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Background: Measures of the built environment such as neighborhood walkability have been associated with health behaviors such as physical activity, the lack of which in turn may contribute to the development of diseases such as obesity, diabetes, cardiovascular disease, and cancer. However, limited research has examined these measures in association with health-related quality of life (HR-QoL), particularly in minoritized populations. We examined the relationship between perceived neighborhood environment and HR-QoL in a sample of mostly Black and Latino residents in New York City (NYC). Methods: This study utilized the baseline survey data from the Physical Activity and Redesigned Community Spaces (PARCS) Study among 1252 residents [34.6% Black, 54.1% Latino, 80.1% female, mean(±SD) age = 38.8 ± 12.5) in 54 park neighborhoods in NYC. Perceived built environment was measured using Neighborhood Environment and Walkability Survey, and mental and physical HR-QoL was estimated using Short Form (SF)-12. Using factor analysis, we identified two subscales of neighborhood walkability: enablers (e.g., trails, sidewalks, esthetics) vs. barriers (e.g., high crime and traffic). In addition, we included a third subscale on neighborhood satisfaction. Generalized Estimating Equation models adjusted for demographics and BMI and accounted for the clustering effect within neighborhood. Multiple imputation was used to account for missing data. Results: Mental HR-QoL was associated with barriers of walkability (β ± SE = − 1.63 ± 0.55, p < 0.01) and neighborhood satisfaction (β ± SE = 1.55 ± 0.66, p = 0.02), after adjusting for covariates. Physical HR-QoL was associated with only barriers of walkability (β ± SE = − 1.13 ± 0.57, p < 0.05). Conclusions: Among NYC residents living in minoritized neighborhoods, mitigating negative aspects of the neighborhood environment may be more crucial than adding positive features in terms of HR-QoL. Our study points to the need to investigate further the role of the built environment in urban, minoritized communities. [ABSTRACT FROM AUTHOR]

Opioid prescribing for patients undergoing orthopedic procedures has been identified as a major contributor to the current opioid crisis in the United States. The rising awareness and more restrictive prescribing guidelines are beginning to affect the practice of medicine. Physicians are looking for alternative methods to effectively control acute pain and improve the treatment of chronic opioid patients. In line with these efforts, hospitals are establishing interventions and policies to address the national epidemic at the institutional level. Our hospital implemented new clinical, regulatory and policy guidelines in 2017 directed toward minimizing opioid use and prescribing while providing adequate analgesia after orthopedic surgery. These included clinical guidelines for managing opioid naïve and opioid tolerant patients and/or those with substance abuse disorder, educational programs for patients and prescribers, and surgery-specific prescribing recommendations to limit unnecessary prescribing of opioids. The aim of this study was to describe changes in opioid use and prescribing associated with the implementation of opioid minimizing initiatives in patients undergoing multilevel lumbar fusion. A retrospective before-and-after analysis of patients who underwent multilevel lumbar fusion at an orthopedic surgery specialty hospital in New York City. Multilevel lumbar fusion patients. The primary outcome was postoperative opioid consumption during the hospital stay and the opioid prescribed upon hospital discharge. The secondary outcomes were length of hospital stay (LOS), opioid-induced side effects, and numeric rating scale (NRS) pain scores. The study included data collected between January 1, 2016 – December 31, 2016 (prior to institutional implementation) and between January 1 – December 31, 2019, (after full institutional implementation). The electronic medical records and office notes were retrospectively reviewed for opioid use before and after surgery, and converted to equianalgesic doses (morphine equivalent dose, MED and expressed as milligrams of morphine per day, mg/day). Demographic and perioperative characteristics were compared between the intervention group and control cohort using Wilcoxon signed rank test for continuous variables and fisher's exact test for dichotomous variables and set the statistical significance at p<0.05. A total of 268 multilevel lumbar fusion patients were included in this analysis. 141 (52.6%) patients had surgery in 2016 and 127 (47.4%) underwent surgery in 2019. We found a statically significantly lower opioid consumption during the hospital stay (p<0.0001) and at discharge (p<0.0001) in 2019 compared to 2016 with statistically significant lower side effects (p=0.03) in 2019. Additionally, preoperative opioid consumption was statistically significantly lower in 2019 (p=0.003). There was no difference in the LOS and NRS pain scores in 2016 and 2019 (p=0.21 and p=0.33). This study found that after the clinical and policy interventions, opioid consumption, prescribed opioids upon hospital discharge and opioid-related side effects were lower. Despite these gains, there were no changes in reported pain associated with surgery and LOS was unchanged. Our findings demonstrate the efficacy of institutional implementation of a set of interventions to address the national opioid epidemic at the local level. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]