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Lindberg J, Broström L, Johansson M. An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities. HEALTH CARE ANALYSIS 2024; 32:126-140. [PMID: 38159128 PMCID: PMC11133185 DOI: 10.1007/s10728-023-00475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically "non-actionable," we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients' comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient's situation and the underlying considerations shaping health care professionals' choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person.
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Affiliation(s)
- Jenny Lindberg
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden.
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Linus Broström
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden
| | - Mats Johansson
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden
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102
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Taghdiri F, Khodadadi M, Sadia N, Mushtaque A, Scott OFT, Hirsch-Reinhagen V, Tator C, Wennberg R, Kovacs GG, Tartaglia MC. Unusual combinations of neurodegenerative pathologies with chronic traumatic encephalopathy (CTE) complicates clinical prediction of CTE. Eur J Neurol 2024; 31:e16259. [PMID: 38404144 DOI: 10.1111/ene.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND PURPOSE Chronic traumatic encephalopathy (CTE) has gained widespread attention due to its association with multiple concussions and contact sports. However, CTE remains a postmortem diagnosis, and the link between clinical symptoms and CTE pathology is poorly understood. This study aimed to investigate the presence of copathologies and their impact on symptoms in former contact sports athletes. METHODS This was a retrospective case series design of 12 consecutive cases of former contact sports athletes referred for autopsy. Analyses are descriptive and include clinical history as well as the pathological findings of the autopsied brains. RESULTS All participants had a history of multiple concussions, and all but one had documented progressive cognitive, psychiatric, and/or motor symptoms. The results showed that 11 of the 12 participants had evidence of CTE in the brain, but also other copathologies, including different combinations of tauopathies, and other rare entities. CONCLUSIONS The heterogeneity of symptoms after repetitive head injuries and the diverse pathological combinations accompanying CTE complicate the prediction of CTE in clinical practice. It is prudent to consider the possibility of multiple copathologies when clinically assessing patients with repetitive head injuries, especially as they age, and attributing neurological or cognitive symptoms solely to presumptive CTE in elderly patients should be discouraged.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Nusrat Sadia
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Asma Mushtaque
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Olivia F T Scott
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Veronica Hirsch-Reinhagen
- Division of Neuropathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Tator
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
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103
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Shah YB, Goldberg ZN, Harness ED, Nash DB. Charting a Path to the Quintuple Aim: Harnessing AI to Address Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:718. [PMID: 38928964 PMCID: PMC11203467 DOI: 10.3390/ijerph21060718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
The Quintuple Aim seeks to improve healthcare by addressing social determinants of health (SDOHs), which are responsible for 70-80% of medical outcomes. SDOH-related concerns have traditionally been addressed through referrals to social workers and community-based organizations (CBOs), but these pathways have had limited success in connecting patients with resources. Given that health inequity is expected to cost the United States nearly USD 300 billion by 2050, new artificial intelligence (AI) technology may aid providers in addressing SDOH. In this commentary, we present our experience with using ChatGPT to obtain SDOH management recommendations for archetypal patients in Philadelphia, PA. ChatGPT identified relevant SDOH resources and provided contact information for local organizations. Future exploration could improve AI prompts and integrate AI into electronic medical records to provide healthcare providers with real-time SDOH recommendations during appointments.
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Affiliation(s)
- Yash B. Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA (Z.N.G.)
| | - Zachary N. Goldberg
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA (Z.N.G.)
| | - Erika D. Harness
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA (Z.N.G.)
| | - David B. Nash
- Jefferson College of Population Health, Philadelphia, PA 19107, USA
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104
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Koyama M, Hiroi S, Hirai Y, Kaida A. Prevalence of human adenovirus type 3 associated with pharyngoconjunctival fever in children in Osaka, Japan during and after the COVID-19 pandemic. Jpn J Infect Dis 2024:JJID.2024.035. [PMID: 38825454 DOI: 10.7883/yoken.jjid.2024.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Since the COVID-19 pandemic has affected the epidemiological pattern of pharyngoconjunctival fever (PCF) caused by human adenovirus (HAdV), the prevalence and type distribution of HAdVs associated with PCF among children in Osaka, Japan, between 2019 and 2023 have been analyzed. The number of reported PCF cases in Osaka decreased from 2020 to 2022, followed by an unprecedented increase in 2023. HAdV-C strains, including types C1, C2, and C5, were annually detected in pathogen surveillance in Osaka. HAdV-B3 was not detected for 2 years and 9 months from March 2020, and the number of detections increased from July 2023. In total, HAdV-B3 was the most frequently detected (27 of 52 strains), and genetic analysis of its hexon hypervariable regions showed that, except for one strain, the HAdV-B3 strains identified after 2022 had different amino acid substitutions compared to those identified in 2019 and 2020. These results suggest that the PCF epidemic in 2023 was predominantly caused by variant strains of HAdV-B3, and children who have not acquired immunity against HAdV-B3 between 2020 and 2022 were thought to be infected. The impact of COVID-19 on the prevalence of HAdV infections needs to be continuously evaluated through surveillance.
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Affiliation(s)
- Mei Koyama
- Division of Microbiology, Osaka Institute of Public Health, Japan
| | - Satoshi Hiroi
- Division of Microbiology, Osaka Institute of Public Health, Japan
| | - Yuki Hirai
- Division of Microbiology, Osaka Institute of Public Health, Japan
| | - Atsushi Kaida
- Division of Microbiology, Osaka Institute of Public Health, Japan
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105
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Han CJ, Tounkara F, Kalady MF, Noonan AM, Paskett ED, Von Ah D. Racial/Ethnic Disparities in HRQoL and Associated Risk Factors in Colorectal Cancer Survivors: With a Focus on Social Determinants of Health (SDOH). J Gastrointest Cancer 2024:10.1007/s12029-024-01070-2. [PMID: 38819610 DOI: 10.1007/s12029-024-01070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE This study aimed to understand how health-related quality of life (HRQoL) differs by race/ethnicity in colorectal (CRC) survivors. We aimed to 1) examine racial/ethnic disparities in HRQoL, and 2) explore the roles of social determinants of health (SDOH) risk factors for HRQoL differ by racial/ethnic groups. METHODS In 2,492 adult CRC survivors using Behavioral Risk Factor Surveillance System (BRFSS) survey data (from 2014 to 2021, excluding 2015 due to the absence of CRC data), we used the Centers for Disease Control and Prevention (CDC) HRQoL measure, categorized into "better" and "poor." Multivariate logistic regressions with prevalence risk (PR) were employed for our primary analyses. RESULTS Compared with non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) (PR = 0.61, p = .045) and Hispanics (PR = 0.32, p < .001) reported worse HRQoL in adjusted models. In adjusted models, unemployed/retired and low-income levels were common risk factors for worse HRQoL across all comparison groups (NHW, NHB, non-Hispanic other races, and Hispanics). Other SDOH associated with worse HRQoL include divorced/widowed/never married marital status (non-Hispanic other races and Hispanics), living in rural areas (NHW and NHB), and low education levels (NHB and Hispanics). Marital status, education, and employment status significantly interacted with race/ethnicity, with the strongest interaction between Hispanics and education (PR = 2.45, p = .045) in adjusted models. CONCLUSION These findings highlight the need for culturally tailored interventions targeting modifiable factors (e.g., social and financial supports, health literacy), specifically for socially vulnerable CRC survivors, to address the disparities in HRQoL among different racial/ethnic groups.
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Affiliation(s)
- Claire J Han
- Center for Healthy Aging, Self-Management and Complex Care, Ohio State University College of Nursing, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA.
| | - Fode Tounkara
- Department of Biomedical Informatics, Ohio State University College of Medicine, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Matthew F Kalady
- Division of Colon and Rectal Surgery, Clinical Cancer Genetics Program, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Anne M Noonan
- GI Medical Oncology Selection, GI Oncology Disease Specific Research Group Leader, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Electra D Paskett
- Department of Internal Medicine in the, College of Medicine, Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, 43210, USA
| | - Diane Von Ah
- Center for Healthy Aging, Self-Management, and Complex Care, Ohio State University, College of Nursing, Cancer Survivorship and Control Group, Ohio State University, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
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106
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Minamitani M, Morishima K, Katano A, Ohira S, Nakagawa K. Exploring the Correlation Between Health Literacy and Knowledge of Cervical Cancer and Radiotherapy Among Japanese Women: A Web-Based Survey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02432-x. [PMID: 38809493 DOI: 10.1007/s13187-024-02432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
Health literacy (HL) plays a vital role in an individual's ability to make informed health decisions. Japan faces several challenges in cervical cancer control, including low human papillomavirus (HPV) vaccination and screening rates, underutilization of radiotherapy, and limited HL. This study explored the association between HL and knowledge of cervical cancer and radiotherapy, particularly among young Japanese women. We conducted a web-based survey among users of LunaLuna, a popular women's healthcare application, to assess their HL and knowledge about cervical cancer and radiotherapy through a 46-question survey. We compared three groups in terms of HL (inadequate, problematic, and sufficient & excellent). Multiple regression analysis was used to identify factors associated with knowledge. In total, 1468 respondents were included in this study. HL was positively correlated with knowledge scores (inadequate: 51.8%; problematic: 56.3%; sufficient & excellent: 60%). Participants displayed relatively low accuracy for treatment-related questions. Higher HL (β = 0.15, p < 0.01), education (β = - 0.11, p < 0.01), cervical cancer screening (β = - 0.11, p < 0.01), income (β = 0.09, p < 0.01), and employment (β = - 0.06, p = 0.04) were significant factors affecting knowledge of cervical cancer and radiotherapy. Our findings underscore the pivotal role of HL in promoting cervical cancer prevention and providing a better understanding of radiotherapy. Despite factors such as age, education, and history of cervical cancer screening, HL showed the strongest association with knowledge of cervical cancer and radiotherapy. The enhancement of HL and knowledge dissemination may be critical for promoting cervical cancer prevention and radiotherapy in Japan.
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Affiliation(s)
- Masanari Minamitani
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Kosuke Morishima
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shingo Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-0033, Japan
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107
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Shinan-Altman S, Elyoseph Z, Levkovich I. The impact of history of depression and access to weapons on suicide risk assessment: a comparison of ChatGPT-3.5 and ChatGPT-4. PeerJ 2024; 12:e17468. [PMID: 38827287 PMCID: PMC11143969 DOI: 10.7717/peerj.17468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/05/2024] [Indexed: 06/04/2024] Open
Abstract
The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors.
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Affiliation(s)
| | - Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, England, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv’on, Israel
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108
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Marx R. Is Prediabetes Overdiagnosed? Yes: A Patient-Epidemiologist's Experience. Ann Fam Med 2024; 22:247-250. [PMID: 38438253 PMCID: PMC11237237 DOI: 10.1370/afm.3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/14/2023] [Accepted: 11/06/2023] [Indexed: 03/06/2024] Open
Affiliation(s)
- Rani Marx
- Initiative for Slow Medicine, Berkeley, California
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109
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Lee MS, Day AD, Bassford TL, Lininger MR, Armin JS, Williamson HJ. Primary Care Providers' Experiences Recommending and Performing Cervical Cancer Screening for Women with Intellectual Disabilities: A Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02454-5. [PMID: 38807001 DOI: 10.1007/s13187-024-02454-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Women with intellectual and developmental disabilities (I/DD) are less likely to receive cervical cancer screening (CCS) relative to women without disabilities. Primary care providers (PCPs) play key roles in recommending CCS. The purpose of this study was to identify factors PCPs consider when recommending and performing CCS for women with I/DD. Using a qualitative approach, in-depth semi-structured interviews (N = 13) were conducted with majority family medicine-trained PCPs. Through inductive data analysis, it was found that most PCPs reported recommending CCS; however, follow-through for performing CCS varied. PCPs attempted to align their CCS recommendations with national guidelines and provided counseling and education to families and patients about CCS while taking an individualized risk-benefit approach. Despite most PCPs reporting a lack of knowledge or training related to providing I/DD-specific care, PCPs attempted to draw upon experiences with similar populations to recommend and perform CCS. There is an opportunity to improve knowledge of PCPs related to performing CCS for women with I/DD.
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Affiliation(s)
- Michele S Lee
- Institute for Human Development, Northern Arizona University, 912 W Riordan Road, Flagstaff, AZ, 86011, USA.
| | - Arden D Day
- Office of the Vice President for Research, Northern Arizona University, Flagstaff, AZ, USA
| | - Tamsen L Bassford
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
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Sin MP, Forsberg BC, Peterson SS, Alfvén T. Assessment of Childhood Stunting Prevalence over Time and Risk Factors of Stunting in the Healthy Village Programme Areas in Bangladesh. CHILDREN (BASEL, SWITZERLAND) 2024; 11:650. [PMID: 38929230 PMCID: PMC11202057 DOI: 10.3390/children11060650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Childhood stunting is a significant public health concern in Bangladesh. This study analysed the data from the Healthy Village programme, which aims to address childhood stunting in southern coastal Bangladesh. The aim was to assess childhood stunting prevalence over time and explore the risk factors in the programme areas. A cross-sectional, secondary data analysis was conducted for point-prevalence estimates of stunting from 2018 to 2021, including 132,038 anthropometric measurements of under-five children. Multivariate logistic regression analyses were conducted for risk factor analysis (n = 20,174). Stunting prevalence decreased from 51% in 2018 to 25% in 2021. The risk of stunting increased in hardcore poor (aOR: 1.46, 95% CI: 1.27, 1.68) and poor (aOR: 1.50, 95% CI: 1.33, 1.70) versus rich households, children with mothers who were illiterate (aOR: 1.25, 95% CI: 1.09, 1.44) and could read and write (aOR: 1.35, 95% CI: 1.16, 1.56) versus mothers with higher education, and children aged 1-2 years compared with children under one year (aOR: 1.32, 95% CI: 1.20, 1.45). The stunting rate was halved over three years in programme areas, which is faster than the national trend. We recommend addressing socioeconomic inequalities when tackling stunting and providing targeted interventions to mothers during the early weaning period.
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Affiliation(s)
- May Phyu Sin
- Department of Orthopedics, Lund University, 221 85 Lund, Sweden;
| | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
| | - Stefan Swartling Peterson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
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111
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Perrone PM, Scarioni S, Astorri E, Marrocu C, Tiwana N, Letzgus M, Borriello C, Castaldi S. Vaccination Open Day: A Cross-Sectional Study on the 2023 Experience in Lombardy Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:685. [PMID: 38928932 PMCID: PMC11203413 DOI: 10.3390/ijerph21060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Vaccination is a highly effective tool for controlling infectious diseases, particularly in populations at high risk of contagion due to clinical conditions or occupational exposure, such as healthcare workers. The purpose of this study is to present the open day event that marked the beginning of the influenza and anti-COVID-19 vaccination campaign in the Lombardy region and to describe the experience of an Istituto di Ricovero e Cura a Carattere Scientifico in Milan. METHODS During the vaccination open day, eligible individuals received free vaccinations for influenza, COVID-19, pneumococcal disease, and shingles, as provided by the Lombardy Agenzia per la Tutela della Salute. In celebration of the centenary of the Università degli Studi di Milano, the Fondazione Ca'Granda Ospedale Policlinico, a contracted hospital of the university, created a special electronic diary for a total of 150 individuals, equally divided between children aged 2-6, pregnant women, and university staff. RESULTS At the regional level, a total of 6634 influenza vaccines, 2055 anti-COVID-19 vaccines, 108 anti-pneumococcal vaccines, and 37 anti-zoster vaccines were administered. A total of 3134 (47.3%) influenza vaccines, 1151 (56%) anti-COVID-19 vaccines, and 77 (62%) anti-pneumococcal vaccines, were given to individuals aged 60-79. No differences were observed between the total number of male and female vaccinees (1017 and 1038, respectively), who received the anti-COVID-19 vaccine. At the Policlinico Foundation, out of 150 available booking slots, 154 vaccines were administered, including 117 influenza vaccines. CONCLUSIONS The establishment of vaccine open days is a beneficial way to increase vaccine compliance. Co-administration of little-known vaccinations outside of healthcare settings could also be a useful tool.
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Affiliation(s)
- Pier Mario Perrone
- Department Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (S.S.); (E.A.); (C.M.); (S.C.)
| | - Simona Scarioni
- Department Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (S.S.); (E.A.); (C.M.); (S.C.)
| | - Elisa Astorri
- Department Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (S.S.); (E.A.); (C.M.); (S.C.)
| | - Chiara Marrocu
- Department Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (S.S.); (E.A.); (C.M.); (S.C.)
| | - Navpreet Tiwana
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.T.); (M.L.)
| | - Matteo Letzgus
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.T.); (M.L.)
| | - Catia Borriello
- Vaccination Unit, ASST Fatebenefratelli Sacco, 20131 Milan, Italy;
- Directorate General for Health, Lombardy Region, 20124 Milan, Italy
| | - Silvana Castaldi
- Department Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (S.S.); (E.A.); (C.M.); (S.C.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.T.); (M.L.)
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Na JS, Bajgai J, Sharma S, Dhakal S, Ahn DW, Doh YA, Kim Y, Lee KJ. Enhancing Health and Empowerment: Assessing the Satisfaction of Underprivileged Rural Women Participating in a Functional Literacy Education Program in Kailali District, Nepal. Healthcare (Basel) 2024; 12:1099. [PMID: 38891174 PMCID: PMC11172237 DOI: 10.3390/healthcare12111099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Women's empowerment and health literacy are essential for fostering community well-being. Empowering women through education and diverse training plays a crucial role in ensuring their prosperity and overall health. This study investigates the satisfaction and experiences of underprivileged rural mothers participating in a functional literacy education program in the Kailali district, Nepal. We assess participants' perceptions of program effectiveness, examining training content, facilities, and trainers while exploring menstrual hygiene practices and maternal health awareness. Through convenience sampling, 141 underprivileged women from five rural villages near Tikapur were selected from literacy centers run by Mahima Group. Utilizing structured questionnaires and statistical analyses, including descriptive analyses, Spearman's rho correlation, and Pearson's chi-square test, we found that 65.2% of participants expressed high satisfaction levels. Moreover, 96.5% found the program highly effective, with 97.9% reporting improved literacy skills and 96.5% demonstrating increased awareness of menstrual hygiene practices. Additionally, 97.2% agreed that the program enhanced maternal and child health knowledge. Significant correlations were observed among the training course, facilities, trainers, and overall training perception. In line with this, significant associations were found between age groups (p = 0.003) and geographical areas (p = 0.023) with satisfaction levels with the literacy program. These results underscore the satisfaction of participants within the literacy program and its impact on their lives, and advocates for its broader implementation to empower marginalized communities for sustainable development.
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Affiliation(s)
- Joong Seon Na
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Gangwon-do, Republic of Korea; (J.S.N.); (J.B.); (S.S.)
| | - Johny Bajgai
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Gangwon-do, Republic of Korea; (J.S.N.); (J.B.); (S.S.)
| | - Subham Sharma
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Gangwon-do, Republic of Korea; (J.S.N.); (J.B.); (S.S.)
| | - Sarmila Dhakal
- Department of Public Health, National Academy of Medical Science, Purbanchal University, Biratnagar 56600, Nepal;
| | - Dong Won Ahn
- Institute for Poverty Alleviation and International Development, Yonsei University, Mirae Campus, Wonju 26493, Gangwon-do, Republic of Korea;
| | - Young-Ah Doh
- Evaluation Department, Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si 13449, Gyeonggi-do, Republic of Korea;
| | - Yundeok Kim
- Department of Internal Medicine, Division of Hematology-Oncology, Wonju Severance Christian Hospital, Wonju 26426, Gangwon-do, Republic of Korea
| | - Kyu-Jae Lee
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Gangwon-do, Republic of Korea; (J.S.N.); (J.B.); (S.S.)
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Gangwon-do, Republic of Korea
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113
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Abuzied Y, Al-Amer R, Saleh MYN, Somduth S, AlBashtawy M, Ali AM. Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study. Int J Nurs Pract 2024:e13268. [PMID: 38798100 DOI: 10.1111/ijn.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure. AIM The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI. DESIGN This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data. METHODS A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis. RESULTS Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'. CONCLUSION It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.
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Affiliation(s)
- Yacoub Abuzied
- Department of Nursing, Spinal Cord Injury, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohammad Y N Saleh
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Shreemathie Somduth
- Nursing Administration, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed AlBashtawy
- Nursing Community Health, Princess Salma Faculty of Nursing, Al Al-Bayt University, Al-Mafraq, Jordan
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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114
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Trang NTD, Jegatheesan V, Thao VTP, Tung NCT, Nam TS, Van Cong N, Thuan NC, Dung DT. Local residents' perception on factors affecting the willingness to pay for improved urban canal water: a case study in Can Tho city of Vietnam. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024:10.1007/s11356-024-33800-1. [PMID: 38797754 DOI: 10.1007/s11356-024-33800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Urbanization and economic development cause water pollution in the inner-city canals and rivers globally. Bung Xang canal in Can Tho city of Vietnam is facing problems with water pollution due to the lack of centralized wastewater treatment plants and low public awareness on environmental protection. Perception of local residents was collected using structured questionnaires including both qualitative and quantitative information. Regression analysis was employed to evaluate the factors affecting the decision of respondents on the willingness to pay (WTP) to improve water quality in the Bung Xang canal. Knowledge about the environmental protection fee for domestic wastewater (10% of the VAT-excluded from the selling price of 1 m3 of tap water purchased), age of the respondents and their education levels affected the WTP positively, while respondents' perception on water quality affected the WTP negatively. There was 58.33% of the respondents showed the WTP for improved water quality in the canal. They agreed to pay a small fee of VND 10,000 to 15,000 (equivalent to USD 0.42-0.63)/month (1 US$= 23,700 VND). The result indicates that environmental education is the only way forward for a successful sustainable urban city.
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Affiliation(s)
- Ngo Thuy Diem Trang
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam.
| | - Veeriah Jegatheesan
- School of Engineering and Water: Effective Technologies and Tools (WETT) Research Centre, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Vo Thi Phuong Thao
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
| | - Nguyen Chau Thanh Tung
- College of Agriculture, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
| | - Tran Sy Nam
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
| | - Nguyen Van Cong
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
| | - Nguyen Cong Thuan
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
| | - Duong Tri Dung
- Department of Environmental Sciences, College of Environment and Natural Resources, Can Tho University, Campus 2, 3/2 Street, Ninh Kieu District, Can Tho City, Vietnam
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115
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Haber Y, Levkovich I, Hadar-Shoval D, Elyoseph Z. The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy. JMIR Ment Health 2024; 11:e54781. [PMID: 38787297 PMCID: PMC11137430 DOI: 10.2196/54781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/24/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Unlabelled This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence's new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the "fourth narcissistic blow" that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy.
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Affiliation(s)
- Yuval Haber
- The PhD Program of Hermeneutics and Cultural Studies, Interdisciplinary Studies Unit, Bar-Ilan University, Ramat Gan, Israel
| | | | - Dorit Hadar-Shoval
- Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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116
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Ogrin R, Robinson E, Rendell K, Alrababah S, Fineberg D, Fiddes K, Yerolemou A, Lim MH, Engel L, Lowthian JA. " Connect Local": protocol for the evaluation of a codesigned whole of community approach to promote social connection in older adults. Front Public Health 2024; 12:1342562. [PMID: 38846622 PMCID: PMC11155451 DOI: 10.3389/fpubh.2024.1342562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Background There is wide acknowledgement in the literature that social connection is protective against loneliness and depression. More robust research, however, is needed to evaluate interventions that promote social connection. This protocol paper outlines the evaluation of a community-wide social connection program, Connect Local, in metropolitan Melbourne, Australia to support people 65 years and older to increase access to local community services/activities; and to ascertain impact on social connection, loneliness, depressive symptoms, physical and mental wellbeing, and use of health services. Methods A Type 1 Hybrid design, including program effectiveness, cost-effectiveness, and implementation evaluation of the Connect Local program, will be undertaken. Eighty-eight participants aged ≥65 years with one or more chronic health condition, who are also either experiencing or at risk of loneliness, social isolation and depressive symptoms will be invited to participate in the evaluation. Outcomes, measured at baseline, 3, 6 and 12 months, include loneliness, social isolation, depressive symptoms, social anxiety, goal attainment, wellbeing, quality of life and health care utilisation. A gender and age matched comparator group of 88 individuals will be recruited from outside the intervention local government area. Impact of the intervention on community service providers in the target region will be evaluated using mixed methods, where triangulation will be used to combine the qualitative and quantitative data using a deductive-simultaneous design. Changes in wellbeing and quality of life of community volunteers will also be measured. All groups will be interviewed to ascertain their experience and perceptions of the program. The economic evaluation will use a Social Return on Investment (SROI) approach, to include outcomes at the individual, community, and system levels. Implementation outcomes will consider Reach, Adoption, Feasibility, Acceptability, Appropriateness, Fidelity, and Sustainability of the intervention. Discussion This study will provide a better understanding of the impacts of a community-wide social connection approach in older adults, the community and broader system. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385192; Identifier ACTRN12623000968673.
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Affiliation(s)
- R. Ogrin
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - E. Robinson
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - K. Rendell
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - S. Alrababah
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | | | - K. Fiddes
- Australian Disease Management Association, Alfred Health, Melbourne, VIC, Australia
| | - A. Yerolemou
- South Eastern Melbourne Public Health Network, Melbourne, VIC, Australia
| | - M. H. Lim
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - L. Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J. A. Lowthian
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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117
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Quirke-McFarlane S, Ogden J. Care or sabotage? A reflexive thematic analysis of perceived partner support throughout the bariatric surgery journey. Br J Health Psychol 2024. [PMID: 38783153 DOI: 10.1111/bjhp.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Social support is mostly seen as a positive resource for many health outcomes. However, some research indicates that weight loss may disrupt the equilibrium of relationships and highlights the potential for a more negative form of social support. This qualitative study aimed to explore bariatric surgery (BS) patients' perceptions of the way in which their current or previous partner supported them throughout their BS journey. DESIGN BS patients (N = 30) participated in semi-structured interviews. METHODS The data were analysed using an inductive approach to reflexive thematic analysis. RESULTS Four themes were derived from the data. While two themes reflected social support as a form of caring (Mutual Investment and Positive Reinforcements), the other two themes indicated aspects of sabotage (Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes). Transcending these themes was the notion of Bariatric Surgery as an Opportunity or Threat to the Relationship. CONCLUSIONS Some patients perceived social support as a positive resource in BS success involving Mutual Investment from their partners and being offered Positive Reinforcements for changes in their weight status and wellbeing. Some, however, described more negative aspects of support which had undermined their BS goals, either unintentionally or intentionally, through acts of sabotage including Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes. Future research should develop interventions to help prepare the partners of those undergoing BS for the changes to both their partner's weight status and the dynamics of their relationship.
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Affiliation(s)
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, Surrey, UK
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118
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Botdorf M, Dickinson K, Lorman V, Razzaghi H, Marchesani N, Rao S, Rogerson C, Higginbotham M, Mejias A, Salyakina D, Thacker D, Dandachi D, Christakis DA, Taylor E, Schwenk H, Morizono H, Cogen J, Pajor NM, Jhaveri R, Forrest CB, Bailey LC. EHR-based Case Identification of Pediatric Long COVID: A Report from the RECOVER EHR Cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.23.24307492. [PMID: 38826460 PMCID: PMC11142266 DOI: 10.1101/2024.05.23.24307492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Objective Long COVID, marked by persistent, recurring, or new symptoms post-COVID-19 infection, impacts children's well-being yet lacks a unified clinical definition. This study evaluates the performance of an empirically derived Long COVID case identification algorithm, or computable phenotype, with manual chart review in a pediatric sample. This approach aims to facilitate large-scale research efforts to understand this condition better. Methods The algorithm, composed of diagnostic codes empirically associated with Long COVID, was applied to a cohort of pediatric patients with SARS-CoV-2 infection in the RECOVER PCORnet EHR database. The algorithm classified 31,781 patients with conclusive, probable, or possible Long COVID and 307,686 patients without evidence of Long COVID. A chart review was performed on a subset of patients (n=651) to determine the overlap between the two methods. Instances of discordance were reviewed to understand the reasons for differences. Results The sample comprised 651 pediatric patients (339 females, M age = 10.10 years) across 16 hospital systems. Results showed moderate overlap between phenotype and chart review Long COVID identification (accuracy = 0.62, PPV = 0.49, NPV = 0.75); however, there were also numerous cases of disagreement. No notable differences were found when the analyses were stratified by age at infection or era of infection. Further examination of the discordant cases revealed that the most common cause of disagreement was the clinician reviewers' tendency to attribute Long COVID-like symptoms to prior medical conditions. The performance of the phenotype improved when prior medical conditions were considered (accuracy = 0.71, PPV = 0.65, NPV = 0.74). Conclusions Although there was moderate overlap between the two methods, the discrepancies between the two sources are likely attributed to the lack of consensus on a Long COVID clinical definition. It is essential to consider the strengths and limitations of each method when developing Long COVID classification algorithms.
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Affiliation(s)
- Morgan Botdorf
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Vitaly Lorman
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nicole Marchesani
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Denver, CO
| | - Colin Rogerson
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Miranda Higginbotham
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH
| | - Daria Salyakina
- Center for Precision Medicine, Nicklaus Children’s Hospital, Miami, FL
| | - Deepika Thacker
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Dima Dandachi
- Division of Infectious Diseases, Department of Medicine, University of Missouri-Columbia, Columbia, MO
| | - Dimitri A Christakis
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA
| | - Emily Taylor
- New York University Grossman School of Medicine Department of Medicine New York, NY
| | - Hayden Schwenk
- Stanford School of Medicine, Division of Pediatric Infectious Diseases, Stanford, CA
| | - Hiroki Morizono
- Center for Genetic Medicine Research, Children’s National Hospital, Washington, DC
| | - Jonathan Cogen
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Nate M Pajor
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati OH
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA
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Liu D, Hong Y, Chen Z, Ma Y, Xia S, Gu S, Zuo H. The Tryptophan Index Is Associated with Risk of Ischemic Stroke: A Community-Based Nested Case-Control Study. Nutrients 2024; 16:1544. [PMID: 38892478 PMCID: PMC11174068 DOI: 10.3390/nu16111544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The relative availability of the essential amino acid tryptophan in the brain, as indicated by the tryptophan index, which is the ratio of tryptophan to its competing amino acids (CAAs) in circulation, has been related to major depression. However, it remains unknown whether tryptophan availability is involved in the pathogenesis of ischemic stroke. AIMS We aimed to investigate the relationship between the tryptophan index and the risk of ischemic stroke. METHODS We performed a nested case-control study within a community-based cohort in eastern China over the period 2013 to 2018. The analysis included 321 cases of ischemic stroke and 321 controls matched by sex and date of birth. The plasma levels of tryptophan and CAAs, including tyrosine, valine, phenylalanine, leucine, and isoleucine, were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry. Conditional logistic regression analyses were employed to determine incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). RESULTS After adjustment for body mass index, current smoking status, educational attainment, physical activity, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated glomerular filtration rate, an elevated tryptophan index was significantly associated with a reduced risk of ischemic stroke in a dose-response manner (IRR, 0.76; 95% CI, 0.63-0.93, per standard deviation increment). The plasma tryptophan or CAAs were not separately associated with the risk of ischemic stroke. CONCLUSIONS The tryptophan index was inversely associated with the risk of ischemic stroke. Our novel observations suggest that the availability of the essential amino acid tryptophan in the brain is involved in the pathogenesis of ischemic stroke.
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Affiliation(s)
- Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren’ai Rd., Suzhou 215123, China;
- School of Public Health, Nantong University, Nantong 226019, China;
| | - Yan Hong
- School of Public Health, Nantong University, Nantong 226019, China;
| | - Zhenting Chen
- Suzhou Medical College of Soochow University, Suzhou 215123, China; (Z.C.); (Y.M.); (S.X.)
| | - Yifan Ma
- Suzhou Medical College of Soochow University, Suzhou 215123, China; (Z.C.); (Y.M.); (S.X.)
| | - Shangyu Xia
- Suzhou Medical College of Soochow University, Suzhou 215123, China; (Z.C.); (Y.M.); (S.X.)
| | - Shujun Gu
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou 215501, China;
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, 199 Ren’ai Rd., Suzhou 215123, China;
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-Communicable Diseases, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
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Finkle C, Bai Y, Chandra-Mouli V, O'Keefe S, Tetui M, Fischer S, Lokko K, Mwaikambo L, Ohkubo S. The Challenge Initiative: Lessons on Rapid Scale-Up of Family Planning and Adolescent and Youth Sexual and Reproductive Health Services. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2400153. [PMID: 38772721 PMCID: PMC11111109 DOI: 10.9745/ghsp-d-24-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
The articles in this supplement showcase The Challenge Initiative’s strategies and insights for sustainably scaling evidence-based family planning and adolescent and youth sexual and reproductive health interventions and emphasize the need for multipronged interventions that address the complex web of factors influencing adolescents’ and youth’s access to contraceptive services.
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Affiliation(s)
| | - Yacine Bai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Venkatraman Chandra-Mouli
- Formerly of the Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Moses Tetui
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Kojo Lokko
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Lisa Mwaikambo
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Saori Ohkubo
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
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Sarmiento I, Cockcroft A, Dion A, Belaid L, Silver H, Pizarro K, Pimentel J, Tratt E, Skerritt L, Ghadirian MZ, Gagnon-Dufresne MC, Andersson N. Fuzzy cognitive mapping in participatory research and decision making: a practice review. Arch Public Health 2024; 82:76. [PMID: 38769567 PMCID: PMC11103993 DOI: 10.1186/s13690-024-01303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. RESULTS The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. CONCLUSIONS A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.
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Affiliation(s)
- Iván Sarmiento
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.
- Universidad del Rosario, Grupo de Estudios en Sistemas Tradicionales de Salud, Bogota, Colombia.
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna Dion
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Loubna Belaid
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Hilah Silver
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Katherine Pizarro
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Juan Pimentel
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Elyse Tratt
- Institut Lady Davis pour la Recherche Médicale, Montreal, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Mona Z Ghadirian
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Marie-Catherine Gagnon-Dufresne
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Saragosa M, Goraya F, Serrano F, Nowrouzi-Kia B, Guilcher S, Abdul Aziz Y, Gohar B. From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives. Healthcare (Basel) 2024; 12:1050. [PMID: 38786460 PMCID: PMC11120773 DOI: 10.3390/healthcare12101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.
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Affiliation(s)
- Marianne Saragosa
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Farwa Goraya
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Frances Serrano
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Sara Guilcher
- Department of Physical Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Yasmin Abdul Aziz
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
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Ampiah JA, Moffatt F, Diver CJ, Ampiah PK. 'Specialist before physiotherapist': physicians' and physiotherapists' beliefs and management of chronic low back pain in Ghana - A qualitative study. Disabil Rehabil 2024:1-11. [PMID: 38767467 DOI: 10.1080/09638288.2024.2356005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE This study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices. MATERIALS/METHODS Thirty-three individual semi-structured interviews, involving eighteen physio-therapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy. RESULTS Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs' knowledge) and sociocultural environment (sociocultural/patients' expectations of passive therapy and paternalism). CONCLUSION The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs' CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, Institute of Health and Social Care, London South Bank University, London, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire J Diver
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Health Sciences, Division of Physiotherapy, College of Health, Medicine and Life Sciences, Brunel University, London, UK
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Xianyu F, Huang Y, Guo S, Chongsuvivatwong V. Evaluating Treatment Outcomes and Tuberculosis Infection Risks: A Comparative Study of Centralized Hospitalization vs. Home-Based Treatment. Trop Med Infect Dis 2024; 9:119. [PMID: 38787052 PMCID: PMC11125710 DOI: 10.3390/tropicalmed9050119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Guizhou Province in Southwest China has experimented with a centralized hospitalization (CH) treatment for active and severe cases of pulmonary tuberculosis (PTB). The objective of this study was to compare treatment outcomes of patients with tuberculosis (TB) receiving care in a CH setting with those receiving home-based (HB) care. In addition, this study aimed to assess the probability of their household contacts contracting tuberculosis infection. Method: A retrospective review of medical records was undertaken for patients with TB who completed their treatment in four counties in Guizhou, China, spanning from January 2022 to August 2023. In addition, a cross-sectional survey was conducted on the tuberculin skin test (TST) among household contacts of new patients with TB who had completed their treatment. Results: In the retrospective study, 94.8% had successful CH treatment, and 93.1% had successful HB treatment (p value = 0.70). In the prospective study, 559 and 448 household contacts of patients receiving CH treatment had 16 positive and 89 negative TST results, whereas those with HB treatment showed 26 positive and 74 negative TST results. Regarding a logistic regression analysis, the CH group was nearly two times more likely to test negative on the TST, 1.95 (95% CI: 0.98, 3.92). After adjusting for confounding variables, the odds ratio increased significantly to 4.42 (95% CI: 1.22, 16.04). Conclusions: CH for treatment of TB did not show superior success rates, but it may reduce the risk of transmitting tuberculosis infection to household contacts compared to home treatment.
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Affiliation(s)
- Fangming Xianyu
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Yuemei Huang
- Guizhou Medical University, Guiyang 550031, China
| | - Shengqiong Guo
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
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Tang D, Ma C, Xu Y. Interpretable machine learning model for early prediction of delirium in elderly patients following intensive care unit admission: a derivation and validation study. Front Med (Lausanne) 2024; 11:1399848. [PMID: 38828233 PMCID: PMC11140063 DOI: 10.3389/fmed.2024.1399848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Background and objective Delirium is the most common neuropsychological complication among older adults admitted to the intensive care unit (ICU) and is often associated with a poor prognosis. This study aimed to construct and validate an interpretable machine learning (ML) for early delirium prediction in older ICU patients. Methods This was a retrospective observational cohort study and patient data were extracted from the Medical Information Mart for Intensive Care-IV database. Feature variables associated with delirium, including predisposing factors, disease-related factors, and iatrogenic and environmental factors, were selected using least absolute shrinkage and selection operator regression, and prediction models were built using logistic regression, decision trees, support vector machines, extreme gradient boosting (XGBoost), k-nearest neighbors and naive Bayes methods. Multiple metrics were used for evaluation of performance of the models, including the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, recall, F1 score, calibration plot, and decision curve analysis. SHapley Additive exPlanations (SHAP) were used to improve the interpretability of the final model. Results Nine thousand seven hundred forty-eight adults aged 65 years or older were included for analysis. Twenty-six features were selected to construct ML prediction models. Among the models compared, the XGBoost model demonstrated the best performance including the highest AUC (0.836), accuracy (0.765), sensitivity (0.713), recall (0.713), and F1 score (0.725) in the training set. It also exhibited excellent discrimination with AUC of 0.810, good calibration, and had the highest net benefit in the validation cohort. The SHAP summary analysis showed that Glasgow Coma Scale, mechanical ventilation, and sedation were the top three risk features for outcome prediction. The SHAP dependency plot and SHAP force analysis interpreted the model at both the factor level and individual level, respectively. Conclusion ML is a reliable tool for predicting the risk of critical delirium in elderly patients. By combining XGBoost and SHAP, it can provide clear explanations for personalized risk prediction and more intuitive understanding of the effect of key features in the model. The establishment of such a model would facilitate the early risk assessment and prompt intervention for delirium.
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Affiliation(s)
| | - Chengyong Ma
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Markey K, Msowoya U, Burduladze N, Salsberg J, MacFarlane A, Dore L, Gilfoyle M. Antecedents and Consequences of Health Literacy among Refugees and Migrants during the First Two Years of COVID-19: A Scoping Review. Trop Med Infect Dis 2024; 9:116. [PMID: 38787049 PMCID: PMC11126087 DOI: 10.3390/tropicalmed9050116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Supporting refugee and migrant health has become a critical focus of healthcare policy. Developing and designing health literacy interventions that meet the needs of refugees and migrants is core to achieving this objective. This literature review sought to identify antecedents and consequences of health literacy among refugees and migrants during the first two years of the COVID-19 pandemic. We systematically searched nine electronic databases and numerous grey literature sources to identify studies published between December 2019 and March 2022. The antecedents (societal and environmental determinants, situational determinants, and personal determinants) and consequences of health literacy among refugees and migrants were mapped to a validated integrated health literacy model. Social and environmental determinants (n = 35) were the most reported antecedent influencing health literacy among refugees and migrants during the first two years of COVID-19. Language (n = 26) and culture (n = 16) were these determinants' most frequently reported aspects. Situational determinants (n = 24) and personal determinants (n = 26) were less frequently identified factors influencing health literacy among refugees and migrants. Literacy (n = 11) and socioeconomic status (n = 8) were the most frequently reported aspects of personal determinants. Media use (n = 9) and family and peer influence (n = 7) were the most cited situational determinants reported. Refugees and migrants with higher levels of health literacy were more likely to use healthcare services, resulting in better health outcomes. The findings of this review reveal personal and situational factors that impacted health literacy among refugees and migrants during COVID-19 that require attention. However, the inadequate adaptation of health literacy interventions for linguistic and cultural diversity was a greater problem. Attention to this well-known aspect of public health preparedness and tailoring health literacy interventions to the needs of refugees and migrants during pandemics and other public health emergencies are paramount.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery and Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Uchizi Msowoya
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Nino Burduladze
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Jon Salsberg
- School of Medicine and Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Anne MacFarlane
- School of Medicine and Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Liz Dore
- Glucksman Library, University of Limerick, V94 T9PX Limerick, Ireland
| | - Meghan Gilfoyle
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON M5S 1B2, Canada
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Głuszek-Osuch M, Cieśla E, Suliga E. Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study. BMC Oral Health 2024; 24:559. [PMID: 38741112 DOI: 10.1186/s12903-024-04337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. METHODS An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. RESULTS The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms. CONCLUSIONS The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.
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Affiliation(s)
- Martyna Głuszek-Osuch
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Elżbieta Cieśla
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Edyta Suliga
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
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Azizy AH, Thontowi HB. Stigma, Support, and Ideation About Suicide in Indonesian Twitter: A Topic Modelling Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241253972. [PMID: 38739857 DOI: 10.1177/00302228241253972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Stigma surrounding suicide is a massive problem in Indonesia. Thus, it is important to study how conversations about suicide take place. We take a machine learning approach and study tweets with suicide keywords to understand how people converse about suicide or express suicide ideation. Tweets with suicide-related keywords were extracted from May to June 2023. 20,057 tweets were subject to topic modelling with an 11-topic solution. While most topics contain negative messages, no purely stigmatizing topics emerge, despite prior research suggesting overwhelming stigma. Various kinds of existential, emotional, and social tweets about suicide take place among Indonesian users, indicating that Indonesian Twitter users utilize the platform to express their thoughts and emotions. Notably, religious-spiritual keywords are highly prevalent, suggesting that in a highly religious society, there is a need for policy makers and awareness campaigns to frame their positive messaging within the society's religious context.
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Affiliation(s)
- Afrizal Hasbi Azizy
- Center for Indigenous and Cultural Psychology, Universitas Gadjah Mada, Sleman, Indonesia
| | - Haidar Buldan Thontowi
- Center for Indigenous and Cultural Psychology, Universitas Gadjah Mada, Sleman, Indonesia
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Yasopa O, Homkham N, Chompook P. Factors affecting the number of influenza patients before and during COVID-19 pandemic, Thailand. PLoS One 2024; 19:e0303382. [PMID: 38728241 PMCID: PMC11086856 DOI: 10.1371/journal.pone.0303382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
This study was aimed to explore the association between potential factors including public health and social measures and the number of influenza patients in Thailand between 2014-2021. Secondary data from relevant agencies were collected. Generalized Estimating Equation (GEE) and regression coefficient (β) were performed at a significance level of 0.05. We found factors associated with number of influenza patients during the time prior to COVID-19 pandemic were monthly income per household (Adjusted β = -0.02; 95% CI: -0.03, -0.01), population density (Adjusted β = 1.00; 95% CI: 0.82, 1.18), rainy season (Adjusted β = 137.15; 95% CI: 86.17, 188.13) and winter time (Adjusted β = 56.46; 95% CI: 3.21, 109.71). During the time of COVID-19 pandemic, population density (Adjusted β = 0.20; 95% CI: 0.15, 0.26), rainy season (Adjusted β = -164.23; 95% CI: -229.93, -98.52), winter time (Adjusted β = 61.06; 95% CI: 0.71, 121.41), public health control measures (prohibition of entering to into an area with high number of COVID-19 infections (Adjusted β = -169.34; 95% CI: -233.52, -105.16), and restriction of travelling also reduced the number of influenza patients (Adjusted β = -66.88; 95% CI: -125.15, -8.62) were associated with number of influenza patients. This study commends strategies in monitoring influenza patients to focus on the areas with low income, high population density, and in specific seasons. Public health and social measures which can be implemented are prohibition of entering to risk-areas (lock down), and restriction of travelling across provinces which their effectiveness in reducing influenza infections.
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Affiliation(s)
- Oiythip Yasopa
- Department of Disease Control, Division of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Pornthip Chompook
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
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Bafageeh F, Loux T. Depression Symptoms Linked to Multiple Oral Health Outcomes in US Adults. JDR Clin Trans Res 2024:23800844241246225. [PMID: 38733119 DOI: 10.1177/23800844241246225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Individuals with mental illness have poor oral health compared to those without mental health conditions. However, the literature is still lacking regarding the specifics of this relationship. OBJECTIVE This study aims at examining the relationship between depression and oral health problems such as oral conditions, access to dental care, and oral hygiene measures. METHODS A cross-sectional study using a secondary data analysis of 9,693 participants from the 2017 to March 2020 prepandemic National Health and Nutrition Examination Survey (NHANES). The independent variable was severity of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9). Proportional odds and binary logistic regression were used to calculate crude and adjusted odds ratios (AORs) between depression and 8 oral health outcomes and oral hygiene-related behaviors. RESULTS After adjusting for sociodemographics, health conditions, and behaviors, individuals with depression were significantly more likely to have dental aches in the past year (AOR = 1.70; 95% confidence interval [CI], 1.13-2.56), difficulty getting dental care when needed (AOR = 1.93; 95% CI, 1.45-2.58), and difficulty at their jobs due to a problem in their mouth (AOR = 1.63; 95% CI, 1.07-2.49) compared to individuals without depression. CONCLUSION Individuals with depressive symptoms often neglect oral hygiene and self-care practices and are less likely to seek medical care for oral health problems, making them at increased risk of poor oral health outcomes. These findings can be applied by dentists, psychologists, and therapists to increase awareness of links between depression and oral health and to encourage patients with depression to seek oral hygiene preventative care. KNOWLEDGE TRANSFER STATEMENT Health care professionals can be on the frontline in creating awareness in the general public about the links between depression and oral health and hygiene. Applying the findings from this study can help communicate about the relationship between depression and poor oral health and relieve some burden on the American health care sector, which often struggles to provide medical care to patients with depression and oral health issues.
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Affiliation(s)
- F Bafageeh
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - T Loux
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
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McCauley S, Stothers S, Semple C. Evaluation of patient satisfaction of receiving Systemic Anti-Cancer Therapy prescribed by nurse Non-Medical Prescribers. Eur J Oncol Nurs 2024; 70:102597. [PMID: 38795439 DOI: 10.1016/j.ejon.2024.102597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To evaluate patient satisfaction of patients receiving Systemic Anti-Cancer Treatment prescribed by nurse Non-Medical Prescribers as a new model of care at a Cancer Unit in Northern Ireland, United Kingdom. METHODS A cross-sectional survey design, with a convenience sample of patients from five tumour groups who received Systemic Anti-Cancer Therapy by nurse Non-Medical Prescribers, across a 3-month period in 2022 was employed. Anonymised data were collected via postal survey, which incorporated a minimally modified version of the 45-item Leeds Satisfaction Questionnaire (LSQ). RESULTS One-hundred and sixteen surveys were returned, yielding a 36% response rate. Overall patients' satisfaction levels with nurse non-medical prescribing of systemic anti-cancer therapy were high across all six subscales of the modified LSQ corroborated by qualitative free-text comments. Eighty-five percent of participants indicated they were happy to continue being prescribed systemic anti-cancer therapy by the nurse non-medical prescribers. CONCLUSION Overall patient satisfaction of Systemic Anti-Cancer Treatment prescribed by nurse Non-Medical Prescribers was positively rated; with high standards of compassionate, person-centred care reported, demonstrating an acceptable transformation in care delivery from a consultant-led model. Nonetheless, there was scope for improved health literacy to enhance patients' understanding and compliance with treatment.
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Affiliation(s)
- Sarah McCauley
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK.
| | - Sheena Stothers
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK; Institute of Nursing and Health Research, Ulster University, York Street, Belfast, Northern Ireland, BT15 1AP, UK
| | - Cherith Semple
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK; Institute of Nursing and Health Research, Ulster University, York Street, Belfast, Northern Ireland, BT15 1AP, UK
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Fiorini G, Pellegrini G, Franchi M, Rigamonti AE, Marazzi N, Sartorio A, Corrao G, Cella SG. Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study. BMJ Open 2024; 14:e078431. [PMID: 38724060 PMCID: PMC11086564 DOI: 10.1136/bmjopen-2023-078431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases. DESIGN Retrospective cohort study. SETTING A big non-governmental organisation in Milano, Italy, giving medical assistance to undocumented migrants. PARTICIPANTS 1918 patients, 998 females and 920 males, with at least one chronic condition (diabetes, cardiovascular diseases (CVDs), mental health disorders) seen over a period of 10 years (2011-2020). Their mean age was 49.2±13 years. RESULTS Adherence to medications decreased over 1 year in all patients. This was more evident during the first 2 months of treatment. Patients on only one medication were less adherent than those on more than one medication; at 6 months the percentage of patients with high adherence was 33% vs 57% (p<0.0001) for diabetes, 15% vs 46% (p<0.0001) for mental disorders and 35% vs 59% (p<0.0001) for CVDs. Patients with mental disorders had the lowest adherence: 25% at 6 months and 3% at 1 year. Mental disorders, when present as comorbidities, greatly reduced the probability of being highly adherent: risk ratio (RR) 0.72 (95% CI 0.57 to 0.91; p=0.006) at 3 months, RR 0.77, (95% CI 0.59 to 1.01; p=0.06) at 6 months, RR 0.35 (95% CI 0.13 to 0.94; p=0.04) at 1 year. This was especially evident for patients with CVDs, whose percentage of high adherents decreased to 30% (p=0.0008) at 6 months and to 3% (p=0.01) at 1 year. We also noted that highly adherent patients usually were those most frequently seen by a doctor. CONCLUSIONS Interventions to increase medication adherence of undocumented migrants with chronic diseases are necessary, particularly in the first 2 months after beginning treatment. These should be aimed at people-centred care and include more outpatient consultations. Educational interventions should especially be taken into consideration for patients on monotherapy.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi Spa, Monza, Italy
- Università degli Studi di Milano, Milano, Italy
| | | | | | | | - Nicoletta Marazzi
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
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Barrett M, Spires M, Vogel C. The Healthy Start scheme in England "is a lifeline for families but many are missing out": a rapid qualitative analysis. BMC Med 2024; 22:177. [PMID: 38715000 PMCID: PMC11077836 DOI: 10.1186/s12916-024-03380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.
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Affiliation(s)
- Millie Barrett
- Centre for Food Policy, City, University of London, London, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
| | - Mark Spires
- Centre for Food Policy, City, University of London, London, UK
| | - Christina Vogel
- Centre for Food Policy, City, University of London, London, UK
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
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134
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Khoury G, Ward JK, Mancini J, Gagneux-Brunon A, Luong Nguyen LB. Health Literacy and Health Care System Confidence as Determinants of Attitudes to Vaccines in France: Representative Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e45837. [PMID: 38713494 PMCID: PMC11109853 DOI: 10.2196/45837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 10/05/2023] [Accepted: 01/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Health literacy involves individuals' knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community. OBJECTIVE This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors. METHODS We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents' different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis. RESULTS Among the participants, 440.4 (21.8%) were classified as "distrustful of vaccines in general," 729.2 (36.1%) were "selectively hesitant," and 852.4 (42.2%) were "nonhesitant." In our model, the level of health literacy was not statistically different between the "distrustful of vaccines in general" and the "selectively hesitant" (P=.48), but it was associated with being a "nonhesitant" (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a "nonhesitant" attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model. CONCLUSIONS Health literacy was associated with a "nonhesitant" attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population's confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens.
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Affiliation(s)
- Georges Khoury
- CIC Cochin Pasteur, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremy K Ward
- Cermes3, CNRS, INSERM, Université Paris Cité, Paris, France
| | - Julien Mancini
- Cancer, Biomedicine & Society Group, APHM, Hop Timone, Public Health Department (BIOSTIC), INSERM, IRD, ISSPAM, SESSTIM, Aix-Marseille University, Marseille, France
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Inserm, U1111, CNRS, UMR530, CHU de Saint-Etienne, Saint-Etienne, France
| | - Liem Binh Luong Nguyen
- CIC Cochin Pasteur, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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135
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Gam NP, Sibiya MN. Doctors' perspectives on the quality of medical imaging in public hospitals in eThekwini District. Health SA 2024; 29:2389. [PMID: 38841359 PMCID: PMC11151430 DOI: 10.4102/hsag.v29i0.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/28/2023] [Indexed: 06/07/2024] Open
Abstract
Background There is a paucity of literature on perspectives of referring doctors about the quality of medical imaging services and this study closes this gap in literature. Aim This quality assurance (QA) study aimed to explore the perspectives of doctors on the quality of medical imaging services in selected regional hospitals within eThekwini District of KwaZulu-Natal. Setting The study was conducted in four public regional hospitals. Methods An exploratory descriptive qualitative research design involving 30 min-45 min of in-depth individual interviews was used. A purposive sampling technique was used to select research participants and hospitals to ensure adequate responses to the research questions. The sample involved nine participants and was guided by data saturation. Responses were recorded through notes and voice recordings and thematic analysis was used to analyse data. Results Three main themes (timeliness of examinations, communication and radiology reports and image quality) and eight subthemes (waiting times, shortage of radiographers, workload, communication between doctors and radiographers, requisition forms, unavailability of radiology reports, clarity of images and image acquisition protocols) emerged from the data. Challenges experienced were exacerbated by high workload and shortage of radiologists and radiographers. Doctors in the data collection sites were mainly dissatisfied with services provided by the medical imaging departments. Conclusion Regular engagements between medical imaging departments and doctors are important in enhancing the provision of quality care to patients. In-service training of radiographers and employment of additional radiographers and finding solutions to mitigate shortage of radiologists are recommended. Contribution This quality assurance (QA) study focused on experiences of doctors while many other medical imaging QA studies in South Africa are equipment based. In-service training of radiographers is recommended to improve image quality and communication skills.
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Affiliation(s)
- Nkululeko P Gam
- Centre for Quality Promotion and Assurance, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N Sibiya
- Division of Research, Innovation and Engagement, Mangosuthu University of Technology, Durban, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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136
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Cruickshank A, Brooks ED, Sperling C, Nelson MLA, Singh H. Exploring the experiences of adults with stroke in virtual community-based stroke programs: a qualitative descriptive study. BMC Health Serv Res 2024; 24:600. [PMID: 38715062 PMCID: PMC11077787 DOI: 10.1186/s12913-024-11043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Stroke is among the top contributors to disability and can impact an individual's cognition, physical functioning, and mental health. Since the COVID-19 pandemic, several community-based organizations have started delivering stroke programs virtually. However, participants' experiences in these programs remain understudied, and evidence-based guidelines to inform and optimize virtual stroke program development and delivery are lacking. Thus, this study aimed to describe the perspectives and experiences of individuals with stroke who participated in virtual community-based organization stroke programs, including perceived access and participation facilitators and barriers and suggestions for improving these programs. METHODS A qualitative descriptive design was used to gather participant experiences through semi-structured interviews. Audio-recorded interviews were conducted on Zoom and transcribed verbatim. Adult participants who had experienced a stroke and attended at least one Canadian virtual community-based organization stroke program were recruited. Data were analyzed using inductive thematic analysis. RESULTS Twelve participants (32-69 years, 2-23 years post-stroke, eight women and four men) participated in this study. Five themes were identified: (1) motives to join virtual community-based organization stroke programs, including gaining peer connections, knowledge and information; (2) perceived barriers to accessing and participating in virtual community-based organization stroke programs, including technology inequities, difficulties navigating technology, and inadequate facilitation; (3) perceived facilitators to accessing and participating in virtual community-based organization stroke programs, including remote access, virtual platform features and program leader characteristics/skills; (4) unmet needs during virtual community-based organization stroke programs, including in-person connection and individualized support; and (5) suggestions and preferences for improving virtual community-based organization stroke programs, including program facilitation, content and format. CONCLUSIONS Study findings highlight opportunities to improve virtual community-based organization stroke programs to optimize participant experiences and outcomes. Addressing the barriers and suggestions identified in this study may improve virtual community-based organization stroke programs' access and quality.
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Affiliation(s)
- Amy Cruickshank
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Emma D'Andrea Brooks
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Christina Sperling
- March of Dimes Canada, 202-885 Don Mills Rd., Toronto, ON, M3C 1V9, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Dr, Toronto, ON, M4G 3V9, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
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Gilca R, Amini R, Carazo S, Doggui R, Frenette C, Boivin G, Charest H, Dumaresq J. The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study. JMIR Public Health Surveill 2024; 10:e40792. [PMID: 38709551 DOI: 10.2196/40792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/15/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. OBJECTIVE This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. METHODS We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. RESULTS During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. CONCLUSIONS Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.
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Affiliation(s)
- Rodica Gilca
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, QC, Canada
- Research Center of Centre hospitalier universitaire de Québec-Université Laval, Québec, QC, Canada
- Département de médecine préventive, Université Laval, Québec, QC, Canada
| | - Rachid Amini
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Sara Carazo
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, QC, Canada
- Research Center of Centre hospitalier universitaire de Québec-Université Laval, Québec, QC, Canada
- Département de médecine préventive, Université Laval, Québec, QC, Canada
| | - Radhouene Doggui
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Charles Frenette
- Department of Medicine, Division of Infectious Diseases, McGill University Health Center, Montreal, QC, Canada
| | - Guy Boivin
- Research Center of Centre hospitalier universitaire de Québec-Université Laval, Québec, QC, Canada
| | - Hugues Charest
- Laboratoire de santé publique, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jeannot Dumaresq
- Departement of Microbiology and Infectiology, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Levis, QC, Canada
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Pepper A, Dening KH. Community support for families affected by dementia. Br J Community Nurs 2024; 29:218-223. [PMID: 38701008 DOI: 10.12968/bjcn.2024.29.5.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This paper provides and overview of the community support services that may be available for people with dementia and their family carers. The authors introduce dementia, including the impact of the diagnosis on both the person with dementia and the wider family. Using a case study approach, the authors describe the support available, spanning health and social care and third sector organisations. They discuss how this support can enable people with dementia and their carers to maintain wellbeing and cope with the impact of dementia. This article will be of interest to community nurses, and health and social care professionals more generally, who may encounter families affected by dementia in community settings. Having a good knowledge of the support available and how to access it will allow community nurses to capitalise on the health promotion opportunities presented to them, when they come into contact with families affected by dementia in the course of their day-to-day practice.
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Affiliation(s)
- Amy Pepper
- Admiral Nurse and Research Fellow, Dementia UK, Floor 7, One Aldgate, London, EC3N 1RE
| | - Karen Harrison Dening
- Head of Research and Publications; Chair of Dementia Nursing (honorary), De Montfort University, The Gateway, Leicester, LE1 9BH
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139
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Xie Z, Shi L, He L. Depression and dental caries in US adults, NHANES 2015-2018. BMC Oral Health 2024; 24:520. [PMID: 38698375 PMCID: PMC11067126 DOI: 10.1186/s12903-024-04288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE This study aimed to investigate the link between depression and untreated dental caries among adults in the United States. METHODS Data were collected from the National Health and Nutrition Survey (2015-2018); respondents aged 20 years or older who completed a patient health questionnaire and underwent a comprehensive oral examination were included. Participants were categorized into three groups according to depressive symptoms as follows: those with no, mild, or moderate to severe depression. Data were weighted, and multiple potential covariates were included in the analysis to provide national estimates and account for the complex sample design. A multivariable weighted logistic regression model was performed to test the hypothesis that varying degrees of depression in American adults are associated with untreated dental caries. Subgroup analyses were performed based on age and gender after adjusting for potential covariates. A P value of <.05 was considered significant. RESULTS Among 8740 participants, the prevalence of untreated coronal and root caries was 20.50% and 12.92%, respectively. Moderate to severe depression was a significant risk factor (odds ratio, 1.25; 95% confidence interval, 1.09-1.66) for untreated root caries. The risk of untreated root caries increased by 87% in young adults (aged 20-44 years) and by 46% in women with moderate to severe depression. The suest analysis revealed that the impact of moderate to severe depressive disorder on untreated root caries was non-significantly different between the age subgroup (p=0.09) and sex subgroup (p=0.51). However, depression was non-significantly associated with untreated coronal caries (mild depression: OR, 1.07; 95% CI, 0.85-1.34; moderate to severe depression 1.06; 95% CI, 0.83-1.36; respectively). CONCLUSION The results of this study suggested a significant association between moderate and severe depression and untreated root caries; however, the association with untreated coronal caries was non-significant. In the United States, moderate and severe depression in adults is associated with root caries.
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Affiliation(s)
- Zefeng Xie
- Department of Stomatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingfang Shi
- Department of Stomatology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Libo He
- Department of Stomatology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
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Lee KE, Lee J, Lee SM, Lee HY. Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19. Korean J Intern Med 2024; 39:477-487. [PMID: 38632896 PMCID: PMC11076898 DOI: 10.3904/kjim.2023.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/19/2023] [Accepted: 12/01/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND/AIMS Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19. METHODS This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness. RESULTS In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality. CONCLUSION Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.
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Affiliation(s)
- Kyung-Eui Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sang-Min Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul,
Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul,
Korea
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Lim B, Chai A, Shaalan M. A Cross-Sectional Analysis of the Readability of Online Information Regarding Hip Osteoarthritis. Cureus 2024; 16:e60536. [PMID: 38887325 PMCID: PMC11181007 DOI: 10.7759/cureus.60536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Osteoarthritis (OA) is an age-related degenerative joint disease. There is a 25% risk of symptomatic hip OA in patients who live up to 85 years of age. It can impair a person's daily activities and increase their reliance on healthcare services. It is primarily managed with education, weight loss and exercise, supplemented with pharmacological interventions. Poor health literacy is associated with negative treatment outcomes and patient dissatisfaction. A literature search found there are no previously published studies examining the readability of online information about hip OA. Objectives To assess the readability of healthcare websites regarding hip OA. Methods The terms "hip pain", "hip osteoarthritis", "hip arthritis", and "hip OA" were searched on Google and Bing. Of 240 websites initially considered, 74 unique websites underwent evaluation using the WebFX online readability software (WebFX®, Harrisburg, USA). Readability was determined using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Reading Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). In line with recommended guidelines and previous studies, FRES >65 or a grade level score of sixth grade and under was considered acceptable. Results The average FRES was 56.74±8.18 (range 29.5-79.4). Only nine (12.16%) websites had a FRES score >65. The average FKGL score was 7.62±1.69 (range 4.2-12.9). Only seven (9.46%) websites were written at or below a sixth-grade level according to the FKGL score. The average GFI score was 9.20±2.09 (range 5.6-16.5). Only one (1.35%) website was written at or below a sixth-grade level according to the GFI score. The average SMOG score was 7.29±1.41 (range 5.4-12.0). Only eight (10.81%) websites were written at or below a sixth-grade level according to the SMOG score. The average CLI score was 13.86±1.75 (range 9.6-19.7). All 36 websites were written above a sixth-grade level according to the CLI score. The average ARI score was 6.91±2.06 (range 3.1-14.0). Twenty-eight (37.84%) websites were written at or below a sixth-grade level according to the ARI score. One-sample t-tests showed that FRES (p<0.001, CI -10.2 to -6.37), FKGL (p<0.001, CI 1.23 to 2.01), GFI (p<0.001, CI 2.72 to 3.69), SMOG (p<0.001, CI 0.97 to 1.62), CLI (p<0.001, CI 7.46 to 8.27), and ARI (p<0.001, CI 0.43 to 1.39) scores were significantly different from the accepted standard. One-way analysis of variance (ANOVA) testing of FRES scores (p=0.009) and CLI scores (p=0.009) showed a significant difference between categories. Post hoc testing showed a significant difference between academic and non-profit categories for FRES scores (p=0.010, CI -15.17 to -1.47) and CLI scores (p=0.008, CI 0.35 to 3.29). Conclusions Most websites regarding hip OA are written above recommended reading levels, hence exceeding the comprehension levels of the average patient. Readability of these resources must be improved to improve patient access to online healthcare information which can lead to improved patient understanding of their own condition and treatment outcomes.
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Affiliation(s)
- Brandon Lim
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Ariel Chai
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Mohamed Shaalan
- Department of Orthopaedics and Traumatology, The Mater Misericordiae University Hospital, Dublin, IRL
- Department of Trauma and Orthopaedics, St James's Hospital, Dublin, IRL
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Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM, Moore EJ. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. J Telemed Telecare 2024; 30:739-746. [PMID: 35549759 DOI: 10.1177/1357633x221095319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center. METHODS A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit. RESULTS There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed. CONCLUSION Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
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Affiliation(s)
- Luis A Antezana
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Katherine Z Xie
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley M Nassiri
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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143
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Tipre M, Scarinci IC, Pandya VN, Kim YI, Bae S, Peral S, Hardy C, Baskin ML. Attitudes toward telemedicine among urban and rural residents. J Telemed Telecare 2024; 30:722-730. [PMID: 35578537 DOI: 10.1177/1357633x221094215] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Adoption of telemedicine by healthcare facilities has dramatically increased since the start of coronavirus pandemic; yet, major differences exist in universal acceptance of telemedicine across different population groups. The goal of this study was to examine population-based factors associated with current and/or future use of telemedicine in Alabama. METHODS A cross-sectional survey was administered to 532 participants online or by phone, in four urban and eight rural counties in Alabama. Data were collected on: demographics, health insurance coverage, medical history, access to technology, and its use in accessing healthcare services. Generalized logit regression models were used to estimate the odds of choosing "virtual visit" and "phone communication" compared to "in-person visit" for the preferred choice of visit with the healthcare provider; as well as odds for willingness to participate in "virtual visit" in the future. RESULTS Our study sample had a mean age of 43 (±15) years, 72.9% women, 45.9% Black or African American; 59.4% population living in an urban county. The odds of "phone communication" were higher compared to the odds of "in-person visit", with a unit increase in age (odds ratio: 1.02, 95% confidence interval: 1.00-1.03), after adjusting for other covariates. Among participants with past experience of virtual communications, the odds for choosing "virtual visit" were significantly higher compared to choice of in-person visit (odds ratio for virtual visit: 3.23, 95% confidence interval: 2.01-5.18), adjusted for other covariates. Further, people with college or more education were 71% less likely to choose "No" compared to those with high school or lower general education development education for future virtual visit [odds ratio for college or more: 0.29, 95% confodence interval: 0.10-0.87). Likewise, participants residing in rural counties were 57% less likely to choose "No" compared to urban counties for future virtual visit (odds ratio for rural participants: 0.43, 95% confidence interval:0.19-0.97). DISCUSSION Our study found notable differences in age, education, and rurality for use and/or preference for telemedicine. Medical institutions and healthcare providers will need to account for these differences to ensure that the implementation of telemedicine does not exacerbate existing health disparities.
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Affiliation(s)
- Meghan Tipre
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Isabel C Scarinci
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, AL, USA
| | - Vishruti N Pandya
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Young-Il Kim
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Sejong Bae
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Sylvia Peral
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
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Tejani AS, Ng YS, Xi Y, Rayan JC. Understanding and Mitigating Bias in Imaging Artificial Intelligence. Radiographics 2024; 44:e230067. [PMID: 38635456 DOI: 10.1148/rg.230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Artificial intelligence (AI) algorithms are prone to bias at multiple stages of model development, with potential for exacerbating health disparities. However, bias in imaging AI is a complex topic that encompasses multiple coexisting definitions. Bias may refer to unequal preference to a person or group owing to preexisting attitudes or beliefs, either intentional or unintentional. However, cognitive bias refers to systematic deviation from objective judgment due to reliance on heuristics, and statistical bias refers to differences between true and expected values, commonly manifesting as systematic error in model prediction (ie, a model with output unrepresentative of real-world conditions). Clinical decisions informed by biased models may lead to patient harm due to action on inaccurate AI results or exacerbate health inequities due to differing performance among patient populations. However, while inequitable bias can harm patients in this context, a mindful approach leveraging equitable bias can address underrepresentation of minority groups or rare diseases. Radiologists should also be aware of bias after AI deployment such as automation bias, or a tendency to agree with automated decisions despite contrary evidence. Understanding common sources of imaging AI bias and the consequences of using biased models can guide preventive measures to mitigate its impact. Accordingly, the authors focus on sources of bias at stages along the imaging machine learning life cycle, attempting to simplify potentially intimidating technical terminology for general radiologists using AI tools in practice or collaborating with data scientists and engineers for AI tool development. The authors review definitions of bias in AI, describe common sources of bias, and present recommendations to guide quality control measures to mitigate the impact of bias in imaging AI. Understanding the terms featured in this article will enable a proactive approach to identifying and mitigating bias in imaging AI. Published under a CC BY 4.0 license. Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Rouzrokh and Erickson in this issue.
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Affiliation(s)
- Ali S Tejani
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Yee Seng Ng
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Yin Xi
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Jesse C Rayan
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Ginman H, Sitch M. Older adult's experiences of navigating healthcare whilst living with multimorbidity. Psychol Health 2024:1-19. [PMID: 38693663 DOI: 10.1080/08870446.2024.2339327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The way older adults navigate their healthcare is critical to supporting positive health outcomes. However, navigating healthcare with multimorbidity is typically disjointed due to complexities in treatment, management, and service provision. This study sought to examine how older patients navigate healthcare whilst living with multimorbidity. METHODS AND MEASURES Semi-structured interviews were undertaken with five older adults, aged 65 or older, living with multimorbidity in residential care in England. An Interpretive Phenomenological Analysis was undertaken. RESULTS Overall, participants experienced navigating healthcare whilst living with multimorbidity as challenging. Group Experiential Themes included 'Health knowledge and understanding', 'Relationships and expectations' and 'Navigating health care with a single lens'. Collectively these themes represented narratives involving how having limited understanding of health conditions, experiencing challenges in communication with health professionals, and receiving segmented care in a health care system driven by a single condition focus interfered with navigation. CONCLUSION These findings highlight experiences of older adults living with multimorbidity navigating healthcare and illustrate several ways older adults living with multimorbidity may be supported to navigate services with less challenges. The research also promotes the need for future research in this area.
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Altara R, Basson CJ, Biondi-Zoccai G, Booz GW. Exploring the Promise and Challenges of Artificial Intelligence in Biomedical Research and Clinical Practice. J Cardiovasc Pharmacol 2024; 83:403-409. [PMID: 38323891 DOI: 10.1097/fjc.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
ABSTRACT Artificial intelligence (AI) is poised to revolutionize how science, and biomedical research in particular, are done. With AI, problem-solving and complex tasks using massive data sets can be performed at a much higher rate and dimensionality level compared with humans. With the ability to handle huge data sets and self-learn, AI is already being exploited in drug design, drug repurposing, toxicology, and material identification. AI could also be used in both basic and clinical research in study design, defining outcomes, analyzing data, interpreting findings, and even identifying the most appropriate areas of investigation and funding sources. State-of-the-art AI-based large language models, such as ChatGPT and Perplexity, are positioned to change forever how science is communicated and how scientists interact with one another and their profession, including postpublication appraisal and critique. Like all revolutions, upheaval will follow and not all outcomes can be predicted, necessitating guardrails at the onset, especially to minimize the untoward impact of the many drawbacks of large language models, which include lack of confidentiality, risk of hallucinations, and propagation of mainstream albeit potentially mistaken opinions and perspectives. In this review, we highlight areas of biomedical research that are already being reshaped by AI and how AI is likely to affect it further in the near future. We discuss the potential benefits of AI in biomedical research and address possible risks, some surrounding the creative process, that warrant further reflection.
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Affiliation(s)
- Raffaele Altara
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Pathology, School of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Cameron J Basson
- School of Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Giuseppe Biondi-Zoccai
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy; and
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS
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Kuzma EK, Ammerman BA, Lee V, Baird J. Re-envisioning Youth Sexual Health Care: Supporting Sex Positivity in a Digital World. J Pediatr Health Care 2024; 38:310-322. [PMID: 38085200 DOI: 10.1016/j.pedhc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Youth in a digital world face challenges to the healthy development of their sexuality from exposure to sexting, pornography, and other sexually explicit media. School-based sexual health education does not cover digital sexual content and its impact on sexuality and sexual relationships. Youth often avoid discussing sexual health with parents or other trusted adults, thus often relying on peers, making them ill-prepared to navigate the complexities (e.g., socially, emotionally, and romantically) of sexually explicit content. METHOD A review of emerging evidence for application into clinical practice. RESULTS This paper provides nurse practitioners with resources and information to incorporate this re-envisioned approach to sexual health care into practice to provide current, timely, and holistic youth sexual health care. DISCUSSION Youth sexual health care must be re-envisioned. Nurse practitioners can improve youth sexual health by incorporating pornography and sexual media literacy, safe sexting, and concepts of consent into care using a sex-positive lens.
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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149
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Ou H. Hearing healthcare utilisation among older adults with self-reported hearing loss during the COVID-19 pandemic in the United States. Int J Audiol 2024; 63:366-372. [PMID: 36905138 PMCID: PMC11234923 DOI: 10.1080/14992027.2023.2183353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To ascertain the prevalence, causes, and risk factors of hearing healthcare delays in older people with self-reported hearing loss in the United States. DESIGN This cross-sectional study used data from the National Health and Ageing Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. A supplemental COVID-19 survey was mailed to the participants from June to October 2020. STUDY SAMPLE By January 2021, 3257 participants had returned completed COVID-19 questionnaires, with the majority having been self-administered between July and August 2020. RESULTS The participants in the study represented 32.7 million older adults in the US, with 29.1% reporting hearing loss. Among over 12.4 million older adults who put off needed or planned medical care, 19.6% of those with self-reported hearing loss and 24.5% of hearing aid or device users stated they delayed hearing appointments. Approximately 629,911 older adults with hearing devices were impacted by the COVID-19 outbreak for audiological services. The top three reasons were deciding to wait, service cancellation, and fear of going. Education and race/ethnicity were associated with delaying hearing healthcare. CONCLUSIONS The COVID-19 pandemic impacted hearing healthcare utilisation among older adults with self-reported hearing loss in 2020, with both patient- and provider- initiated delays.
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Affiliation(s)
- Hua Ou
- Epidemiology and Statistics Program, Division of Scientific Programs, NIDCD, NIH
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150
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Luiz LMD, Marques IA, Folador JP, Andrade AO. Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease. Neurologia 2024; 39:345-352. [PMID: 38616062 DOI: 10.1016/j.nrleng.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.
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Affiliation(s)
- L M D Luiz
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil.
| | - I A Marques
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - J P Folador
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - A O Andrade
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
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