development of cancer of the lower urinary tract ("bladder cancer") were evaluated in Boston, Massachusetts, USA, Manchester, UK, and Nagoya, Japan. Population-based series of incident cases and controls were identified and interviewed in each area. The present analysis was limited to men and was based on 430 cases and 397 controls in Boston, 399 cases and 493 controls in Manchester, and 226 cases and 443 controls in Nagoya. In Boston, elevated risk of bladder cancer was associated with employment related to dyes (relative risk = 2 X 1; 90% confidence interval, 0 X 9-5 X 1), leather (1 X 7; 1 X 1-2 X 6), paint (1 X 5; 0 X 9-2 X 4), or organic chemicals (1 X 6; 1 X 1-2 X 5). In Manchester, elevated risk was associated with 0 X 9-3 X 6). No clear association was observed between occupation and risk in Nagoya. Elevations in risk related to occupation generally were stronger in men under 65 years of age compared to older men. Differences from place to place in associations between occupation and risk may be the result of differences in the exposures to hazardous agents that jobs with the same title involve.

Adult↗

PubMed1996

Rifampin preventive therapy for tuberculosis in Boston's homeless.

An epidemic of isoniazid (INH)- and streptomycin (SM)-resistant tuberculosis began among Boston's homeless population in 1984. Individuals with skin test conversions who agreed to preventive therapy received either INH, rifampin, or a combination of INH and rifampin. A total of 204 individuals with documented tuberculin skin test conversions who did not have active tuberculosis at the time of the clinical evaluation for their positive skin test were eligible for preventive therapy. Data on type and length of preventive therapy were obtained from the Tuberculosis Clinic and the Boston Tuberculosis Registry records at Boston City Hospital. The individuals were followed for development of active tuberculosis. Six of 71 (8.6%) individuals who received no therapy, 3 of 38 (7.9%) in the INH group, and none in the rifampin or rifampin plus INH groups (49 and 37 persons, respectively) developed active tuberculosis. Patients in the rifampin group were significantly less likely to develop tuberculosis than patients in the no therapy group (p = 0.04; odds ratio [OR] = 0.00, 95% confidence interval [CI] = 0.00-0.91). Treatment with any rifampin-containing preventive therapy (rifampin or rifampin plus INH) was effective (p < 0.01 ) in preventing development of active disease. The three INH failures were with organisms that were resistant to INH.

Adult↗

PubMed2006

Self-reported safety belt use among emergency department patients in Boston, Massachusetts.

BACKGROUND: Safety belt use is 80% nationally, yet only 63% in Massachusetts. Safety belt use among potentially at-risk groups in Boston is unknown. We sought to assess the prevalence and correlates of belt non-use among emergency department (ED) patients in Boston. METHODS: A cross-sectional survey with systematic sampling was conducted on non-urgent ED patients age > or = 18. A closed-ended survey was administered by interview. Safety belt use was defined via two methods: a single-item and a multiple-item measure of safety belt use. Each was scored using a 5-point frequency scale. Responses were used to categorize safety belt use as 'always' or less than 'always'. Outcome for multivariate logistic regression analysis was safety belt use less than 'always'. RESULTS: Of 478 patients approached, 381 (80%) participated. Participants were 48% female, 48% African-American, 40% White, median age 39. Among participants, 250 (66%) had been in a car crash; 234 (61%) had a valid driver's license, and 42 (11%) had been ticketed for belt non-use. Using two different survey measures, a single-item and a multiple-item measure, safety belt use 'always' was 51% and 36% respectively. According to separate regression models, factors associated with belt non-use included male gender, alcohol consumption >5 drinks in one episode, riding with others that drink and drive, ever receiving a citation for belt non-use, believing that safety belt use is 'uncomfortable', and that 'I just forget', while 'It's my usual habit' was protective. CONCLUSION: ED patients at an urban hospital in Boston have considerably lower self-reported safety belt use than state or national estimates. An ED-based intervention to increase safety belt use among this hard-to-reach population warrants consideration.

Adolescent↗

PubMed1995

Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston.

Hospitalization rates for asthma in New York City are highest in poor urban neighborhoods, although the reasons for this are unknown. We performed a small area analysis of asthma hospitalization rates in Boston, to determine whether this pattern of asthma hospitalization also obtained in a medium-sized city and to identify characteristics of neighborhoods with high hospitalization rates, including the relative use of inhaled anti-inflammatory medication. Zip codes were used to define 22 small areas within Boston. The number of asthma hospitalizations for residents of each area in 1992 was obtained from the Codman Research Group. Population and demographic characteristics of each area were obtained from the 1990 US Census. Estimates of inhaled asthma medications (beta-agonists, steroids, and cromolyn) dispensed in each area in 1992 were obtained from IMS America. Asthma hospitalization rates for each of the six areas with the highest rates (5.3 to 9.8 per 1,000 persons) were significantly greater than the city-wide average of 4.2 hospitalizations per thousand persons (p < 0.001 for each comparison). Asthma hospitalization rate was positively correlated with poverty rate and with the proportion of nonwhite residents and inversely correlated with income and educational attainment. Asthma hospitalization rate was inversely correlated with the ratio of inhaled anti-inflammatory to beta-agonist medication use (r = -0.55, p = 0.008). We conclude that asthma hospitalization rates in Boston are highest in poor inner city neighborhoods, and that these high rates affect both genders and all age groups. Underuse of inhaled anti-inflammatory medication may be one of the many factors that contributes to this excess hospitalization.

Adolescent↗

PubMed2004

Intracerebral abscess in children: historical trends at Children's Hospital Boston.

OBJECTIVES: A previous study performed at Children's Hospital Boston describing the natural history of intracerebral abscess between 1945 and 1980 demonstrated a decline in mortality after 1970. This current study examines the occurrence of intracerebral abscess at Children's Hospital Boston between 1981 and 2000, inclusive, and compares the results with the previous study. Our objectives were to determine whether there had been a change in the predisposing factors, whether there were changes in the microbiology of intracerebral abscesses, and whether mortality rate had continued to decline. METHODS: To ensure that all occurrences of intracerebral abscess treated at Children's Hospital Boston between 1981 and 2000 were identified, we searched 4 separately maintained databases for the keywords "brain" or "abscess" or the International Classification of Diseases, Ninth Revision code 324.x. This search yielded the names of 386 patients. Of these 386 patients, a solitary intracerebral abscess or multiple noncontiguous intracerebral abscesses could be confirmed in 54 patients on the basis of cranial imaging (computed tomography or magnetic resonance imaging) or autopsy reports. The complete retrospective review of the medical records of these 54 patients constitutes the basis for this study. RESULTS: Congenital heart disease was the most common predisposing factor during both eras. Compared with the previous era, important historical trends identified include a reduction in the number of abscesses that occurred in the settings of sinus or otitic infection (11% during 1981-2000 vs 26% during 1945-1980), an increase in number of intracranial abscesses in infants (18% vs 7%) and in the setting of immunosuppression (16% vs 1%), an increase in the number of children who were treated with antibiotics alone (22% vs 1%), a stable overall mortality rate (24% vs 27%), and the identification of Citrobacter and fungus as causes of intracranial abscess not observed during the previous era of 1945-1980. Citrobacter was observed only during the neonatal period. Fungi were the causative organisms predominantly in the setting of immunosuppression. CONCLUSIONS: Intracerebral abscess in children continues to be associated with high rates of neurologic impairment and death. Because earlier detection may reduce morbidity and mortality, intracranial abscess should be considered when evaluating children with new-onset neurologic signs or symptoms, especially in children who have acute immunosuppression and disseminated fungal disease or fungemia.

Adolescent↗

PubMed2004

Old and sleeping rough: elderly homeless persons on the streets of Boston.

Older individuals living on the streets of our urban cities are a unique sub-group of the homeless population. No studies have been published about these elderly "rough sleepers" who face daunting obstacles to health care while facing a litany of health risks on the streets that are magnified by the physical and mental limitations of advancing years. To improve our understanding of this itinerant group, the Street Team of the Boston Health Care for the Homeless Program prospectively followed 30 individuals aged 60 or older living on Boston's streets for the four-year period from 2000 through 2003. This cohort included 8 (27%) women and 22 (73%) men ranging in age from 60 to 82 years. The average age was 67 years old At the end of the four year study period, 9 (30%) had died and 6 (20%) were in nursing homes. Despite intense efforts, only 5 (17%) found housing. Seven (23%) were still on Boston's streets after four years, and one was lost to follow-up. We conclude that elderly rough sleepers have high morbidity and mortality and pose significant challenges to programs seeking to provide housing and supportive health care services for this vulnerable sub-group of elderly homeless persons. New and creative housing options are needed, and the delicate issues of competency and guardianship must be addressed.

Age Factors↗

PubMed1989

Multiple program participation: comparison of nutrition and food assistance program benefits with food costs in Boston, Massachusetts.

The values of government cash and food assistance benefits are compared to estimated food costs in Boston for households whose sole source of income is Aid to Families with Dependent Children (AFDC) and who have housing in the private sector. Methods developed by the General Accounting Office (GAO) in 1978 are replicated. GAO found that the value of combined benefits can exceed the cost of the United States Department of Agriculture's Thrifty Food Plan. Key assumptions underlying GAO's methodology are challenged, and an alternate method is applied. The new results contradict GAO's conclusions and suggest that Boston food costs exceed the combined value of benefits that AFDC households may receive, although participation in multiple food assistance programs is more beneficial than receipt of benefits from single programs. The authors conclude that food stamps and AFDC benefits indexed to actual costs of living are needed to meet the food needs of low-income families in Boston.

Adolescent↗

PubMed1997

The Boston AIDS Survival Score (BASS): a multidimensional AIDS severity instrument.

OBJECTIVES: This study developed a new acquired immunodeficiency syndrome (AIDS) severity system by including diagnostic, physiological, functional, and sociodemographic factors predictive of survival. METHODS: Three-hundred five persons with AIDS in Boston were interviewed; their medical records were reviewed and vital status ascertained. RESULTS: Overall median (+/- SD) survival for the cohort from the first interview until death was 560 +/- 14.4 days. The best model for predicting survival, the Boston AIDS Survival Score, included the Justice score (stage 2 relative hazard [RH] = 1.25, 95% confidence interval [CI] = 0.80, 1.96; stage 3 RH = 1.76, 95% CI = 1.15, 2.70), a newly developed opportunistic disease score (Boston Opportunistic Disease Survival Score; stage 2 RH = 1.35, 95% CI = 0.90, 2.02; stage 3 RH = 2.10, 95% CI = 1.38, 3.18), and measures of activities of daily living (any intermediate limitations, RH = 1.84, 95% CI = 1.05, 3.21; any basic limitations, RH = 2.60, 95% CI = 1.44, 4.69). This model had substantially greater predictive power (R2 = .17, C statistic = .68) than the Justice score alone (R2 = .09, C statistic = .61). CONCLUSIONS: Incorporating data on clinically important events and functional status into a physiologically based system can improve the prediction of survival with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Fear of crime among elderly Jews in Boston and London.

This article deals with the impact of fear of crime on the daily behavior of elderly Jews in two racially mixed, deteriorating neighborhoods, one in Boston and the other in London. Although people in both places expressed their fears in a similar language, their behavior was different: the Boston elderly retreated behind locked doors, while the London elderly continued their daily routine almost uninterrupted. Three factors are discussed: crime rate in each neighborhood, the different ecological pattern of both cities, and the impact of racial change. Above all, it seems, the different effect of fear of crime on behavior can be explained by the way the elderly regarded themselves vis-a-vis the community. The London Jews still felt themselves to be a part of their community while the Boston Jews felt alienated from it.

Aged↗

PubMed2005

Boston: a city where everybody (or nobody) knows your name.

Boston is a city where patriots and health care pioneers helped shaped history--and everybody knows their names. Boston is also home to many unnamed citizens such as homeless children, uninsured families, HIV-infected African Americans, adolescents with alcohol and/or drug problems, and isolated elders. Globally, there are also major health disparities and resource gaps. Primary care providers face many economic and technological challenges as they strive to give names to and serve the underserved. This article is an adapted version of the opening keynote address at the 11th Annual Primary Care for the Underserved Conference held May 2003 in Boston, MA.

Boston↗

PubMed2005

Characterization of particulate and gas exposures of sensitive subpopulations living in Baltimore and Boston.

Personal exposures to particulate and gaseous pollutants and corresponding ambient concentrations were measured for 56 subjects living in Baltimore, Maryland, and 43 subjects living in Boston, Massachusetts. The 3 Baltimore cohorts consisted of 20 healthy older adults (seniors), 21 children, and 15 individuals with physician-diagnosed chronic obstructive pulmonary disease (COPD*). The 2 Boston cohorts were 20 healthy seniors and 23 children. All children were 9 to 13 years of age; seniors were 65 years of age or older; and the COPD participants had moderate to severe physician-diagnosed COPD. Personal exposures to particulate matter with aerodynamic diameters less than 2.5 microm (PM2.5), sulfate (SO(4)2-), elemental carbon (EC), ozone (03), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were measured simultaneously for 24 hours/day. All subjects were monitored for 8 to 12 consecutive days. The primary objectives of this study were (1) to characterize the personal particulate and gaseous exposures for individuals sensitive to PM health effects and (2) to assess the appropriateness of exposure assessment strategies for use in PM epidemiologic studies. Personal exposures to multiple pollutants and ambient concentrations were measured for subjects from each cohort from each location. Pollutant data were analyzed using correlation and mixed-model regression analyses. In Baltimore, personal PM2.5 exposures tended to be comparable to (and frequently lower than) corresponding ambient concentrations; in Boston, the personal exposures were frequently higher. Overall, personal exposures to the gaseous pollutants, especially O3 and SO2, were considerably lower than corresponding ambient concentrations because of the lack of indoor sources for these gases and their high removal rate on indoor surfaces. Further, the impact of ambient particles on personal exposure (the infiltration factor) and differences in infiltration factor by city, season, and cohort were investigated. No difference in infiltration factor was found among the cohorts, which suggests that all subjects were exposed to the same fraction of ambient PM2.5 for a given ambient concentration. In addition, the results show significant correlations between ambient PM2.5 concentrations and corresponding personal exposures over time and provide further indication that ambient gaseous pollutant concentrations may be better surrogates for personal PM2.5 exposures, especially personal exposures to PM2.5 of ambient origin, than their respective personal exposures. These results have important implications for PM health effects studies that use regression models including both ambient PM2.5 and gaseous pollutant concentrations as independent variables, because both parameters may be serving as surrogates for PM2.5 exposures.

Adolescent↗