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The United States has a rapidly aging prison population with complex medical comorbidities. Medical parole has been proposed as a mechanism to address the heavy medical burden posed by the aging and chronically ill prison population. Current studies demonstrate medical parole is underutilized, but little is known about the factors considered when rendering a medical parole decision. The aim of this study was to describe the characteristics of medical parole applications in Massachusetts and identify predictors of the final parole decision. We conducted a retrospective review of 31 applications submitted by a non-profit legal services organization between 2022 and 2023. Univariate analysis demonstrated that a supportive superintendent recommendation and prison-contracted clinician assessment that an applicant could not perform ADLs independently were statistically significant factors in approval of medical parole. Unexpectedly, a history of disciplinary action while incarcerated was also associated with a higher likelihood of application approval, suggesting prior disciplinary action does not decrease the chances of a successful parole application. Our study suggests the superintendent and prison medical clinicians are key stakeholders with influence on the likelihood of approval of a medical parole application. Further work is needed to assess parole board decision-making when evaluating applications.

Background There are roughly 6,000 individuals incarcerated in the Massachusetts Department of Corrections (MADOC), and in 2025, 32% of these individuals were age 50 and older. Older incarcerated individuals have a higher burden of chronic disease, and caring for them is associated with higher healthcare costs. In 2018, Massachusetts passed legislation enabling medical parole, a process by which an individual can be released due to terminal illness or permanent incapacitation. Existing literature suggests medical parole is underutilized. The aim of this study was to characterize the cause of death of individuals in MADOC custody to determine potential medical parole eligibility and gaps in referrals. Methods We conducted a retrospective analysis of deaths of individuals in MADOC custody between 2021 and 2023 using death records obtained from MADOC and death certificates from the Massachusetts Vital Statistics Program. Cause of death was categorized through structured review of death certificates and supplemental MADOC medical documentation. Results Between January 1, 2021 and December 31, 2023, 87 individuals died in MADOC custody. The primary disease processes leading to death involved infection (28%), complications of chronic disease (25%), and cancer (22%). Nearly half (41.7%) of infection-related deaths were due to COVID-19. The most common causes of death categorized by primary organ system were cardiovascular conditions (26%) and respiratory conditions (25%). The majority of deaths were attributed to acute causes (58%). Conclusions In our study, nearly half of the population died in custody from a chronic condition or complications related to a chronic condition and could have been identified for medical parole eligibility. The majority of individuals died from acute causes, suggesting the need for an expedited review process and expanded eligibility criteria. A small number of correctional facilities and hospitals saw the majority of deaths, and these locations may be ideal targets for future interventions. Further work is needed to compare death data before and after the COVID-19 pandemic, assess barriers to utilization of medical parole, and explore other interventions to decrease the number of deaths in MADOC custody.

Background Rapid decline in balance is a hallmark of aging, elevating the risk of falls and other age-related geriatric illnesses among older adults. Objective Our aim was to assess whether impairment in balance function is associated with the risk of incident CVD in older adults. Design Retrospective cohort analysis. Participants A total of 129,024 participants who had undergone health screening between 2002 and 2009 were derived from the National Health Insurance Service-Senior cohort. Main measures Balance impairment was evaluated using the open-eyes one-leg standing (OLS) test. The association between balance impairment and incident CVD was analyzed using the Cox proportional hazards regression model. All participants were followed up with until either the date of the first incident of CVD, death, or 31 December 2019. Key results Those with abnormal balance function (< 10 s in OLS test) had a higher risk of CVD (adjusted hazard ratio [aHR] 1.23, CI 1.16–1.31). The association was significant in both the obese and the non-obese, but it seemed to be more pronounced in the latter. Results were supported by sensitivity analyses that did not include cases of CVD development in the first 1, 2, or 3 years and that used a different criterion to define balance dysfunction (< 9 s in OLS test). Conclusions Older adults with balance impairment were found to have an increased risk of incident CVD. Patients with impaired balance function may be a high-risk population who require preventive managements against CVD.

It is difficult to accurately predict the natural course of allergic rhinitis (AR), because it is affected by a wide variety of environmental influences, as well as genetic predisposition. Considering the high prevalence of allergic rhinitis in children and adolescents, caregivers should be given appropriate information regarding the disease course. This study aimed to understand the prognosis of allergic rhinitis by examining the relationship between allergic sensitization and rhinitis symptoms during this developmental period. This cross-sectional study included 1069 children aged 9-16 years from the Korean International Study of Asthma and Allergies in Childhood Survey database who had completed health questionnaires, and for whom skin prick test results were available. Data were collected during May 2016. The distribution of sensitization and allergic symptoms was compared by age groups (elementary, middle, and high school). Data were analyzed using linear-by-linear analysis. Sensitization to at least one tested allergen differed by age (59.2%, 58.3%, 68.2%, in elementary, middle, and high school students, respectively; p = 0.025), and seasonal allergen sensitization (35.0%, 37.1%, 53.9%, respectively) increased with age (p < 0.001). Conversely, the proportion of rhinitis symptoms among sensitized children decreased as age increased (58.80%, 52.90%, 49.70%, respectively; p = 0.047). However, the rate of non-allergic rhinitis was age-independent. With increasing age during childhood and adolescence, symptomatic allergic rhinitis decreases; thus, subclinical allergic rhinitis increases. This suggests that the symptoms of later-sensitized children are less clearly manifested, or that the symptoms reduce as previously sensitized children mature. This should be clarified further in a longitudinal study.

As incarcerated individuals age, prison systems often struggle to provide appropriate long-term care. Compassionate release policies can address this gap by allowing seriously ill or aging individuals to transition to community-based care. Many nursing homes, however, are reluctant to admit individuals recently released from prison. This study examined how incarceration status affects nursing home admission decisions. Using a statewide secret shopper methodology, researchers contacted all 74 licensed nursing homes in Rhode Island. Callers first inquired about bed availability for a standardized model patient, then disclosed the patient would be arriving from prison under compassionate release. Responses before and after disclosure were categorized and analyzed using ordinal regression. Of 74 facilities, 61 (82.4%) were reached. Before disclosure, 52.5% reported bed availability within one month; this dropped to 26.2% after incarceration was mentioned. Complete rejections increased from 9.8 to 44.3%. Facilities were 3.41 times more likely to downgrade admission status after disclosure (OR = 3.41; 95% CI: 1.76–6.70; p  < 0.001). For patients with serious criminal offenses, the rejection rate reached 70.5%, and the odds of rejection increased to 11.39 (95% CI: 5.48–24.65; p  < 0.0001). Facility size was not associated with rejection likelihood. Incarceration and criminal history significantly reduce access to nursing home care, even when medical need and payment ability are constant. These findings highlight the need for policy and system-level interventions to reduce stigma and increase care access for aging individuals eligible for compassionate release.

Background: A correlation between the harmful effects of air pollutants and atopic dermatitis has been reported. There are few studies on the correlation between the concentration of heavy metals in the indoor atmosphere and symptoms of atopic dermatitis. Methods: Twenty-two homes of children showing atopic dermatitis symptoms were enrolled, and eighteen homes with similarly aged children without symptoms or a history of atopic dermatitis participated as a control group. We measured the concentrations of various air pollutants (particulate matter 10, carbon dioxide, carbon monoxide, formaldehyde, nitrogen dioxide, volatile organic compounds (VOCs), ozone, radon, bacterial aerosols, and mold) as well as various heavy metals, such as lead, cadmium, and mercury, in the living room and children’s bedroom of each home. Results: Lead was more commonly detected in the indoor air in houses of children with atopic dermatitis (15/22) as compared to in the control group (3/18) (chi square test, p = 0.002). In adjusted logistic regression analysis, VOCs and lead were significantly associated with atopic dermatitis (p < 0.05). Conclusion: Our study shows that lead in indoor air might be associated with atopic dermatitis, even if the concentrations of airborne lead are below the safety levels suggested by health guidelines.

A total of 203 surveys were completed, with a 25% response rate overall. [...]our study demonstrates gaps in healthcare coordination. Declaration of competing interest None. n = 195 Staff role APP 13 (7%) Attending 47 (24%) Resident 32 (16%) Nurse 77 (39%) Not specified 26 (13%) Years working at current site in current role 0–5 years 91 (47%) 6–10 years 23 (12%) 11–15 years 22 (11%) 16–20 years 13 (7%) >20 years 21 (11%) Not specified 25 (13%) Site Ben Taub Hospital 51 (26%) Cook County Hospital 47 (24%) San Francisco General Hospital 72 (37%) Not specified 25 (13%) Age <31 32 (16%) 31–40 70 (36%) 41–50 30 (15%) >50 34 (17%) Not specified 29 (15%) Gender Cis Men 57 (29%) Cis Women 101 (52%) Other 3 (2%) Not specified 34 (17%) Race Asian 26 (13%) Black 22 (11%) Mixed 16 (8%) Other 13 (7%) White 88 (45%) Not specified 30 (15%) Ethnicity Hispanic 21 (11%) Non-Hispanic 142 (73%) Not specified 32 (16%) Table 1 Characteristics of Survey Responders.

Objectives This study examined the association between metabolic dysfunction‐associated steatotic liver disease (MASLD) and the risk of sudden sensorineural hearing loss (SSNHL) in elderly individuals. Methods A population‐based cohort study using the Korean National Health Insurance Service‐Senior cohort included 189,623 individuals aged 65 and older, categorized as non‐SLD or MASLD. Cox proportional hazards regression and Fine‐Gray subdistribution hazard models were used to evaluate the risk of SSNHL and Ménière's disease, considering all‐cause mortality as a competing event. Results Baseline characteristics showed that MASLD participants had higher metabolic dysfunction markers, including elevated body mass index, waist circumference, and blood pressure, compared to the non‐SLD group. During 9 years of follow‐up, 3803 SSNHL events occurred in the MASLD group, with an incidence rate of 2.44 per 1000 person‐years. After inverse probability of treatment weighting, MASLD was associated with a significantly increased risk of SSNHL (adjusted hazard ratio: 1.05, 95% CI: 1.00–1.10; p = 0.039; subdistribution hazard ratio: 1.06, 95% CI: 1.01–1.11; p = 0.016). Conclusion MASLD is associated with an increased risk of SSNHL. This study provides evidence supporting a metabolic influence on auditory health, warranting further investigation into the liver‐ear axis. Level of Evidence Step 3 (Level 3*)—Cohort study. This study investigates the association between MASLD and sudden sensorineural hearing loss (SSNHL) among older adults in Korea. Our findings suggest a potential link between MASLD and an increased risk of SSNHL, emphasizing the need for further research and clinical awareness of this association.

Sensitization to seasonal allergens usually requires repeated exposure to them. However, research on the extent of exposure that increases the risk of sensitization to specific allergens is lacking. Therefore, we investigated the levels of exposure to Japanese cedar pollen that increased the risk of sensitization to it. A cross-sectional study was conducted with 857 college students living in Jeju, South Korea, as it is the only province in Korea where Japanese cedar pollen levels are high. Questionnaires about demographic characteristics were distributed and skin prick tests for allergic sensitization were performed. Sensitization rates of groups divided by residence period were 3.8% (less than 1 year), 1.8% (1–2 years), 8.5% (2–3 years), 10.3% (3–4 years), 14.8% (4–10 years), and 19.1% (over 10 years). Residence period was an influencing factor of sensitization rate to Japanese cedar pollen, and the cut-off value of the residence period that increased the risk of sensitization to Japanese cedar pollen was found to be 25 months. Repeated exposure to seasonal allergens was related to an increased sensitization rate in young adults. Our results suggested that exposure to Japanese cedar pollen for over two seasons could increase the risk in Korean adults.

COVID-19 vaccination is an important tool in protecting patients and combating the pandemic. This report describes an emergency department (ED)-based initiative for vaccinating underserved patients against COVID-19 at a public academic hospital. A key challenge identified in ED COVID-19 vaccination was time constraints among emergency clinicians, which can be addressed through attention to workflow and delegation of counseling discussions within care teams of trainee and supervising clinicians. As patient receptivity to vaccination varies, strategies to promote ED-based vaccination include emergency clinicians sharing personal experiences of COVID-19 with patients and having multiple care team members recommend vaccination to an unvaccinated patient during an ED visit. Racial, ethnic, and gender diversity within a care team may also improve vaccine acceptance among racial/ethnic minorities. As safety nets of the larger United States healthcare system, EDs can play a significant role in primary prevention of COVID-19, and ED-based vaccination may be an effective strategy that can be adopted more widely for other infectious diseases.