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Research Roundup

December 14, 2010, Volume 57, No. 15


Penn IUR Report on Vacant Land Management

The 40,000 vacant parcels of land in Philadelphia cause $3.6 billion in reduced property values, cost more than $20 million per year in city maintenance and net the city $70 million less in property taxes, according to a report on the vacant land management system in Philadelphia released last month by the Redevelopment Authority of the City of Philadelphia.

The report, “No More Vacancy: A Look at the Costs Vacant Land Imposes on the City of Philadelphia and Its Residents, and the Benefits from Reforming the Way It Is Managed,” is co-authored by the Penn Institute for Urban Research at the University of Pennsylvania, along with the Econsult Corporation and May 8 Consulting.

“These findings are of great importance for pointing to specific steps that could be taken to strengthen Philadelphia’s tax base and to build family friendly neighborhoods in Philadelphia,” said Penn IUR co-director Susan Wachter. “It illustrates the extensive costs of the current system and the immense benefits that reform will bring.”

In addition, the report recommends characteristics for a reformed system that would streamline the redevelopment process, make the city a good faith partner when dealing with for-profit and non-profit developers, and take advantage of legislation to allow for land banking in Philadelphia, based on the model of the Genesee County, Michigan.

Only one-quarter of the vacant parcels are publicly owned, and the vast majority of all vacant parcels are concentrated in North and West Philadelphia. Parcels come in all shapes, but small, 1/10-acre former rowhouse sites are predominant.

The report concludes that a strategic and coordinated response by the city could substantially reduce the negative effect of vacant parcels and transform them from liabilities to assets through redevelopment, with significant gains in neighborhood stability, job creation and tax revenue generation. It estimated that reformed vacant land management would activate new construction in neighborhoods in which there exists some potential for development, which would lead to the addition of about 3,400 new housing units within Philadelphia within the next five years.

The result would be $180 million in economic impact each year from construction, including 800 jobs, $30 million in earnings and $1.9 million in local taxes. Ultimately, units sold could gain Philadelphia $30 million in tax revenue within five years including property, sales, wage and real estate transfer tax, in addition to recovering the losses from the strain that the current system puts on city finances.

Hospital CPR Quality is Worse at Night

CPR quality is worse during in-hospital cardiac arrests occurring overnight than those that happen during the day, according to a University of Pennsylvania School of Medicine study presented at the American Heart Association’s annual Scientific Sessions on November 14. The researchers found that chest compression rates varied more at night—often dipping well below the rate per minute that is necessary to properly circulate blood—than during resuscitation efforts during the day, and rescuers paused for longer when switching between chest compressions and defibrillator shocks at night.

“Our study reveals an important factor to explain why, as previous studies have shown, patients who have cardiac arrests in hospitals during daytime hours are more likely to survive,” said senior author Benjamin Abella, assistant professor of emergency medicine and clinical research director in Penn’s Center for Resuscitation Science. “These findings suggest that more attention to clinical emergency training and staffing at night may be an important way to improve hospital safety and patient outcomes.”

The authors studied 173 cardiac arrests that occurred in non-intensive care settings over the course of two years at three urban teaching hospitals. Resuscitation efforts were monitored via a device that tracks compression depth and rates during CPR and the duration of pauses during defibrillation attempts.

Among factors that the authors say may influence the variability in CPR quality between night and day are fatigue, lower staffing levels, and lack of supervision from supervising physicians, who are less likely to be present during overnight resuscitations. But Dr. Abella said these disparities could be addressed with a variety of interventions, including more widespread use of cardiac arrest simulated event drills, devices that monitor CPR quality and provide real-time feedback, staff debriefings following resuscitations, and more supervising physician involvement in cardiac arrest care.

“Although these results show a disparity in the care cardiac arrest patients may receive overnight, we now have one answer about where to concentrate our efforts to better ensure the safety of patients around the clock,” he said.

Violence in Inner City Neighborhoods: Trouble with Asthma

Patients with asthma who are exposed to violence in their community are at an increased risk for an asthma-related hospitalization and emergency room visits for asthma or any cause, according to new research from the University of Pennsylvania School of Medicine. The findings are reported in the September 2010 issue of The Journal of Allergy & Clinical Immunology.

“We know that asthma morbidity is high in low-income, inner-city neighborhoods,” said lead author Andrea J. Apter, professor of medicine, chief, section of allergy and immunology, division of pulmonary, allergy, and critical care medicine. “So it’s important for us to understand how poverty affects health, particularly asthma health, so we can find ways of reducing exacerbations.” 

The prospective cohort study tracked 397 adults living in an inner city community with moderate to severe asthma for six months as part of a large study of asthma management. Participants were interviewed to determine sociodemographics, asthma status, asthma-specific quality of life, depressive symptoms, social support, and exposure to community violence.

The researchers found that exposure to violence, specifically “a fight in which a weapon was used, a violent argument between neighbors, a gang fight, a sexual assault or rape, a robbery or mugging,” was quite common in their study group, affecting almost one-quarter of the group. Those previously exposed to violence had nearly twice the rate of subsequent hospitalizations or emergency care visits for asthma compared to asthmatics who had not experienced violence exposure. Asthma-related quality of life was also found to be lower in the violence-exposed group. Younger adults were more likely to be exposed to violence and more likely to have an emergency department visit in general.

The Penn researchers said it is difficult to determine exactly how exposure to violence affects health. One possibility for persons with asthma is that exposure to violence is a marker for other exposures such as physical or social conditions that contribute to the development of their disease, exacerbate their symptoms, and interfere with successful treatment and management of their condition such as outdoor pollution, inadequate housing, or limited access to pharmacies. Another possibility, and not mutually exclusive, is that the psychological stress of living in a community with concentrated disadvantage directly affects the health of persons with asthma. It is known that such stress can affect overall health.

The authors’ findings emphasize the importance of neighborhood factors on overall health. The findings also highlight the need for physicians to carefully evaluate each patient and consider the environment in which the patient lives in order to recommend the most effective treatments.

Desktop Medicine: Transforming the Practice of Medicine

Gone are the days when a doctor’s only way of helping patients is by treating the disease after symptoms have started. Instead, a new approach to medicine, called “Desktop Medicine,” is emerging, in which the emphasis shifts from diagnosing diseases and treating symptoms to identifying risk-factors for medical conditions such as hypertension and osteoporosis, and intervening before they develop. The commentary appears in the November 10 Journal of the American Medical Association.

“Desktop medicine,” a model defined by Dr. Jason Karlawish, associate professor of medicine and medical ethics in the School of Medicine, involves clinicians continuously gathering risk-factor information—from a patient’s medical history, electronic medical records or recent office visit—and combining it with clinical studies about disease risk. Once the patient’s risk has been assessed, the physician can provide the appropriate intervention to prevent the onset of disease, rather than treat the disease once it is fully developed. 

“Desktop medicine has substantial implications for how we ought to educate, train, and practice medicine,” said Dr. Karlawish. “For example, medical training should teach how to help patients appreciate their relevant risks and manage these risks, as many patients fail to adhere to a long-term intervention intended to prevent disease.”

This new model may also explain why primary care is suffering. Physicians need to learn how to incorporate both bedside and desktop medicine into an office visit, so long-term disease prevention is not overlooked while a short-term symptom is being addressed, and vice versa. Transformations in medical practice, such as electronic medical records, are also essential.

Medical and pre-medical education focused on epidemiology, genomics and information sciences are increasingly important. Electronic medical records are crucial, as physicians use statistical models that require large sample sizes to detect risk. Both physicians and patients will have to learn how to collaborate on the decision-making process. In addition, as new techniques are developed to change patient behaviors—such as payments for adhering to medications—physicians will need to learn how to talk with patients about these financial incentives.

Almanac - December 14, 2010, Volume 57, No. 15