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Gaye B, Naji NB, Sims M, Cuffee Y, Ogungbe O, Michos ED, Lassale C, Sabouret P, Jouven X. Deep Diving Into the Cardiovascular Health Paradox: A Journey Towards Personalized Prevention. Public Health Rev 2024; 45:1606879. [PMID: 39145154 PMCID: PMC11322578 DOI: 10.3389/phrs.2024.1606879] [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: 11/21/2023] [Accepted: 06/24/2024] [Indexed: 08/16/2024] Open
Abstract
Objectives The Life's Simple 7 score (LS7) promotes cardiovascular health (CVH). Despite this, some with optimal LS7 develop cardiovascular disease (CVD), while others with poor CVH do not, termed the "CVH paradox." This paper explores pathways explaining this paradox. Methods We examined methodological aspects: 1) misclassification bias in self-reported lifestyle factors (smoking, physical activity, diet); 2) cumulative exposure to risk factors over a lifetime, impacting the CVH paradox. Punctual risk factor assessments are suboptimal for predicting outcomes. We proposed personalized prevention using "novel" elements to refine CVH assessment: 1) subclinical vascular disease markers, 2) metabolic biomarkers in blood and urine, 3) emerging risk factors, 4) polygenic risk scores (PRS), 5) epigenetics, and 6) the exposome. Results Addressing the CVH paradox requires a multifaceted approach, reducing misclassification bias, considering cumulative risk exposure, and incorporating novel personalized prevention elements. Conclusion A holistic, individualized approach to CVH assessment and CVD prevention can better reduce cardiovascular outcomes and improve population health. Collaboration among researchers, healthcare providers, policymakers, and communities is essential for effective implementation and realization of these strategies.
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Affiliation(s)
- Bamba Gaye
- Alliance for Medical Research in Africa (AMedRA), Department of Medical Physiology, Cheikh Anta Diop University, Dakar, Senegal
- Université Paris Cité, PARCC, INSERM, Paris, France
| | | | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Yendelela Cuffee
- Alliance for Medical Research in Africa (AMedRA), Epidemiology Program, University of Delaware, Newark, DE, United States
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Camille Lassale
- Alliance for Medical Research in Africa (AMedRA), Barcelona Institute for Public Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Pierre Sabouret
- Heart Institute, Pitié Salpétrière Hospital, Sorbonne University, Paris, France
- National College of French Cardiologists, Paris, France
| | - Xavier Jouven
- Université Paris Cité, PARCC, INSERM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Cardiology Department, Paris, France
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Wang P, Tadeo X, Chew HSJ, Sapanel Y, Ong YH, Leung NYT, Chow EKH, Ho D. N-of-1 health optimization: Digital monitoring of biomarker dynamics to gamify adherence to metabolic switching. PNAS NEXUS 2024; 3:pgae214. [PMID: 38881838 PMCID: PMC11179112 DOI: 10.1093/pnasnexus/pgae214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
The digital health field is experiencing substantial growth due to its potential for sustained and longitudinal deployment. In turn, this may drive improved monitoring and intervention as catalysts for behavioral change compared to traditional point-of-care practices. In particular, the increase in incidence of population health challenges such as diabetes, heart disease, fatty liver disease, and other disorders coupled with rising healthcare costs have emphasized the importance of exploring technical, economics, and implementation considerations, among others in the decentralization of health and healthcare innovations. Both healthy individuals and patients stand to benefit from continued technical advances and studies in these domains. To address these points, this study reports a N-of-1 study comprised of sustained regimens of intermittent fasting, fitness (strength and cardiovascular training), and high protein, low carbohydrate diet and parallel monitoring. These regimens were paired with serial blood ketone, blood glucose (wearable and finger stick) and blood pressure readings, as well as body weight measurements using a collection of devices. Collectively this suite of platforms and approaches were used to monitor metabolic switching from glucose to ketones as energy sources-a process associated with potential cardio- and neuroprotective functions. In addition to longitudinal biomarker dynamics, this work discusses user perspectives on the potential role of harnessing digital devices to these dynamics as potential gamification factors, as well as considerations for the role of biomarker monitoring in health regimen development, user stratification, and potentially informing downstream population-scale studies to address metabolic disease, healthy aging and longevity, among other indications.
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Affiliation(s)
- Peter Wang
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
| | - Xavier Tadeo
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yoann Sapanel
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- Singapore's Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
| | - Yoong Hun Ong
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
| | - Nicole Yong Ting Leung
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
| | - Edward Kai-Hua Chow
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Dean Ho
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
- Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore 117456, Singapore
- Singapore's Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
- The Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
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Long CR, Yaroch AL, Shanks CB, Short E, Mitchell E, Stotz SA, Seligman HK. Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward. Adv Nutr 2024; 15:100192. [PMID: 38401799 PMCID: PMC10951502 DOI: 10.1016/j.advnut.2024.100192] [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: 11/09/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs' cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.
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Affiliation(s)
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Sarah A Stotz
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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Sudat SEK, Huang Q, Szwerinski N, Romanelli RJ, Azar KMJ. Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss. Am J Prev Med 2024; 66:619-626. [PMID: 37907133 PMCID: PMC10957326 DOI: 10.1016/j.amepre.2023.10.018] [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: 07/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. METHODS Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. RESULTS Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). CONCLUSIONS Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
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Affiliation(s)
- Sylvia E K Sudat
- Sutter Health, Center for Health Systems Research, Walnut Creek, California.
| | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | - Nina Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | | | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, California; Sutter Health, Institute for Advancing Health Equity, Sacramento, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Do DH, Mounasamy V, Sambandam S. Predictors of Higher Costs Following Reverse Total Shoulder Arthroplasty. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:469-476. [PMID: 39070874 PMCID: PMC11283295 DOI: 10.22038/abjs.2024.77124.3564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/02/2024] [Indexed: 07/30/2024]
Abstract
Objectives The rising popularity of reverse total shoulder arthroplasties (RTSA) demands attention to its growing costs on the healthcare system, especially with the implementation of bundled payments. Charges associated with patients' inpatient stays can be mitigated with a better understanding of the drivers of cost following RTSA. In this study, we evaluate potential pre-operative and post-operative factors associated with higher inpatient costs following RTSA. Methods We identified 59,925 patients who underwent RTSA using the National Inpatient Sample between 2016 and 2019. Total inpatient hospital charges were collected, and patients were divided into "normal cost" or "high cost" groups. The high cost group was defined as patients with total costs greater than the 75th percentile. Univariate and multivariate analyses were performed on pre-operative demographic and comorbidity variables as well as post-operative surgical and medical complications to predict factors associated with higher costs. T-tests and Chi-squared tests were performed, and odds ratios were calculated. Results The mean total charges were $141.213.93 in the high cost group and $59,181.94 in the normal cost group. Following multivariate analysis, non-white patients were associated with higher costs by 1.31-fold (P<0.001), but sex and age were not. Cirrhosis and non-elective admission had higher odds of higher costs by 1.56-fold (P<0.001) and 3.13-fold (P<0.001), respectively. Among surgical complications, there were higher odds of high costs for periprosthetic infection by 2.43-fold (P<0.001), periprosthetic mechanical complication by 1.28-fold (P<0.001), and periprosthetic fracture by 1.56-fold (P<0.001). Medical complications generally had higher odds of high costs than surgical complications, with deep vein thrombosis having nearly five times (P<0.001) and myocardial infarction almost four times (P<0.001) higher odds of high inpatient costs. Conclusion Post-operative medical complications were the most predictive factors of higher cost following RTSA. Pre-operative optimization to prevent infection and medical complications is imperative to mitigate the economic burden of RTSA's.
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Affiliation(s)
- Dang-Huy Do
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas, USA, 75390
| | - Varatharaj Mounasamy
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas, USA, 75390
| | - Senthil Sambandam
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas, USA, 75390
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Downing KF, Klewer SE, Nembhard WN, Goudie A, Oster ME, Farr SL. Healthcare and Socioeconomic Outcomes Among Young Adults With Congenital Heart Defects and Functional Cognitive Disabilities, CH STRONG 2016 to 2019. Am J Cardiol 2023; 201:229-231. [PMID: 37390699 PMCID: PMC10527851 DOI: 10.1016/j.amjcard.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, Arkansas
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention
| | - Anthony Goudie
- Arkansas Children's Research Institute; Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kim SJ, Martin M, Caskey R, Weiler A, Van Voorhees B, Glassgow AE. The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City. FAMILY & COMMUNITY HEALTH 2023; 46:112-122. [PMID: 36799944 PMCID: PMC9930887 DOI: 10.1097/fch.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.
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Affiliation(s)
- Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Molly Martin
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Rachel Caskey
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Amanda Weiler
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Benjamin Van Voorhees
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Anne Elizabeth Glassgow
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
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Bernardo J, Apóstolo J, Loureiro R, Santana E, Yaylagul NK, Dantas C, Ventura F, Duque FM, Jøranson N, Zechner M, van Staalduinen W, De Luca V, Illario M, Silva R. eHealth Platforms to Promote Autonomous Life and Active Aging: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15940. [PMID: 36498018 PMCID: PMC9738367 DOI: 10.3390/ijerph192315940] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
New technologies, namely eHealth platforms, are being used more than ever before. These platforms enable older people to have a more independent lifestyle, enhance their participation, and improve their well-being. Information and communication technologies are expected to be linked to the triad of aging, social inclusion, and active participation, which is in line with the implementation of Smart Healthy and Age-Friendly Environments. This scoping review aimed to map eHealth platforms designed to promote autonomous life and active aging. The Joanna Briggs Institute methodology and the PRISMA-ScR checklist were used. A search was conducted on MEDLINE (via PubMed), CINAHL Complete (via EBSCOhost), Scopus, Cochrane Database of Systematic Reviews (via EBSCOhost), SciELO, DART-Europe, CAPES, and MedNar databases. Fourteen studies were included. This scoping review synthesized information on eHealth platforms designed to promote active living, their domains of intervention, and the outcomes assessed in those studies that have implemented and evaluated these eHealth platforms.
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Affiliation(s)
- Joana Bernardo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
| | - João Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3030 Coimbra, Portugal
| | - Ricardo Loureiro
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
| | - Elaine Santana
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
| | | | | | - Filipa Ventura
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
| | - Filipa Margarida Duque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, N-3019 Oslo, Norway
| | - Minna Zechner
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland
| | | | - Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80138 Naples, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80138 Naples, Italy
| | - Rosa Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3030 Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3030 Coimbra, Portugal
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Canada K, Barrenger S, Bohrman C, Banks A, Peketi P. Multi-Level Barriers to Prison Mental Health and Physical Health Care for Individuals With Mental Illnesses. Front Psychiatry 2022; 13:777124. [PMID: 35722588 PMCID: PMC9203858 DOI: 10.3389/fpsyt.2022.777124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives People with mental illnesses are overrepresented in the U.S. prison population. It is well established that incarceration for this population poses physical and mental health risks including greater likelihood of victimization and suicide compared to the general prison population. Yet, research is less clear about how staff and services shape these prison experiences. The aim of this study was to examine how people with mental illnesses experience incarceration through interactions with correctional officers and treatment staff and their use of physical and mental health care services. Methods This project utilized a non-experimental design and qualitative research approach to address the research aims. Adults with mental illnesses who were formerly incarcerated were recruited from three different sites in the Midwest and East Coast. Participants completed an in-depth interview and brief survey on health histories. Data were analyzed using descriptive statistics and the framework method for qualitative analysis. Results Participants (n = 43) identified challenges to utilizing health and mental health care including perceived access and quality of mental health, medical, or substance use treatments obtained during prison as well as participant's willingness to engage in services. Access to health care was marked by cumbersome procedures required for service use requests and inadequate staffing. Participants reported mixed experiences with medical and mental health staff ranging from experiencing kindness to feeling staff did not believe them. Participants perceived most correctional officers as exhibiting professionalism while some enacted stigma and created additional stressors. Conclusion Interactions with correctional staff and health care services have the potential to buffer the stressors and risks inherent in prisons for people with mental illnesses. Perceptions from participants suggest both individual- and systems-level opportunities for intervention to better support people with mental illnesses in prison.
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Affiliation(s)
- Kelli Canada
- School of Social Work, University of Missouri, Columbia, MO, United States
| | - Stacey Barrenger
- Psychiatry, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Casey Bohrman
- School of Social Work, West Chester University, West Chester, PA, United States
| | - Anthony Banks
- School of Social Work, University of Missouri, Columbia, MO, United States
| | - Punita Peketi
- Psychiatry, Northeast Ohio Medical University, Rootstown Township, OH, United States
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10
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Ukoha WC, Mtshali NG, Adepeju L. Current state of preconception care in sub-Saharan Africa: A systematic scoping review. Afr J Prim Health Care Fam Med 2022; 14:e1-e11. [PMID: 35532112 PMCID: PMC9082216 DOI: 10.4102/phcfm.v14i1.3096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services. Aim This study aims to review the current literature on the knowledge, utilisation and provision of PCC. Setting This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries. Methods Arksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study. Results Out of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least. Conclusion The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.
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Affiliation(s)
- Winifred C Ukoha
- School of Nursing and Public Health, College of Health Science, University of KwaZulu-Natal, Durban.
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11
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Lorvick J, Hemberg JL, Browne EN, Comfort ML. Routine and preventive health care use in the community among women sentenced to probation. HEALTH & JUSTICE 2022; 10:5. [PMID: 35122518 PMCID: PMC8817638 DOI: 10.1186/s40352-022-00167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/03/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Women involved in the criminal legal (CL) system in the United States have much higher levels of chronic and infectious illness than women in the general population. Over 80% of women in the CL system are on community supervision, which means they receive health care in community settings. While the use of Emergency Department care among CL involved populations has been examined fairly extensively, less is known about engagement in routine and preventive medical care among people on community supervision. METHODS We conducted a longitudinal study of health care utilization among women with Medicaid who were currently or previously sentenced to probation in Alameda County, CA (N = 328). At baseline, 6- and 12-months, we interviewed participants about every medical care visit in the six months prior, and about potential influences on health care utilization based on the Behavioral Model for Vulnerable Populations (BMVP). Associations between BMVP factors and utilization of routine or preventive care were estimated using Poisson regression models with robust standard errors. Generalized estimating equations (GEE) were used account for repeated measures over time. RESULTS A diagnosis of one or more chronic illnesses was reported by 82% of participants. Two-thirds (62%) of women engaged in routine or preventive care in the six months prior to interview. A quarter of women engaging in routine or preventive care did not have a primary care provider (PCP). Having a PCP doubled the likelihood of using routine or preventive care (adjusted Relative Risk [adjRR] 2.27, p < 0.001). Subsistence difficulty (adjRR 0.74, p = 0.01) and unmet mental health care need (adjRR 0.83, p = 0.001) were associated with a lower likelihood of using routine or preventive care. CONCLUSION Findings underscore the importance of meeting the basic needs of women on community supervision and of connecting them with primary health care providers.
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Affiliation(s)
- Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, Berkeley Office, 2150 Shattuck Ave, Suite 800, Berkeley, CA 94704 USA
| | - Jordana L. Hemberg
- Community Health and Implementation Research Program, RTI International, Berkeley Office, 2150 Shattuck Ave, Suite 800, Berkeley, CA 94704 USA
| | - Erica N. Browne
- Women’s Global Health Imperative, RTI International, Berkeley Office, 2150 Shattuck Ave, Suite 800, Berkeley, CA 94704 USA
| | - Megan L. Comfort
- Applied Justice Research Program, RTI International, Berkeley Office, 2150 Shattuck Ave, Suite 800, Berkeley, CA 94704 USA
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12
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Sheikholeslami N, Moore MLG, Jayakumar P, Uhler LM, Bozic KJ. Effect of a Question-Building Intervention on Patient Activation in Integrated Musculoskeletal Care. Orthopedics 2021; 44:e661-e667. [PMID: 34590944 DOI: 10.3928/01477447-20210817-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patient activation, the propensity for patients to engage in adaptive health behaviors, is a modifiable factor associated with health outcomes and treatment compliance. The authors evaluated the effect of a question-building intervention (QBI) on patient activation among patients with musculoskeletal symptoms and a low baseline level of activation. Patients seeking treatment for musculoskeletal pain were recruited at the beginning of their outpatient clinic appointment, and they completed the Patient Activation Measure 10-item version (PAM-10) and a demographic questionnaire. Those identified as low activating, based on the initial PAM-10 scores, completed a QBI protocol before their consultation with their provider. A follow-up PAM-10 survey was administered at the end of the visit. A paired sample Student's t test was used to evaluate preintervention and postintervention PAM-10 scores. Fisher's exact test and an unpaired t test were used to assess the association between demographic variables and achievement of minimal clinically important difference (MCID) for PAM-10. Of 194 patients who consented to participate, 60 were identified as low activating and completed the QBI. A paired Student's t test showed a statistically significant increase in mean PAM-10 scores from preintervention (47.3±7.4) to postintervention (54.8±16.8; P<.001). No statistically significant differences were shown in the likelihood of achieving MCID for PAM-10 scores for the sociodemographic variables that were tested. Low-activating patients may benefit from a simple question-formulating intervention before consultation with an orthopedic provider. [Orthopedics. 2021;44(5):e661-e667.].
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13
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Toonders SAJ, van Westrienen PE, Konings S, Nieboer ME, Veenhof C, Pisters MF. Patients' Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study. J Med Internet Res 2021; 23:e19794. [PMID: 34581674 PMCID: PMC8512187 DOI: 10.2196/19794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/17/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient’s expectations, their effectiveness grows. Objective This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients’ perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions The successful implementation of integrated blended care interventions based on patients’ perspectives requires matching treatments to patients’ individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability.
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Affiliation(s)
- Suze Adriana Johanna Toonders
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research Group, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paula Elisabeth van Westrienen
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research Group, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sophie Konings
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Physical Therapy Sciences Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marianne E Nieboer
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Cindy Veenhof
- Physical Therapy Research Group, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.,Physical Therapy Sciences Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Martijn F Pisters
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research Group, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.,Physical Therapy Sciences Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
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14
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Lianov LS, Barron GC, Fredrickson BL, Hashmi S, Klemes A, Krishnaswami J, Lee J, Le Pertel N, Matthews JA, Millstein RA, Phillips EM, Sannidhi D, Purpur de Vries P, Wallace A, Winter SJ. Positive psychology in health care: defining key stakeholders and their roles. Transl Behav Med 2021; 10:637-647. [PMID: 32766868 DOI: 10.1093/tbm/ibz150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.
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Affiliation(s)
- Liana S Lianov
- American College of Lifestyle Medicine, Chesterfied, MO, USA
| | - Grace Caroline Barron
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Barbara L Fredrickson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean Hashmi
- Adult Weight Management, Southern California Kaiser Permanente, Woodland Hills, CA, USA
| | | | | | - Jenny Lee
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Noémie Le Pertel
- Empowered Wellness and Center for Positive Leadership LLC, Primary Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica A Matthews
- Department of Kinesiology, Point Loma Nazarene University, San Diego, CA, USA
| | - Rachel A Millstein
- Behavioral Medicine Program and Cardiac Psychiatry Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward M Phillips
- Physical Medicine and Rehabilitation Service, VA Boston Health Care System and Institute of Lifestyle Medicine, Boston, MA, USA
| | - Deepa Sannidhi
- Division of Family Medicine, Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Division of Preventive Medicine, Department of Family Medicine and Public Health, UC San Diego Health, La Jolla, CA, USA
| | | | - Anne Wallace
- Beech Acres Parenting Center, Cincinnati, OH, USA
| | - Sandra J Winter
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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15
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The Role of Prevention in Reducing the Economic Impact of ME/CFS in Europe: A Report from the Socioeconomics Working Group of the European Network on ME/CFS (EUROMENE). ACTA ACUST UNITED AC 2021; 57:medicina57040388. [PMID: 33923830 PMCID: PMC8073750 DOI: 10.3390/medicina57040388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be beneficial. There is a need for more research on risk factors for ME/CFS to establish a basis for the development of primary prevention programmes, particularly in respect of occupational risk factors. Secondary prevention offers the greatest scope for intervention, to minimise diagnostic delays associated with prolonged illness, increased severity, and increased costs.
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16
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Siddiqi A, Warren JA, McLaughlin J, Kamath AF, Krebs VE, Molloy RM, Piuzzi NS. Demographic, Comorbidity, and Episode-of-Care Differences in Primary Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:227-234. [PMID: 33534292 DOI: 10.2106/jbjs.20.00597] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding time trends in age, demographic characteristics, and comorbidities is especially critical to highlight the effects on clinical practice change, outcomes, and the value of total knee arthroplasty (TKA). Therefore, the purpose of this study was to identify trends in the demographic characteristics, comorbidities, and episode-of-care outcomes for patients who underwent TKA from 2008 to 2018. METHODS The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients who underwent primary TKA from 2008 to 2018 (n = 350,879). Trends for continuous variables were analyzed using analysis of variance, and categorical variables were analyzed using chi-square tests. RESULTS From 2008 to 2018, there was no clinically important difference in age, body mass index (BMI), and percentage of patients with BMI of >40 kg/m2 and no clinically important difference in chronic obstructive pulmonary disease (3.5% in 2008 and 3.2% in 2018), congestive heart failure within 30 days (0.3% in both 2008 and 2018), and acute renal failure (0.1% in 2008 and <0.1% in 2018) among patients undergoing TKA. However, modifiable comorbidities, including smoking status (9.5% in 2008 and 7.7% in 2018; p < 0.001), hypertension (71.0% in 2008 and 63.7% in 2018; p < 0.001), and anemia (16.2% in 2008 and 9.7% in 2018; p < 0.001), functional status, and overall morbidity and mortality probability have improved, with no clinically important difference in the percentage of diabetes (19.0% in 2008 and 18.1% in 2018). The hospital length of stay (mean [and standard deviation], 3.8 ± 2.2 days in 2008 and 2.1 ± 2.0 days in 2018; p < 0.001) and 30-day readmission (4.6% in 2011 and 3.0% in 2018; p < 0.001) decreased, with a significant increase in home discharge (65.6% in 2011 and 87.8% in 2018; p < 0.001). CONCLUSIONS The overall patient health status improved from 2008 to 2018, with improvement in the modifiable comorbidities of smoking status, malnutrition, hypertension, and anemia; the functional status; and the overall morbidity and mortality probability, with no clinically relevant change in patient age; patient BMI; percentage of patients with BMI of >40 kg/m2; or patients with diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure within 30 days, or acute renal failure. Our findings may be a reflection of a global shift toward value-based care focusing on patient optimization prior to arthroplasty, quality of care, and improved outcomes. The results of our study highlight the potential increase in TKA procedural value, which is paramount for health-care policy changes in today's incentivized, value-based, health-care environment.
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Affiliation(s)
- Ahmed Siddiqi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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17
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Barnert E, Applegarth DM, Aggarwal E, Bondoc C, Abrams LS. Health Needs of Youth in Detention With Limited Justice Involvement. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105412. [PMID: 33071410 PMCID: PMC7561019 DOI: 10.1016/j.childyouth.2020.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although incarcerated youth (i.e., youth sentenced to secure custody) have high health needs, the health of detained youth with limited justice involvement remains poorly understood. Between September 2018 and February 2019, social workers from the Los Angeles County Whole Person Care Juvenile Reentry Aftercare Program (WPC) assessed the health and social needs of youth in pre-trial detention. We partnered with the WPC team to analyze assessments completed by 83 youth participants. Youth were on average 16 years old, most (83%) identified as male, and all were from racial or ethnic minority groups. Participants reported high behavioral health needs, including a high prevalence of prior suicide attempts (16%) and history of substance use (81%). Participants demonstrated a pattern of crisis healthcare utilization. Youth also indicated areas of strength, including personal positive traits, engagement in extracurricular activities, educational achievements, and having multiple sources of social support. The majority of youth (74%) desired vocational training and nearly all (94 %) wanted to return to school after release. Overall, the findings indicate that detained youth with limited involvement in the justice system are a resilient group that have notably higher health risk than same-age peers, signifying a critical opportunity for intervention.
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Affiliation(s)
- Elizabeth Barnert
- UCLA Department of Pediatrics, 10955 Le Conte Ave, Los Angeles, California
| | | | - Ektha Aggarwal
- Office of Diversion and Reentry, Los Angeles County Department of Health Services, Los Angeles, California
| | - Christopher Bondoc
- UCLA Department of Pediatrics, 10955 Le Conte Ave, Los Angeles, California
| | - Laura S. Abrams
- UCLA Luskin School of Public Affairs, Los Angeles, California
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18
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Weaver RH, Burley M. Identification of Functional, Social, and Health Needs of Older Residents in Nonurban Settings: A Community Risk Assessment. J Aging Health 2020; 32:1614-1624. [PMID: 32772635 DOI: 10.1177/0898264320947309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We examined functional, social, and health needs and service delivery gaps among a geographically expansive and economically diverse population of older adults to identify service priorities. Methods: We conducted analyses based on 1280 respondents aged 60 years and older surveyed for an 8-county needs assessment. Results: We identified three distinct risk profiles using two-step cluster analysis. ANOVA and chi-square analyses revealed significant differences between risk profiles on a range of health and social service needs. Discussion: Identifying high-risk residents can support community providers' efforts to help older adults age in place. Community-based organizations are well-positioned to respond early to social determinants of health needs. Targeting services and supports that reduce risk, extend independence, and prevent avoidable adverse healthcare situations to improve health and achieve health equity among historically underserved and hard-to-reach populations and prioritizing low-cost community interventions can reduce the need for high-cost interventions (e.g., emergency care and hospitalizations).
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19
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Beiranvand S, Saki M, Behzadifar M, Bakhtiari A, Behzadifar M, Keshvari M, Bragazzi NL. The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis. BMC Health Serv Res 2020; 20:327. [PMID: 32306975 PMCID: PMC7168862 DOI: 10.1186/s12913-020-05186-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/05/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Healthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. In May 2014, the Iranian Ministry of Health and Medical Education has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP). This study aimed to determine the effect of the HTP on hospitalization rate in Iranian public hospitals affiliated to the Ministry of Health and Medical Education. METHODS This study was designed as a quasi-experimental, counterfactual study utilizing the interrupted time series analysis (ITSA), comparing the trend of hospitalization rate before and after the HTP implementation in 16 hospitals in the Lorestan province. Data was collected from March 2012 to February 2019. RESULTS In the first month of the HTP implementation, an increase of 2.627 [95% CI: 1.62-3.63] was noted (P < 0.001). Hospitalization rate increased by 0.68 [95% CI: 0.32-0.85] after the HTP implementation compared to the first month after the launch of the HTP (P < 0.001). After the HTP implementation, monthly hospitalization rate per 1000 persons significantly increased by 0.049 [95% CI: 0.023-0.076] (P < 0.001). CONCLUSIONS The HTP implementation has resulted in an increased hospitalization rate. Health planners should continue to further improve this service. ITSA can play a role in evaluating the impact of a given health policy.
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Affiliation(s)
- Siavash Beiranvand
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Bakhtiari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Mohammad Keshvari
- Vice Chancellor Treatment, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada
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20
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Williams SA, Kivimaki M, Langenberg C, Hingorani AD, Casas JP, Bouchard C, Jonasson C, Sarzynski MA, Shipley MJ, Alexander L, Ash J, Bauer T, Chadwick J, Datta G, DeLisle RK, Hagar Y, Hinterberg M, Ostroff R, Weiss S, Ganz P, Wareham NJ. Plasma protein patterns as comprehensive indicators of health. Nat Med 2019; 25:1851-1857. [PMID: 31792462 PMCID: PMC6922049 DOI: 10.1038/s41591-019-0665-2] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 12/31/2022]
Abstract
Proteins are effector molecules that mediate the functions of genes1,2 and modulate comorbidities3-10, behaviors and drug treatments11. They represent an enormous potential resource for personalized, systemic and data-driven diagnosis, prevention, monitoring and treatment. However, the concept of using plasma proteins for individualized health assessment across many health conditions simultaneously has not been tested. Here, we show that plasma protein expression patterns strongly encode for multiple different health states, future disease risks and lifestyle behaviors. We developed and validated protein-phenotype models for 11 different health indicators: liver fat, kidney filtration, percentage body fat, visceral fat mass, lean body mass, cardiopulmonary fitness, physical activity, alcohol consumption, cigarette smoking, diabetes risk and primary cardiovascular event risk. The analyses were prospectively planned, documented and executed at scale on archived samples and clinical data, with a total of ~85 million protein measurements in 16,894 participants. Our proof-of-concept study demonstrates that protein expression patterns reliably encode for many different health issues, and that large-scale protein scanning12-16 coupled with machine learning is viable for the development and future simultaneous delivery of multiple measures of health. We anticipate that, with further validation and the addition of more protein-phenotype models, this approach could enable a single-source, individualized so-called liquid health check.
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Affiliation(s)
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
- University College London, British Heart Foundation Research Accelerator, London, UK
- Health Data Research UK, London, UK
| | - J P Casas
- Massachusetts Veterans Epidemiology and Research Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Claude Bouchard
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Christian Jonasson
- HUNT Research Center and K. G. Jebsen Center for Genetic Epidemiology, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | - Peter Ganz
- Division of Cardiology, Center of Excellence in Vascular Research, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
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21
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Kwee RM, Kwee TC. Whole-body MRI for preventive health screening: A systematic review of the literature. J Magn Reson Imaging 2019; 50:1489-1503. [PMID: 30932247 PMCID: PMC6850647 DOI: 10.1002/jmri.26736] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background The yield of whole‐body MRI for preventive health screening is currently not completely clear. Purpose To systematically review the prevalence of whole‐body MRI findings in asymptomatic subjects. Study Type Systematic review and meta‐analysis. Subjects MEDLINE and Embase were searched for original studies reporting whole‐body MRI findings in asymptomatic adults without known disease, syndrome, or genetic mutation. Twelve studies, comprising 5373 asymptomatic subjects, were included. Field Strength/Sequence 1.5T or 3.0T, whole‐body MRI. Assessment The whole‐body MRI literature findings were extracted and reviewed by two radiologists in consensus for designation as either critical or indeterminate incidental finding. Statistical Tests Data were pooled using a random effects model on the assumption that most subjects had ≤1 critical or indeterminate incidental finding. Heterogeneity was assessed by the I2 statistic. Results Pooled prevalences of critical and indeterminate incidental findings together and separately were 32.1% (95% confidence interval [CI]: 18.3%, 50.1%), 13.4% (95% CI: 9.0%, 19.5%), and 13.9% (95% CI: 5.4%, 31.3%), respectively. There was substantial between‐study heterogeneity (I2 = 95.6–99.1). Pooled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included (cardio)vascular and/or colon MRI compared with studies that did not (49.7% [95% CI, 26.7%, 72.9%] vs. 23.0% [95% CI, 5.5%, 60.3%], P < 0.001). Pooled proportion of reported verified critical and indeterminate incidental findings was 12.6% (95% CI: 3.2%, 38.8%). Six studies reported false‐positive findings, yielding a pooled proportion of 16.0% (95% CI: 1.9%, 65.8%). None of the included studies reported long‐term (>5‐year) verification of negative findings. Only one study reported false‐negative findings, with a proportion of 2.0%. Data Conclusion Prevalence of critical and indeterminate incidental whole‐body MRI findings in asymptomatic subjects is overall substantial and with variability dependent to some degree on the protocol. Verification data are lacking. The proportion of false‐positive findings appears to be substantial. Level of Evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1489–1503.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology and Nuclear Medicine, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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22
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McGrady A, Badenhop D, Lynch D. Effects of a Lifestyle Medicine Elective on Self-Care Behaviors in Preclinical Medical Students. Appl Psychophysiol Biofeedback 2019; 44:143-149. [PMID: 30826911 DOI: 10.1007/s10484-019-09431-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to explore the impact of a lifestyle medicine elective on medical students' self-care behaviors. From fall, 2015, through spring, 2017, a lifestyle medicine elective was offered to first and second year medical students. Acquisition of data was approved by the IRB. Students attended four group sessions, two at the beginning and two at the end of the elective. At the first session, information about the effects of lifestyle on mental and physical health was presented. Students completed screening instruments to assess their own physical activity, nutrition, anxiety, and depression. At the next class, students received their scores. They chose one of three focus groups: nutrition, physical activity or stress management and set a specific goal in that area. At the end of the elective, students attended two group sessions, which focused on patient cases. They again completed the screening instruments, and received their scores. They also evaluated the course. Sixty-three students signed the consent form and provided data. Comparison of baseline scores by gender revealed that women had statistically significant higher scores on the depression screener than men, and lower physical activity scores than men. Pre and post elective comparison in the whole group showed statistically significant improvements in nutrition, depression, and anxiety (all p < .05). Further analysis in the focus groups demonstrated that the stress management group's scores on anxiety were significantly improved. The nutrition group significantly lowered their fat consumption and increased their intake of fruits and vegetables (all p < .05). The physical activity group did not significantly increase their daily physical activity, although this analysis was limited by missing data and wide variability. Student evaluations of the course were positive. Medical students are able to make improvements in their own lifestyle behaviors while acquiring information that may be useful in later patient care.
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Affiliation(s)
- Angele McGrady
- Department of Psychiatry, University of Toledo Medical Center, Mail Stop 1190 3000 Arlington Ave., Toledo, OH, 43614, USA.
| | - Dalynn Badenhop
- Department of Medicine, University of Toledo Medical Center, Mail Stop 1190 3000 Arlington Ave., Toledo, OH, 43614, USA
| | - Denis Lynch
- Department of Psychiatry, University of Toledo Medical Center, Mail Stop 1190 3000 Arlington Ave., Toledo, OH, 43614, USA
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