RACIST AMERIKAN MEDICINE

Racial disparities exist in emergency department treatment of children with unintentional ingestions

Research found that Black children seeking emergency treatment for an unintentional ingestion more likely than white children to be referred for social worker and Children Services Bureau interventions

American Academy of Pediatrics

ORLANDO, Fla.— Unintentional injuries like falls, drownings and poisonings are the leading cause of death in patients ages 1-4, and a significant portion of these deaths are linked to unintentional ingestions—such as swallowing a drug or poison. New research shows racial and socioeconomic disparities exist in the emergency management of unintentional ingestions in children.  

Black patients younger than age 6 with the diagnosis of unintentional ingestion were more likely than white children to have a social work consult, Children Services Bureau referral, and urine drug screen, according to a research abstract, “Disparities in the Emergency Evaluation and Management of Unintentional Ingestions in Preschool Children,” presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.  

The research also found that children from poorer backgrounds (lower childhood opportunity index), those with higher severity of illness and pharmaceutical ingestions resulted in either a social work consultation, a Children Services Bureau referral, or both.  

“This study is important in understanding where underlying bias exists in emergency departments and hospital management and where changes can be made to address this problem, thus providing equitable care for all children,” said principal investigator Jennifer Allen, DO, FAAP.  “These findings could be useful to healthcare workers in emergency departments to help develop a framework for standardized clinical decision making.” 

Researchers examined the records of 4,411 patients, younger than age 6, who had unintentional ingestions between January 2013 and March 2024 identified by the International Classification of Disease in the electronic health record. They found: 

• Most ingestions were non-pharmaceutical (56%) 

• Patients with pharmaceutical ingestions had higher odds of a social work consult and a Children Services Bureau referral 

• Independent of ingestion type, non-white children were more likely to have a social worker consult or Children Services Bureau referral  

• White children were less likely to be exposed to cannabis 

• Private insurance was associated with reduced odds of social worker or Children Services Bureau referral.  

“This isn’t the only research to find racial disparities in the emergency department,” Dr. Allen said. “Disparity has been identified among different races regarding pain management for fractures and appendicitis in the emergency department.” 

Akron Children’s Hospital supported this research.  

Study author Dr. Jennifer Allen is scheduled to present this research, which is below, from 2:30 - 2:40 p.m. Friday, Sept. 27, 2024, during the Section on Emergency Medicine program during the AAP’s National Conference and Exhibition. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

 

ABSTRACT 

 

Program Name: 2024 AAP National Conference-Abstracts 

Submission Type: Section on Emergency Medicine 

Abstract Title: Disparities in the emergency evaluation and management of unintentional ingestions in preschool children 

Unintentional injuries consisting of trauma and poisonings are the leading cause of death in patients aged 1-4 years old with a significant portion attributed to ingestions. National Poison Control data in 2021 showed there were 37 incidences of poison exposure per 1000 children under 6 years old (2023). Between 2010-2019, poisoning deaths among minority children increased (West, 2021). Evidence of treatment disparity exists as seen in the decreased use of opioids or analgesia in minority children with long bone fractures or appendicitis in the emergency department (ED) (Goyal, 2015 and 2020). There is a knowledge gap regarding the extent, causes, and impact of disparities in assessing and managing acute ingestions in children. This study aimed to determine whether there is a difference in the evaluation and management of children with unintentional ingestions in a pediatric tertiary care center’s ED. 

From January 2013 to March 2024, patients less than 6 years of age were identified by International Classification of Disease (ICD) 9 and 10 codes in the electronic health record (EHR). Independent variables included: race, childhood opportunity index (COI), payor status, severity, age, sex, and substance type. Dependent variables included: urine drug screen (UDS), social work (SW) consult, and child service bureau (CSB) referral. Summary statistics were calculated and described as mean (sd). The relationship between independent and dependent variables was described using odds ratio (OR) with 95% confidence interval (CI). The relationship between pharmaceutical ingestion type was described using the receiver operating characteristic curve (ROC). Significance was defined as p-value < 0.05. Races are defined as White, African American, and Other; due to low numbers in categories comparisons are between all White and Non-White children. 

4411 patients had unintentional ingestions and most ingestions were non-pharmaceutical (56%). Patients with pharmaceutical ingestions had higher odds of a social work consult and a CSB referral (OR 8.3, 9.0). Independent of ingestion type, Non-White children were more likely to have a SW consult, CSB referral, and UDS order (ROC 0.78, 0.84, and 0.86). Looking at pharmaceutical ingestions, Non-White children had more cannabis ingestions than White children (Figure 1). Private insurance and ED discharge were associated with reduced odds of SW consults or CSB referral. A lower COI was associated with higher odds of SW consult and CSB referral (Table 1). When adjusted for COI, payor type, and severity, African Americans had higher odds of a SW consult, CSB referral, and UDS order (OR 1.8, 2.8, 2.3). 

This study revealed there are racial disparities in the management of unintentional ingestions within the ED setting. The next step would be to discuss findings with ED professionals and develop a framework for standardized clinical decision making. 

Childhood opioid prescription rates vary by patient’s background, research finds

Research presented during American Academy of Pediatrics 2024 Conference & Exhibition analyzes opioid prescriptions following fracture diagnoses

American Academy of Pediatrics

ORLANDO, Fla.—Children born to greater socioeconomic backgrounds are significantly more likely to be prescribed opioids, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1. 

The abstract, “Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures,” looked at the rates in opioid prescriptions following childhood broken elbow diagnoses from 2012 to 2021.

Apurva Shah, MD, MBA, Attending Surgeon, Orthopaedic Surgery at the Children’s Hospital of Philadelphia, who authored the abstract, also pointed to results that showed a third of patients in the abstract received at least one opioid dose during their visit.

“As orthopaedic surgeons, we clearly need improved opioid use stewardship to improve healthcare outcomes for our patients,” Dr. Shah said.

Results found disparities in patient racial backgrounds, with Black children 27% less likely to receive an opioid prescription compared to other patients. By comparison, white patients were also shown to be 10% more likely to be given opioids.

Other factors that impacted patients’ likelihood of being given opioids included age and where they live, according to Dr. Shah.

“Non-opioid pain management has proven sufficient for pain management,” Dr. Shah said. “Knowing this, along with this abstract, pediatricians must consider the potential harm these drugs can have on populations with disproportionately easier access to healthcare.”

This research was funded by Children’s Hospital of Philadelphia, Division of Orthopaedics.

Scott Mahon is scheduled to present the research, which is below, at 8:51 – 8:55  a.m. on Sunday, Sept. 29 during the Section on Orthopaedics program at Orange County Convention Center, West Building, W311H. To request an interview with the authors, contact Ashley Moore at moorea1@chop.edu.

 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

ABSTRACT 

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Orthopaedics

Abstract Title: Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures

Apurva Shah

Philadelphia, PA, United States

Nonmedical use of opioids in children and adolescents is a well-established public health concern. For many adolescent patients, an initial opioid prescription can act as a gateway that may lead to opioid misuse later in life. The purpose of this study is to investigate if patient factors, including sex, race, ethnicity, or Childhood Opportunity Index (COI), are associated with higher or lower likelihood of opioid prescription in children with fractures, utilizing pediatric supracondylar humerus fracture as an archetypal example.

Data was obtained from the Pediatric Health Information System (PHIS), an administrative database consisting of patient encounters across 52 pediatric hospitals. Patients with supracondylar humerus fractures who presented to an emergency department and were treated non-operatively were included. The primary outcome variable of interest was whether or not patients received an opioid prescription. We also extracted and assessed patient-level predictors for opioid use, including age, sex, race, ethnicity, primary payer, COI, and geographic region. To account for hospital level variation, we conducted mixed-effects logistic regression.

In total, 35,452 children (52% male) with non-operative supracondylar humerus fractures at a mean age of 5.7 ± 2.8 years were included. About one-third of patients (10,731; 30.3%) received at least one dose of opioids. After accounting for hospital-level characteristics, White patients were significantly more likely to receive an opioid prescription (OR 1.1, p=0.016), while those with public insurance were less likely (OR 0.85, p=0.001). Kids from moderate, high, and very high COI regions were significantly more likely to receive opioids compared to very low COI regions (OR 1.1-1.2). Additionally, older children (5-13 years) were significantly more likely to be prescribed more opioids compared to younger children (1-5 years) (OR 1.4, p< 0.001). No differences due to region or sex were found statistically significant. Results are further described in Table 1.

Opioids for supracondylar humerus fractures, despite the efficacy of non-opioid alternatives, are prescribed at high rates and disproportionately to White children and patients from higher COI areas, reflecting important socioeconomic disparities in opioid prescription patterns. Though non-opioid pain management using acetaminophen or ibuprofen provides sufficient pain control for treating supracondylar humerus fractures, unfortunately, almost one-third of patients being treated non-operatively were prescribed opioids. Our investigation demonstrates that White patients and children with higher COI are especially likely to be prescribed opioids, indicating that prescription pattern disparities may be harming the portion of the population that has historically had better access to healthcare.

Black infants with heart abnormalities more likely to die in first year

Study of infant mortalities from heart defects finds while death rates decreased, white infants more likely to survive than Black infants

Reports and Proceedings

American Academy of Pediatrics

ORLANDO, Fla.— Some babies are born with abnormalities involving the structure of the heart, known as congenital heart disease (CHD). While many studies have shown that more babies with congenital heart disease are surviving past their first birthday as deaths from CHD have significantly decreased in the United States, a research abstract found that race impacts these survival rates.

Black infants with congenital heart disease are 40% more likely to die in the first year of life than white infants with congenital heart disease, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.

The research, “Trend in Racial Differences in Mortality Attributed to Congenital Heart Diseases in Infants in the United States from 2005 to 2019," found that improvements in death rates for children with heart abnormalities were due to reduced death rates for white babies with congenital heart disease.

“The death rate in white infants decreased significantly but the rate in Black infants did not. Overall, we also found that Black infants died from these abnormal heart structures at a rate that was 1.4 times that of white infants,” said lead author Kwadwo Danso, MBChB.

Researchers examined data from the Centers for Disease Control and Prevention on 60,243,988 live births, which included 19,004 congenital heart disease-related infant deaths, to investigate if death rates varied based on race for children born with CHD. They found that the overall congenital heart disease infant mortality rate declined from 36.1 to 27.0 per 100,000 live births, down 25.2%. However, throughout the study, Black infants with congenital heart disease died at higher rates.

“Our findings may have implications for patient care and public health policy by serving as a foundation for additional studies to determine the drivers behind these disparities,” Dr. Danso said. “More research is needed on this disparity to understand why Black infants with congenital heart disease are more likely to die.”

Study author Kwadwo Danso, MBChB, is scheduled to present the research, which is below, during the Section on Cardiology and Cardiac Surgery program at the AAP’s National Conference and Exhibition.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

 

# # #

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Cardiology & Cardiac Surgery

Abstract Title: Trend in racial differences in mortality attributed to Congenital Heart Diseases in infants in the United States from 2005 to 2019

Kwadwo Danso

Peoria, IL, United States

Deaths from congenital heart disease (CHD) in children have been decreasing. We examined the differences in CHD mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants in the United States from 2005 to 2019. We hypothesized that a disparity in mortality rates exists between NHB and NHW infants.

We performed a retrospective cross-sectional analysis of publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research. The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P< 0.05 was considered statistically significant.

Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% confidence interval (CI)-2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P< 0.0001) and this difference remained when the CHD mortality rate was stratified by the neonatal and post-neonatal period. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], however, it was not significant in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 and there was no significant change during the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2).

The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was significantly higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.

 

Figure 1 shows the overall CHD-IMR decline over the study period

 

Figure 2 shows the NHB-NHW CHD IMR ratio over the time

Preterm births are on the rise, with ongoing racial and economic gaps

Study identifies how changes in risk factors may be contributing to growing number of babies born prematurely

Peer-Reviewed Publication

New York University

Preterm births have increased by more than 10 percent over the past decade, with racial and socioeconomic disparities persisting over time, according to a new study analyzing more than five million births.

The study, published in the journal JAMA Network Open, also found that some factors that increase the risk for preterm birth—such as diabetes, sexually transmitted infections, and mental health conditions—became much more common over the past decade, while other factors that protect against preterm birth declined. 

“Our findings not only show that preterm births are on the rise, but provide clues as to why this may be the case,” said Laura Jelliffe-Pawlowski, the study’s lead author, an epidemiologist and professor at the NYU Rory Meyers College of Nursing and professor emeritus of epidemiology, biostatistics, and of global health sciences in the University of California San Francisco (UCSF) School of Medicine. “Understanding patterns of and factors related to preterm birth is important for informing clinical care and the development of public health programs to address this critical need.”

Babies born preterm or prematurely—before the 37th week of pregnancy—are more likely to experience a range of short and longer-term problems, including a higher risk for illness, intellectual and emotional difficulty, and death. Certain factors are known to increase the risk of preterm birth, including mothers having high blood pressure, diabetes, an infection, or smoking. In addition, Black, Native American, and Hawaiian and Pacific Islander expectant mothers are at higher risk for preterm birth, which is thought to be driven by a long history of structural racism experienced by these groups.

To understand recent trends around preterm births, Jelliffe-Pawlowski and her colleagues looked at more than 5.4 million singleton births (not twins or other multiples) from 2011 to 2022 in the state of California. They examined how preterm birth rates changed over time and explored patterns in risk and protective factors within racial/ethnic and socioeconomic groups. Health insurance type was used as a proxy for socioeconomic status, comparing public insurance (MediCal, California’s Medicaid program) with nonpublic insurance (including private insurance and coverage through the military and the Indian Health Service). 

A growing risk and “alarm bells”

The researchers found that preterm births increased by 10.6 percent over the decade studied, from 6.8 percent in 2011 to 7.5 percent in 2022—echoing a report from the Centers for Disease Control and Prevention (CDC) released earlier this year that also found an increase in preterm birth across the nation from 2014 to 2022.

Rates of preterm birth grew across nearly all groups, but varied by racial/ethnic and socioeconomic group. The highest rates of preterm birth were among Black mothers with public insurance (11.3 percent), while the lowest rates were among white mothers who had nonpublic insurance (5.8 percent). Preterm birth rates decreased slightly over time among Black mothers with nonpublic insurance, from 9.1 percent in 2011 to 8.8 percent in 2022, but were still significantly higher than rates among white mothers. In contrast, preterm birth rates jumped from 6.4 percent to 9.5 percent among Native American mothers with nonpublic insurance.

“We found stark differences in terms of what it looks like to be a Black or Native American pregnant person compared with a white individual who is of middle or higher income,” said Jelliffe-Pawlowski.

Expanding on the CDC report’s findings by looking at risk and protective factors over time, the researchers determined that several factors were linked to an increased risk for preterm birth, including diabetes, high blood pressure, previously having a preterm birth, having fewer than three prenatal care visits, and housing insecurity. Notably, the rates of preexisting diabetes, sexually transmitted infections, and mental health conditions more than doubled during the decade studied.

“These patterns and changes in risk factors should be setting off alarm bells,” said Jelliffe-Pawlowski. 

Several factors were found to protect against preterm birth among low-income expectant mothers, including receiving prenatal care and participation in WIC, the supplemental nutrition program supporting women and children. Unfortunately, the researchers observed a decline in WIC participation across most low-income racial/ethnic groups over the period studied.

What can be done to improve birth outcomes

The researchers note that their findings underscore the need to improve pregnancy care and promote treatments that address risk factors associated with preterm birth—which are often underutilized during pregnancy, especially among mothers of color.

“We need to do a better job of sharing information with pregnant people about risk factors for preterm birth and interventions that may be able to help them address this risk. Some providers report not wanting to scare or overwhelm pregnant people, but pregnant people tend to report wanting to have this information,” said Jelliffe-Pawlowski. “For those who are at increased risk due to factors like hypertension or previous preterm birth, for example, providers should be having conversations about how taking low-dose aspirin might be helpful to them and their growing baby. This also extends to things like screening for sexually transmitted infections and offering mental health care in a non-judgmental, supportive way.”

“There is also important work to be done to improve structural issues and respectful care in WIC to increase participation,” added Jelliffe-Pawlowski.

Jelliffe-Pawlowski and her colleagues are also working to develop a digital platform called Hello Egg to help expectant mothers better understand their risk for preterm birth, identify interventions that may be helpful to them, and create a healthy pregnancy plan co-developed with prenatal providers. Jelliffe-Pawlowski and the team at the start-up, EGG Healthy Pregnancy, aim to conduct a large study to see if using the platform boosts a pregnant person’s knowledge; a key outcome will be seeing if this information sharing leads to increases in the use of interventions and, ultimately, to a reduced risk of preterm birth and other adverse outcomes. 

The research was supported by the University of California, San Francisco California Preterm Birth Initiative. Additional study authors include Audrey Lyndon of NYU Meyers and collaborators from the University of California, San Francisco; University of California San Diego; Stanford University; UCLA Medical Center; California State University, Northridge; San Francisco State University; Indiana University Bloomington; University of Alabama at Birmingham; and the University of Illinois Urbana-Champaign.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.35887 

Method of Research

Observational study

Subject of Research

People

Article Title

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

Article Publication Date

27-Sep-2024

 

Do natural disasters jeopardize women’s reproductive health?

Wiley

In research published in Brain and Behavior, investigators found increased rates of menstrual irregularities in women living in areas affected by the 2023 earthquake in Turkey.

In the study, 309 women of reproductive age living in regions declared as disaster areas completed online forms 9 months after the earthquake. Responses revealed an increase of menstrual irregularities from 14.3% before the earthquake to 44.8% after the earthquake. Risk factors for menstrual irregularities included post-traumatic stress symptoms, chronic diseases, and smoking.

The findings reveal that reproductive health can be significantly affected in the aftermath of natural disasters, and they highlight the importance of addressing mental health in post-disaster interventions to mitigate these effects.

“Traumatic events like earthquakes can disrupt not only physical but also hormonal and psychological balances, which can directly affect women's reproductive health,” said corresponding author Sibel Kiyak, RN, PhD, of Necmettin Erbakan University.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/brb3.7003

 

Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.

About the Journal
Brain and Behavior is an open access journal that publishes research relating to every area of neurology, neuroscience, psychology and psychiatry. We publish interdisciplinary research reports - all enhancing the understanding of the brain and behavior. Brain and Behavior is part of Wiley’s Forward Series which are inclusive open access journals increasing discoverability.

About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.

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Journal

Brain and Behavior

DOI

10.1002/brb3.70034 

Article Title

The Relationship Between Menstrual Cycle Pattern and Post-traumatic Stress in Women Following the 2023 Earthquake in Turkey

Article Publication Date

25-Sep-2024

AMERIKA

Growing divide: Rural men are living shorter, less healthy lives than their urban counterparts

The urban-rural gap in life expectancy and health quality for men nearing retirement age has widened over two decades

University of Southern California

 

image: 

Source: Authors' analysis of data from the Health and Retirement Study and life-course projections using the Future Elderly Model.

view more 

Credit: USC Schaeffer Center for Health Policy & Economics

Rural men are dying earlier than their urban counterparts, and they’re spending fewer of their later years in good health, according to new research from the USC Schaeffer Center for Health Policy & Economics.

Higher rates of smoking, obesity and cardiovascular conditions among rural men are helping fuel a rural-urban divide in illness, and this gap has grown over time, according to the study published this week in the Journal of Rural Health. The findings suggest that by the time rural men reach age 60, there are limited opportunities to fully address this disparity, and earlier interventions may be needed to prevent it from widening further.

The findings also point to a rising demand for care in rural areas, which will particularly challenge these communities. Rural areas are more likely than urban ones to have shortages of healthcare providers and are aging faster as younger residents move to cities, which further shrinks the supply of potential caregivers.

"Rural populations face a higher prevalence of chronic diseases, which has serious implications for healthy aging," said lead author Jack Chapel, a postdoctoral scholar at the Schaeffer Center. "With an aging population and fewer physicians available, the burden on rural communities is set to grow, leading to significant challenges in providing care for those who will face more health issues in the future."

Researchers used data from the Health and Retirement Survey and a microsimulation known as the Future Elderly Model to estimate future life expectancy for rural and urban Americans after age 60. They also assessed their likely quality of health in those years – a measure known as heath-quality-adjusted life expectancy (QALE). They estimated health trajectories for a cohort of Americans who were 60 years old between 2014-2020 and compared it with a similarly aged cohort from 1994-2000.

They found 60-year-old rural men can now expect to live two years less than their urban counterparts – a gap that’s nearly tripled from two decades ago. Rural men can also expect to live 1.8 fewer years in quality health than urban men, with this disparity more than doubling over the same period. For women, the urban-rural gap in life expectancy and health quality is much smaller and grew more slowly over time.

Nearly a decade after a landmark study found that people with lower levels of education are more likely to die from so-called “deaths of despair” – such as drug overdose or suicide – this new study finds that while education was an important factor in determining health quality, it cannot fully explain the gap between urban and rural populations. After adjusting rural education levels to match those of urban areas, the gap in healthy life expectancy was cut nearly in half. However, disparities existed even within each educational group, suggesting important geographic factors beyond education contribute to differences in healthy life expectancy.

Researchers found that interventions to reduce smoking, manage obesity, and treat and control widespread heart disease would benefit older rural residents more than urban ones. However, most interventions researchers tested were not able to completely bridge the urban-rural divide in healthy life expectancy.

“While education matters, so does smoking, prevalent obesity, cardiovascular conditions – and simply living in a rural area – which leads not only to more deaths but more illness among rural American men,” said co-author Elizabeth Currid-Halkett, the James Irvine Chair in Urban and Regional Planning and a senior scholar at the USC Schaeffer Institute for Public Policy & Government Service.

“Closing the gap in healthy life expectancy between urban and rural areas for older adults would require encouraging health behavior changes earlier in life and making broader social and economic improvements in rural areas,” said co-author Bryan Tysinger, director of health policy simulation at the Schaeffer Center.

This work was supported by funding from the National Institute on Aging of the National Institutes of Health under award P30AG024968.

About the USC Schaeffer Center

The USC Schaeffer Center for Health Policy & Economics is a joint enterprise between the USC Price School of Public Policy and the USC Mann School of Pharmacy and Pharmaceutical Sciences. The Schaeffer Center is one of two flagship programs at the USC Leonard D. Schaeffer Institute for Public Policy & Government Service, formed in 2024 to develop evidence-based solutions to policy issues and educate future generations of public service leaders.

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Journal

The Journal of Rural Health

DOI

10.1111/jrh.12875 

Article Title

The urban–rural gap in older Americans’ healthy life expectancy

 

Container with Lithium-Ion Batteries Catches Fire at Port of Montreal

Smoke from the battery fire caused warnings in Montreal (CBC News screen shot)

Published Sep 24, 2024 2:39 PM by The Maritime Executive

 

 

A container transporting lithium-ion batteries caught fire Monday, September 23, on the dock at the Port of Montreal causing evacuations and warnings for residents to stay indoors for several hours. There were widespread images of smoking blanketing parts of the city and even today people are complaining of a strong chemical smell in the air.

Fire officials said it was a difficult fire due to the nature of the batteries and fears that it would turn into a chemical runaway situation. Reports indicate more than 100 firefighters responded to the two-alarm blaze. CBC said they had to borrow a special drill from fire teams at the city’s airport to access the container.

The first reports of the fire were received around 2:20 p.m. local time in Montreal and shortly thereafter the city issued an alert for residents around the port to remain indoors. They were instructed to close doors and windows and shut off ventilation systems. Between 50 and 100 residents were also evacuated from their homes as a precaution. Electrical power was also turned off in the area.

 

 

The container was on the dock and firefighters said it held around 15,000 kg of lithium. One report said the container was coming from Poland and bound for Windsor, Canada raising speculation it was for the auto industry. It is unclear when the container arrived, but the Montreal Gazette reports that Vistula Maersk was on the dock near the scene of the fire.

Because of the nature of the fire, a special hazardous materials intervention team was brought in. They chose to water the container and not attempt to enter. One firefighter suffered a minor injury to his knee during the effort.

 

 

 

By about 7:30 p.m. the shelter order was lifted after the fire was contained, but it continued to burn overnight. The fire was extinguished Tuesday, September 24 by 7:00 a.m.

The Port of Montreal’s team is investigating the fire. A special team was coming in to handle the removal of the material.

Thousands of bones and hundreds of weapons reveal grisly insights into a 3,250-year-old battle

Ashley Strickland, CNN
Tue, September 24, 2024 

A new analysis of dozens of arrowheads is helping researchers piece together a clearer portrait of the warriors who clashed on Europe’s oldest known battlefield 3,250 years ago.

The bronze and flint arrowheads were recovered from the Tollense Valley in northeast Germany. Researchers first uncovered the site in 1996 when an amateur archaeologist spotted a bone sticking out of a bank of the Tollense River.

Since then, excavations have unearthed 300 metal finds and 12,500 bones belonging to about 150 individuals who fell in battle at the site in 1250 BC. Recovered weaponry has included swords, wooden clubs and the array of arrowheads — including some found still embedded in the bones of the fallen.

No direct evidence of an earlier battle of this scale has ever been discovered, which is why Tollense Valley is considered the site of Europe’s oldest battle, according to researchers who have studied the area since 2007.

Studies of the bones have yielded some insights into the men — all young, strong and able-bodied warriors, some with healed wounds from previous skirmishes. But details on who was involved in the violent conflict, and why they fought in such a bloody battle, has long eluded researchers.

There are no written accounts describing the battle, so as teams of archaeologists have unearthed more finds from the valley, they have used the well-preserved remains and weapons to try to piece together the story behind the ancient battle scene.

Now, a team of researchers studying arrowheads used in the battle has discovered evidence that it included local groups as well as an army from the south. These findings, published Sunday in the journal Antiquity, suggest the clash was the earliest example of interregional conflict in Europe — and raise questions about the state of organized, armed violence thousands of years ago.

“The arrowheads are a kind of ‘smoking gun,’” said lead study author Leif Inselmann, researcher at the Berlin Graduate School of Ancient Studies within the Free University of Berlin, in a statement. “Just like the murder weapon in a mystery, they give us a clue about the culprit, the fighters of the Tollense Valley battle and where they came from.”

An ancient skull recovered from the Tollense Valley site was found perforated with a bronze arrowhead. - Volker Minkus/Minkusimages
Evidence of invasion

Previous discoveries of foreign artifacts, such as a Bohemian bronze ax and a sword from southeastern Central Europe, and analyses of the remains have suggested that outsiders fought in the Tollense Valley battle. But the researchers of the new study were curious to see what clues the arrowheads would yield.

When Inselmann and his colleagues analyzed the arrowheads, they realized that no two were identical — not exactly shocking before the days of mass production. But the archaeologists could pick out key differences in the shapes and features that signified some of the arrowheads were not made within Mecklenburg-Western Pomerania, a state in northeast Germany that’s home to the Tollense Valley.

Inselmann collected literature, data and examples of more than 4,700 Bronze Age arrowheads from Central Europe and mapped out where they came from to compare them with the Tollense Valley arrowheads.

Many matched the style of arrowheads from other sites in Mecklenburg-Western Pomerania, suggesting they were locally made and carried by men who called the region home, according to the study.

Lead study author Leif Inselmann holds one of the arrowheads recovered from Mecklenburg-Western Pomerania, a state in northeast Germany that’s home to the Tollense Valley. - Leif Inselmann

But other arrowheads with straight or rhombus-shaped bases and side spurs and barbs matched those from a southern region that now includes modern Bavaria and Moravia, Inselmann said.

“This suggests that at least a part of the fighters or even a complete battle faction involved in Tollense Valley derive from a very distant region,” Inselmann wrote in an email.

Inselmann and his colleagues suspect it unlikely that the arrowheads were imported from another region to be used by local fighters. Otherwise, they would expect to find evidence of arrowheads within ceremonial burials in the region that were practiced during the Bronze Age.

Researchers uncovered a variety of bronze and flint arrowheads at the Tollense Valley site. - Leif Inselmann

The spark of war

A causeway that crossed the Tollense River, constructed about 500 years before the battle, is thought to have been the starting point of the conflict, said study coauthor Thomas Terberger.

Terberger, a professor in the department of prehistoric and historical archaeology at Germany’s University of Göttingen, has studied the site, a 1.8-mile (3-kilometer) stretch of the river, since 2007.

“The causeway was probably part of an important trade route,” he said. “Control of this bottleneck situation could well have been an important reason for the conflict.”

However, the fact that researchers haven’t found any clear evidence in the area of sources of wealth, such as mines for metal or places to extract salt, makes the trade route theory less likely, said Barry Molloy, an associate professor in the school of archaeology at University College Dublin. Molloy was not involved in the study.

“The causes of warfare were many, but it is likely in my view that this was about a group seeking to impose political control over another — an age old thing — in order to extract wealth systematically over time, not simply as plunder,” Molloy said in an email.

The exact scale and cause of the battle remain unknown, but the remains and weaponry found so far suggest more than 2,000 people were involved, according to the study. And researchers believe that more human bones are preserved in the valley, which could represent hundreds of victims.

The 13th century BC was a time of increased trade and cultural exchange, but the discovery of bronze arrowheads across Germany has suggested it was also when armed conflict arose.

“This new information has considerably changed the image of the Bronze Age, which was not as peaceful as believed before,” Terberger said. “The 13th century BC saw changes of burial rites, symbols and material culture. I consider the conflict as a sign that this major transformation process of Bronze Age society was accompanied by violent conflicts. Tollense is probably only the tip of the iceberg.”

The new study also points to the placement of arrow injuries found on remains buried at the battle site, which suggests that shields may have protected warriors from the front, while their backs were left exposed.

The research drives home the importance of archery on the battlefield, which has often been underestimated in previous studies of Bronze Age warfare, Molloy said.

“This is a really convincing study that uses routine archaeological methods to great effect to provide insight into the nature of this key prehistoric battle site, with regard to aspects of battlefield actions and the participants involved,” he said. “The authors make a robust case that there were at least two competing forces and that they were from distinct societies, with one group having travelled hundreds of kilometers. That is a crucial insight into the logistics behind the armies involved at Tollense.”

Researchers cataloged the types of injuries inflicted on remains recovered in the Tollense Valley to understand how the conflict played out. - Ute Brinker

The scale of conflict

The large scale of battle has researchers rethinking what social organization and warfare were like during the Bronze Age.

“Were the Bronze Age warriors (organized) as a tribal coalition, the retinue or mercenaries of a charismatic leader — a kind of ‘warlord’ — or even the army of an early kingdom?” Inselmann said.

For a long time, researchers argued that Bronze Age violence was a small-scale affair involving tens of individuals from local communities, but Tollense blows that theory wide open, Molloy said.

“We have many sites where we find evidence of mass killing and even slaughter of whole communities,” Molloy said, “but this is the first time that the demographics of the dead are those we can reasonably argue were warriors and not, for example, whole families migrating.”

Bronze Age societies built fortified settlements and smiths to forge weapons, but Tollense shows that both were more than just displays of power, he said.

“Tollense shows us that they were also created for very real military purposes including full scale battles that involved armies on the march, moving into hostile lands and waging war,” Molloy said.

Thousands of prehistoric artifacts found where Wake County highway opens this week

Richard Stradling
Tue, September 24, 2024 

Before the trees were cut and the bulldozers moved in to build NC. 540 across southern Wake County, archaeologists followed the route, looking for places people might have lived thousands of years ago.

They discovered a treasure trove along a creek east of Interstate 40. Sifting through the dirt, they found more than 24,000 artifacts, including shards of clay pots and other vessels; stone points used on spears, arrows and hand tools; and at least one piece of jewelry.

As the southern leg of the Triangle Expressway opens to traffic this week, those items are poised to join the state’s archaeological collection in Raleigh. Without the work of the archaeologists, they would have been churned up and paved over by the six-lane highway.

“It was going to be blitzed by the construction,” said Matt Wilkerson, who heads the N.C. Department of Transportation’s archaeology program. “This site was pretty much smack dab in the middle.”

NCDOT is required by state and federal law to determine whether road and bridge projects are likely to destroy important archaeological sites. That falls to Wilkerson and his team of six archaeologists, with help from consultants and the State Office of Archaeology.

They evaluate between 300 and 400 projects a year, focusing on those most likely to yield results: roads built on new right-of-way and bridges where flood plains can conceal well-preserved artifacts. The 18-mile extension of N.C. 540, across fields, forests and house lots from Apex to near Garner, was a good candidate.

NCDOT’s team gradually moved the length of the future highway corridor, pushing soil samples through a quarter-inch mesh to see what showed up.

“It’s like a chess board,” Wilkerson said. “We dig holes at a certain interval. If we find something, we tighten up that interval and dig some more.”

The goal is not to find and remove every artifact in the highway’s path. Instead, it’s to document what’s there and explore more deeply the most significant sites.

“We’re after sites that have integrity, where the soils are intact,” Wilkerson said. “That way we know the materials that we’re finding are not just all jumbled up. They might actually be able to tell us a little something about the site.”

The team found artifacts in more than 150 places along the path of the highway. But only one site was so rich and undisturbed that it was considered eligible for the National Register of Historic Places. And that site needed to be excavated, because it was directly in the highway’s path.

Artifacts including pottery, tools and jewelry--some made 10,000 years ago--were found during digging in 2021 for the last leg of the Triangle Expressway.
A popular spot over thousands of years

It was on a small rise just above a creek, which likely made it an attractive place to camp. It was extensive enough that NCDOT contracted with Commonwealth Heritage Group, a consulting firm based in Tarboro, to help with the work.

Using radio carbon dating and other techniques, the archaeologists determined that most of the artifacts they found were from two distinct periods: 6,000 to 5,500 BC or middle archaic and the middle woodland era, from 300 BC and 800 AD.

In neither case does it look as if the site was a permanent settlement, Wilkerson said. People may have spent a season along the creek, before moving on. The more recent occupants in particular seem to have spent little time at the site, which may have been a satellite of a larger settlement nearby, he said.

Perhaps the coolest item the archaeologists found was part of a gorget or piece of jewelry from sometime in the woodland period. The polished piece of stone was tapered on both ends and had been drilled with holes for a cord or leather strap.

“We don’t really know if it’s ceremonial or it’s just jewelry that someone would wear,” Wilkerson said. “We haven’t found many of those.”

A stone gorget or piece of jewelry found during an archaeological dig before construction of N.C. 540 in southern Wake County. N.C. Department of Transportation’s archaeologists and their consultants found more than 24,000 artifacts at one site where the highway runs now.

None of what the archaeologists found at the site is a museum piece, said Davis Cranfield, an assistant state archaeologist with the Department of Natural and Cultural Resources. But taken together, they are notable, Cranfield said.

“Usually we say, ‘It’s not what you find but what you find out,’ the collective assemblage that can help tell a story,” he said. “And this was a pretty significant site.”

In particular, the concentration of ceramic pottery, the presence of a hearth or fire pit and fragments of burned walnut shells help show how people lived at the time.

NCDOT and its consultants cataloged and documented what they found; a few of the items were on display at 540 Fest, when people were invited to run and cycle on the nearly completed highway in June.

Their permanent home will be at the State Office of Archaeology’s Research Center, where they’ll be available for future study.