Violent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n=51,942) from 2006 to 2010, licensed alcohol outlets establishments (n=1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR=1.022, 95 % CI=1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR= 1.048, 95 % CI=1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.

Objective: To examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity. Design: Weight and height measurements were extracted from all visits for a sample of 0-4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity. Setting: Baltimore, MD, USA. Subjects: Latino (n 210) and non-Latino (n 253) children, born in [2003][2004]. Results: An increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth. Conclusions: An increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.

We found that caretaker social networks are independently associated with certain aspects of child health, suggesting the importance of the broader social environment for low-income children's health.

Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study.

Background Study coordinators play an essential role on study teams; however, there remains a paucity of research on the supports and services they need to effectively recruit and retain study participants. Methods A cross-sectional survey was conducted with 147 study coordinators from a large academic medical center. Survey items assessed barriers and facilitators to recruitment and retention, anxiety about reaching enrollment numbers, confidence for talking to potential study participants about research involvement, awareness and use of CTSA resources, and PI involvement with recruitment planning. Results Significant associations were found between anxiety about reaching target enrollment numbers and whether the study coordinator was the primary person responsible for developing a recruitment strategy. Three years or more serving as a study coordinator and levels of anxiety for reaching enrollment numbers was also significant. Conclusion More institutional level supports and formal training opportunities are needed to enhance study coordinators’ effectiveness to recruit participants.

We present this Viewpoint to increase the awareness of and provide some personal perspectives on a recently released study from the National Academies of Sciences, Engineering, and Medicine (NASEM) on summertime and the healthy development and well-being of children and adolescents. 1 Summertime is a unique season of possibilities and a time when perturbations in the ecosystems of children, adolescents, and families can affect development and well-being in substantial ways. These perturbations can include levels of adult supervision, time spent in structured vs unstructured experiences, food security, community environmental exposures (including drugs, alcohol, violence, and police activity), access to health care, sedentary time, and use of media and technology. Armed with key findings and recommendations from this report, pediatricians can have a greater influence on research, policy, and practice to optimize summertime experiences that advance academic learning, health, safety, and positive development for children and adolescents.The NASEM summertime report 1 summarizes the evidence on the role of summertime experiences in promoting the health and well-being of children and adolescents. Furthermore, it identifies opportunities for government, employers, nonprofit organizations, and other sectors to improve access to high-quality summer experiences for all children and adolescents, provide greater support to parents, and improve the effectiveness of existing resources and additional funding. Notable among the NASEM report's conclusions is that robust data on seasonal changes in developmental trajectories are generally lacking. The one exception is the evidence of changes in academic learning, for which older literature showed declines in reading and math computation during the summer and more recent studies showed a slowing of academic progress overall, with declines associated with lower family income. 1 Notwithstanding the limited amount of scientific research on summertime experiences among children and adolescents, some evidence exists that health and safety, social and emotional maturation, and risk behaviors can all be affected by summertime experiences. The magnitude and direction of these outcomes varies by economic, social, and environmental circumstances, such as access to structured activities (eg, camps); the quality of the community's built environment; exposure to alcohol, drugs, violence, and crime; and access to healthy food and transportation. For example, increases occur in the risk of experiencing crime and overall crime rates, weight gain among those who already have overweight or obesity, drownings, recreational injuries, and first-time drug use. Conversely, declines occur in over-VIEWPOINT

Background It is important to monitor the scope of clinical research of all types, to involve participants of all ages and subgroups in studies that are appropriate to their condition, and to ensure equal access and broad validity of the findings. Objective We conducted a review of clinical research performed at New York University with the following objectives: (1) to determine the utility of institutional administrative data to characterize clinical research activity; (2) to assess the inclusion of special populations; and (3) to determine if the type, initiation, and completion of the study differed by age. Methods Data for all studies that were institutional review board–approved between January 1, 2014, and November 2, 2016, were obtained from the research navigator system, which was launched in November 2013. One module provided details about the study protocol, and another module provided the characteristics of individual participants. Research studies were classified as observational or interventional. Descriptive statistics were used to assess the characteristics of clinical studies across the lifespan, by type, and over time. Results A total of 22%-24% of studies included children (minimum age <18 years) and 4%-5% focused exclusively on pediatrics. Similarly, 64%-72% of studies included older patients (maximum age >65 years) but only 5%-12% focused exclusively on geriatrics. Approximately 85% of the studies included both male and female participants. Of the remaining studies, those open only to girls or women were approximately 3 times as common as those confined to boys or men. A total of 56%-58% of projects focused on nonvulnerable patients. Among the special populations studied, children (12%-15%) were the most common. Noninterventional trial types included research on human data sets (24%), observational research (22%), survey research (16%), and biospecimen research (8%). The percentage of projects designed to test an intervention in a vulnerable population increased from 17% in 2014 to 21% in 2015. Conclusions Pediatric participants were the special population that was most often studied based on the number of registered projects that included children and adolescents. However, they were much less likely to be successfully enrolled in research studies compared with adults older than 65 years. Only 20% of the studies were interventional, and 20%-35% of participants in this category were from vulnerable populations. More studies are exclusively devoted to women’s health issues compared with men’s health issues.

Introduction: Hypertension and diabetes control are leading modifiable risk factors for cardiovascular disease (CVD) risk. Contemporary epidemiological research suggests that individual and health system characteristics are associated with control. Yet, there is little evidence examining how the neighborhood environment influences hypertension or diabetes control among patients engaged in primary care. Methods: We analyzed data of adult patients (n = 5,711) with hypertension or diabetes who received primary care at 1 of 3 clinics of a statewide health care organization in Baltimore, MD and lived within the Baltimore city limits. The neighborhood environment exposures were tertiles of neighborhood socioeconomic status (SES), crime, and healthy food availability index (HFAI) assessed at the census tract level. Separate multivariate logistic regression models were constructed to estimate the odds ratio (OR) for each of these neighborhood environment characteristics and hypertension and diabetes control, adjusting for patient demographics, and health behaviors; and for physician demographic characteristics. Results: The overall mean age was 57.8 ± 14.3 years, 67.2% were female, and 89.6% were Black. There were 5,325 patients with hypertension and 2,094 patients with diabetes (not mutually exclusive). In bivariate analyses, high neighborhood SES (p= 0.030) and low crime (p= 0.006) were associated with hypertension control, and none of the neighborhood exposures were associated with diabetes control. In fully adjusted analyses, being Black was significantly associated with decreased odds of hypertension control in all models (OR range: 0.63 – 0.65), independent of neighborhood exposures. Among those with hypertension, living in a low or moderate SES neighborhood or a high crime neighborhood was associated with lower odds of hypertension control; however, these associations were attenuated in adjusted models. None of the neighborhood exposures were significantly associated with odds of diabetes control in models that adjusted for patient characteristics. Yet, compared to high SES neighborhoods, living in a low or moderate SES neighborhood (OR=0.74, 95% CI: 0.57 - 0.97 and OR=0.75, 95% CI: 0.57 - 0.98, respectively) was associated with reduced diabetes control after adjusting for both patient and physician characteristics. Conclusion: Exposure to neighborhood disadvantage may contribute to poor diabetes and hypertension control among patients in primary care, independent of patient and physician characteristics. Patient-centered risk assessments including measures of social need and preventive interventions adapted to neighborhood environments could be useful for optimizing hypertension and diabetes control in clinical settings.