ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based Primary Care Diagnosis of Autism Spectrum Disorder.

Objective: Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD.

Data for Equity: Creating an Antiracist, Intersectional Approach to Data in a Local Health Department.

Objective: To develop recommendations to embed equity into data work at a local health department and a framework for antiracist data praxis.

Design: A working group comprised staff from across the agency whose positions involved data collection, analysis, interpretation, or communication met during April-July 2018 to identify and discuss successes and challenges experienced by staff and to generate recommendations for achieving equitable data practices.

Setting: Local health department in New York City.

Restless Legs Symptoms and Periodic Leg Movements in Sleep Among Patients with Parkinson's Disease.

Background: The association between restless legs syndrome (RLS) and Parkinson's disease (PD) remains controversial, with epidemiologic and descriptive evidence suggesting some potential overlap while mechanistic/genetic studies suggesting relative independence of the conditions.

Objective: To examine a known, objectively measured endophenotype for RLS, periodic leg movements (PLMS) in sleep, in patients with PD and relate that objective finding to restless legs symptoms.

Methods: We performed polysomnography for one (n = 8) or two (n = 67) consecutive nights in 75 PD patients and examined the association of PLMS with restless legs symptoms.

Heart Disease Death Rates Among Blacks and Whites Aged ≥35 Years - United States, 1968-2015.

Problem/condition: Heart disease is the leading cause of death in the United States. In 2015, heart disease accounted for approximately 630,000 deaths, representing one in four deaths in the United States. Although heart disease death rates decreased 68% for the total population from 1968 to 2015, marked disparities in decreases exist by race and state.

Habitual and Recent Sleep Durations: Graded and Interactive Risk for Impaired Glycemic Control in a Biracial Population.

Background: We examined how habitual sleep duration interacts with recent sleep (2 nights) to predict morning oral glucose tolerance test results. We hypothesized that short habitual and recent sleep durations would be additive for poor glucose control.

Methods: A biracial population of adults (n = 1559) without known diabetes and recruited from the workforce of 2 urban universities was assessed for glycated hemoglobin and underwent oral glucose tolerance testing.

County Health Factors Associated with Avoidable Deaths from Cardiovascular Disease in the United States, 2006-2010.

Objective: Many cardiovascular deaths can be avoided through primary prevention to address cardiovascular disease (CVD) risk factors or better access to quality medical care. In this cross-sectional study, we examined the relationship between four county-level health factors and rates of avoidable death from CVD during 2006-2010.

Methods: We defined avoidable deaths from CVD as deaths among U.

Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010.

Background: Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality.

Methods And Results: Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases.

Comparing methods of measuring geographic patterns in temporal trends: an application to county-level heart disease mortality in the United States, 1973 to 2010.

Purpose: To demonstrate the implications of choosing analytical methods for quantifying spatiotemporal trends, we compare the assumptions, implementation, and outcomes of popular methods using county-level heart disease mortality in the United States between 1973 and 2010.

Methods: We applied four regression-based approaches (joinpoint regression, both aspatial and spatial generalized linear mixed models, and Bayesian space-time model) and compared resulting inferences for geographic patterns of local estimates of annual percent change and associated uncertainty.

Results: The average local percent change in heart disease mortality from each method was -4.

Association of the neighborhood retail food environment with sodium and potassium intake among US adults.

Introduction: High sodium intake and low potassium intake, which can contribute to hypertension and risk of cardiovascular disease, may be related to the availability of healthful food in neighborhood stores. Despite evidence linking food environment with diet quality, this relationship has not been evaluated in the United States. The modified retail food environment index (mRFEI) provides a composite measure of the retail food environment and represents the percentage of healthful-food vendors within a 0.

Metropolitan racial residential segregation and cardiovascular mortality: exploring pathways.

Racial residential segregation has been associated with an increased risk for heart disease and stroke deaths. However, there has been little research into the role that candidate mediating pathways may play in the relationship between segregation and heart disease or stroke deaths. In this study, we examined the relationship between metropolitan statistical area (MSA)-level segregation and heart disease and stroke mortality rates, by age and race, and also estimated the effects of various educational, economic, social, and health-care indicators (which we refer to as pathways) on this relationship.

EMS medical direction and prehospital practices for acute cardiovascular events.

Objective: The purpose of this analysis was to determine whether there is an association between type of emergency medical services (EMS) medical direction and local EMS agency practices and characteristics specifically related to emergency response for acute cardiovascular events.

Methods: We surveyed 1,292 EMS agencies in nine states. For each cardiovascular prehospital procedure or practice, we compared the proportion of agencies that employed paid (full- or part-time) medical directors with the proportion of agencies that employed volunteer medical directors.

Nocturnal sleep enhances working memory training in Parkinson's disease but not Lewy body dementia.

Working memory is essential to higher order cognition (e.g. fluid intelligence) and to performance of daily activities.

Daytime alertness in Parkinson's disease: potentially dose-dependent, divergent effects by drug class.

Many patients with idiopathic Parkinson's disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of antiparkinsonian medications, the disease itself, or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson's patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness.

Racial residential segregation and stroke mortality in Atlanta.

Objective: To assess the association between neighborhood-level racial residential segregation and stroke mortality using a spatially derived segregation index.

Design: Cross-sectional study

Setting: Atlanta Metropolitan Statistical Area

Methods: The study population consisted of non-Hispanic Black and White residents of the Atlanta Metropolitan Statistical Area during the time period Jan 1, 2000 to December 31, 2006. Census tract-level stroke death rates for Blacks and Whites were modeled as a function of the segregation index while controlling for two neighborhood-level chronic stressors (poverty, low education).

Factors associated with emergency medical services scope of practice for acute cardiovascular events.

Objectives: To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability.

Methods: In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel.

Results: A total of 1,292 providers responded to the survey, for a response rate of 67%.

Geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers in North Carolina, South Carolina, and Georgia.

Introduction: Timely access to facilities that provide acute stroke care is necessary to reduce disabilities and death from stroke. We examined geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers (JCPSCs) and other hospitals with stroke care quality improvement initiatives in North Carolina, South Carolina, and Georgia.

Methods: We defined boundaries for 30- and 60-minute drive-time areas to JCPSCs and other hospitals  by  using geographic information systems (GIS) mapping technology and calculated the proportions of the population living in these drive-time areas by sociodemographic characteristics.

Sleep disturbance in dementia with Lewy bodies and Alzheimer's disease: a multicenter analysis.

Background/aims: Evidence suggests that patients with dementia with Lewy bodies (DLB) may have more nocturnal sleep disturbance than patients with Alzheimer's disease (AD). We sought to confirm such observations using a large, prospectively collected, standardized, multicenter-derived database, i.e.

Phasic muscle activity in sleep and clinical features of Parkinson disease.

Objective: The absence of atonia during rapid eye movement (REM) sleep and dream-enactment behavior (REM sleep behavior disorder [RBD]) are common features of sleep in the alpha-synucleinopathies. This study examined this phenomenon quantitatively, using the phasic electromyographic metric (PEM), in relation to clinical features of idiopathic Parkinson disease (PD). Based on previous studies suggesting that RBD may be prognostic for the development of later parkinsonism, we hypothesized that clinical indicators of disease severity and more rapid progression would be related to PEM.

Geographic disparities in heart failure hospitalization rates among Medicare beneficiaries.

Objectives: This study was designed to document local-level geographic disparities in heart failure (HF) hospitalization rates among Medicare beneficiaries.

Background: Although the burden of HF is well documented at the national level, little is known about the geographic disparities in HF.

Methods: The study population consisted of fee-for-service Medicare beneficiaries >or=65 years of age who resided in the U.

Correlates of PLMs variability over multiple nights and impact upon RLS diagnosis.

Objective: Night-to-night variability of periodic leg movements (PLMs) in restless legs syndrome (RLS) was examined to define the range of intra-subject values, impact upon diagnosing RLS, and clinical correlates.

Methods: Twenty RLS patients were monitored for 10-15 nights using a validated, tri-axial accelerometer worn on the ankle.

Results: The mean difference in PLMs index (PLMI) between the lowest and highest night was 25.

Effect of supine knee position on obstructive sleep apnea.

We previously reported a case of a middle-aged man whose obstructive sleep apnea (OSA) was virtually eliminated when he slept in the supine "knees up" position. In this study, we attempt to replicate this phenomenon in a group of volunteers with previously diagnosed OSA. Results indicated no significant improvement in OSA when sleeping supine knees up.