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Mckinney J, Salmanian B, Grace R, Moufarrij S, Sangi-Haghpeykar H, Eppes C, Gandhi M. Social Drivers of COVID-19 Disease Severity in Pregnant Patients. Am J Perinatol 2024; 41:e2269-e2278. [PMID: 37311541 DOI: 10.1055/a-2109-3876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had global impact in all populations, certain groups of patients have experienced disproportionate rates of morbidity and mortality. The purpose of this study was to assess the relationship between COVID-19 disease severity, demographic variables, race and ethnicity, and social determinants of health among pregnant patients in a diverse urban population. STUDY DESIGN A retrospective analysis was performed of all pregnant patients diagnosed with COVID-19 at two urban tertiary care centers in Houston, TX between March and August 2020. Maternal demographic, COVID-19 illness criteria, and delivery characteristics were collected. The Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI) were obtained based on a patients' census tract of residence. Analyses compared persons with asymptomatic, mild, or severe-critical disease at diagnosis. RESULTS A total of 317 persons tested positive for COVID-19 during this time period. Asymptomatic persons were more likely to be diagnosed at later gestational ages, but there were no other differences in baseline maternal characteristics. Persons with more severe disease had greater social vulnerability specifically for housing and transportation than those with mild disease (mean SVI [standard error]: 0.72 [0.06] vs. 0.58 [0.2], p = 0.03). Total SVI, total CCVI, and other themed SVI and CCVI indices were not significantly different between groups. CONCLUSION In this cohort of pregnant persons infected with SARS-CoV-2, an association was shown between disease severity and increased vulnerability in living conditions and transportation. Drivers of the pandemic and COVID-19 outcomes are complex and multifactorial, and likely change over time. However, continued efforts to accurately identify and measure social determinants of health in medicine will likely help identify geographic areas and patient populations that are at risk of higher disease burden. This could facilitate preventative and mitigation measures in these areas in future disaster or pandemic situations. KEY POINTS · SVI and CCVI estimate social determinants of health.. · COVID-19 is associated with housing and transportation vulnerability.. · Social determinants contribute to disease burden in pregnancy..
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Affiliation(s)
- Jennifer Mckinney
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Bahram Salmanian
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca Grace
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Sara Moufarrij
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Catherine Eppes
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Division of Maternal Fetal Medicine, Texas Children's Hospital Pavilion for Women, Houston, Texas
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Phoenix M, Moll S, Vrzovski A, Bhaskar L, Micsinszki S, Bruce E, Mulalu L, Hossain P, Freeman B, Mulvale G, Consortium C. Advancing a collective vision for equity-based cocreation through prototyping at an international forum. Health Expect 2024; 27:e14041. [PMID: 38567877 PMCID: PMC10989061 DOI: 10.1111/hex.14041] [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: 12/06/2023] [Revised: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Cocreation has the potential to engage people with lived and living experiences in the design and evaluation of health and social services. However, guidance is needed to better include people from equity-deserving groups (EDGs), who are more likely to face barriers to participation, experience ongoing or historical harm, and benefit from accessible methods of engagement. OBJECTIVE The aim of this international forum (CoPro2022) was to advance a collective vision for equity-based cocreation. DESIGN A participatory process of engagement in experiential colearning and arts-based creative and reflective dialogue. Visual prototypes were created and synthesised to generate a collective vision for inclusive equity-based cocreation. SETTING AND PARTICIPANTS The Forum was held at the Gathering Place by the Grand River in Ohsweken, Ontario, Canada. A total of 48 participants attended the forum. They were purposely invited and have intersecting positionalities (21 academic experts, six experience experts, 10 trainees, and 11 members of EDGs) from nine countries (Bangladesh, Botswana, Canada, England, Italy, Norway, Scotland, Singapore, Sweden). COPRO2022 ACTIVITIES: CoPro2022 was an immersive experience hosted on Indigenous land that encouraged continuous participant reflection on their own worldviews and those of others as participants openly discussed the challenges and opportunities with engaging EDGs in cocreation activities. Visual prototypes and descriptions created in small groups were informed by participants' reflections on the panel presentations at the Forum and their own experiences with equity-based cocreation. Following the event, the authorship team inductively coded themes from the prototype descriptions and met to discuss the cross-cutting themes. These informed the design of an illustrated collective vision for Equity Based Co-Creation (EqCC). RESULTS Six prototypes were cocreated by each small group to illustrate their vision for EqCC. Within these, four cross-cutting themes were identified: (i) go to where people are, (ii) nurture relationships and creativity, (iii) reflect, replenish and grow, (iv) and promote thriving and transformation. These four themes are captured in the Collective EqCC Vision to guide a new era of inclusive excellence in cocreation activities. PATIENT OR PUBLIC CONTRIBUTION Service users, caregivers, and people with lived experience were involved in leading the design of the CoPro2022 and co-led the event. This included activities at the event such as presenting, facilitating small and large group discussion, leading art-based activities, and reflecting with the team on the lessons learned. People with lived experience were involved in the analysis and knowledge sharing from this event. Several members of the research team (students and researchers) also identified as members of EDGs and were invited to draw from their personal and academic knowledge.
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Affiliation(s)
- Michelle Phoenix
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Sandra Moll
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alexa Vrzovski
- Ahousaht First NationAhousatBritish ColombiaCanada
- Indigenous Project Coordinator, School of MedicineToronto Metropolitan UniversityTorontoOntarioCanada
| | - Le‐Tien Bhaskar
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Samantha Micsinszki
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Emma Bruce
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | | | - Puspita Hossain
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Bonnie Freeman
- School of Social Work and Indigenous Studies DepartmentMcMaster University; Algonquin/Mohawk, Member of the Six Nations of the Grand RiverCanada
| | - Gillian Mulvale
- Health Policy and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
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Lijewski VA, Aldrich H, Straub HL. The Impact of Social Vulnerability on Substance Use Detection Practices in Pregnancy. Am J Perinatol 2024. [PMID: 38503303 DOI: 10.1055/s-0044-1782686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
This study aimed to synthesize current literature regarding the impact of social vulnerability on pregnancy-related substance use detection in the United States and highlight disparities in substance use detection practices. Clinicaltrials.gov, Google Scholar, PubMed (includes MEDLINE), and Cochrane Library databases were searched using the following Medical Subject Headings (MeSH): (["pregnancy" or "prenatal"] AND ["substance use screening" or "urine toxicology testing" or "toxicology testing" or "urine drug screening" or "CRAFFT" or "4P's" or "4P's Plus" or "NIDA Quick Screen" or "DAST-10" or "SURP-P" or "WIDUS"], AND ("bias" or "disparities" or "social vulnerability"]). The search included systematic reviews, prospective and retrospective studies, randomized controlled trials, case studies, and qualitative and quantitative research from January 2014 through November 2023. Selected literature was limited to studies published in English, which included a study population of either pregnant individuals or pregnancy health care providers in the United States, and that were focused on inequities in pregnancy substance use detection. Using Covidence, three authors screened abstracts, and two screened full articles for inclusion. The included studies were evaluated for quality of evidence using the mixed methods appraisal tool. The search yielded 4,188 manuscripts; 37 were eligible for full review. A total of 18 manuscripts were included based on the relevancy of the topic. The most common social vulnerability domain identified was minority status (17/18), followed by socioeconomic status (11/18), household characteristics (8/18), and housing type (1/18). Social vulnerability plays a role in substance use detection among pregnant individuals. Most notably, race and ethnicity, age, and public insurance lead to increased rates of detection, though most individual factors need to be studied in greater depth. This study was registered with PROSPERO (PROSPERO ID CRD42022352598), the International Prospective Register of Systematic Reviews. KEY POINTS: · Socially vulnerable pregnant individuals are more likely to receive substance use screening or urine toxicology testing.. · Race, ethnicity, age, and insurance influence substance use detection disparities.. · More research is needed to understand how other characteristics influence disparities in substance use detection..
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Affiliation(s)
- Virginia A Lijewski
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heather Aldrich
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heather L Straub
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
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Hogg-Graham R, Benitez JA, Lacy ME, Bush J, Lang J, Nikolaou H, Clear ER, McCullough JM, Waters TM. Association Between Community Social Vulnerability and Preventable Hospitalizations. Med Care Res Rev 2024; 81:31-38. [PMID: 37731391 DOI: 10.1177/10775587231197248] [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: 09/22/2023]
Abstract
Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient's social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations. Our results suggest wide variation in community-level preventable hospitalization rates, with robust evidence that variation is strongly related to a community's social vulnerability. The human toll, societal cost, and preventability of these hospitalizations make understanding and mitigating these inequities a national priority.
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Affiliation(s)
| | | | | | | | - Juan Lang
- University of Kentucky, Lexington, USA
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Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Littlejohn EL, Booker NE, Chambers S, Akinsanya JA, Sankar CA, Benson RT. Advancing Health Equity in Neurologic Disorders and Stroke: Stakeholder Insights Into Health Disparities, Research Gaps, and Potential Interventions. Neurology 2023; 101:S92-S103. [PMID: 37580149 PMCID: PMC10605949 DOI: 10.1212/wnl.0000000000207570] [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: 09/09/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the National Institute of Neurological Disorders and Stroke (NINDS) Request for Information (RFI) input from the public-including health care providers, researchers, patients, patient advocates, caregivers, advocacy organizations, professional societies, and private and academic stakeholders with an interest in health disparities (HDs) in neurologic disease. RFI questions were structured to solicit input on what stakeholders believe are neurologic disease HD research priorities, drivers of health inequity, and potential interventions. Furthermore, these stakeholder insights were examined within the context of contemporary scientific literature and research frameworks on health equity and health disparities. BACKGROUND The NINDS published a RFI from March 31 to July 15, 2020. The RFI analysis presented here is part of a larger strategic planning process aimed to guide future NINDS efforts in neurologic disorder health equity (HE) research and training. The public commented on facilitators of HDs, populations that experience HDs (HDPs), potential interventions, and research opportunities related to HDs in neurologic disease and/or care in the United States across the lifespan. Responses were analyzed using qualitative methodology. Frequently suggested interventions were thematically clustered using the interpretive phenomenological analysis methodology and are presented in this article to provide a stakeholder-identified roadmap for advancing HE. RESULTS Respondents identified socioecological factors as driving HDs in 89% of determinants reported. Stakeholder-reported HD determinants and subsequent interventions could be classified into the following conceptual categories: HDP neurospecialty care access, innovative HDP engagement and research inclusion strategies, and development of a well-trained clinician-scientist HD workforce. Clustering of the feedback from patient and patient-adjacent respondents (i.e., caretakers and patient advocates) highlighted the prevalence of patient-provider interpersonal factors and limited resources driving access-to-care barriers among their sentiments. DISCUSSION Respondent sentiments suggest prioritization of social determinants of health (SDOH) research, shifting away from the common target of biological and behavioral themes addressed in the existing body of HE research provided by the stakeholder. Overall, respondents suggest focusing research prioritization on access to care, engagement across the HE research and care landscape, and HE workforce development.
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Affiliation(s)
- Erica L Littlejohn
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
| | - Naomi E Booker
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Stacey Chambers
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jemima A Akinsanya
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Cheryse A Sankar
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Richard T Benson
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Kelly ML, Parente V, Redmond R, Willis R, Railey K. Development of a curriculum in cultural determinants of health and health disparities. J Natl Med Assoc 2023; 115:428-435. [PMID: 37407380 PMCID: PMC10977997 DOI: 10.1016/j.jnma.2023.06.005] [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: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Current sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners' awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year. METHODS Two cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students' self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare. RESULTS Students' self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students' mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students' mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students' overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course. CONCLUSION Perceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.
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Affiliation(s)
- Megan L Kelly
- Medical Scientist Training Program, Department of Biochemistry, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Redmond
- Office of Diversity and Inclusion, Duke University School of Medicine, Durham, NC, USA
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenyon Railey
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA.
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Chau AJ, Sudore RL, Hays RD, Tseng CH, Walling AM, Rahimi M, Gibbs L, Patel K, Sanz Vidorreta FJ, Wenger NS. Telephone Outreach Enhances Recruitment of Underrepresented Seriously Ill Patients for an Advance Care Planning Pragmatic Trial. J Gen Intern Med 2023; 38:1848-1853. [PMID: 36717432 PMCID: PMC10271940 DOI: 10.1007/s11606-022-08000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients experiencing systemic patterns of disadvantage, such as racial/ethnic minorities and those with limited English proficiency, are underrepresented in research. This is particularly true for large pragmatic trials of potentially sensitive research topics, such as advance care planning (ACP). It is unclear how phone outreach may affect research participation by underrepresented individuals. OBJECTIVE To assess the effect of phone outreach, in addition to standard mail survey recruitment, in a population-based ACP pragmatic trial at three academic health systems in California. DESIGN Retrospective cohort study PATIENTS: Primary care patients with serious illness were mailed a survey in their preferred language. Patients who did not initially respond by mail received up to three reminder phone calls with the option of survey completion by phone. MAIN MEASURES Effect of phone outreach on survey response rate associated with respondent demographic characteristics (e.g., Social Vulnerability Index [SVI], range 0 (low) to 1 (high)). RESULTS Across the health systems, 5998 seriously ill patients were mailed surveys. We obtained completed surveys from 1215 patients (20% response rate); 787 (65%) responded after mail alone and 428 (35%) participated only after phone outreach. Patients recruited after phone outreach compared to mail alone were more socially vulnerable (SVI 0.41 v 0.35, P < 0.001), were more likely to report being a racial/ethnic minority (35% v 28%, P = 0.006), and non-English speaking (16% v 10%, P = 0.005). Age and gender did not differ significantly. The inclusion of phone outreach resulted in a sample that better represented the baseline population than mail alone in racial/ethnic minority (28% mail alone, 30% including phone outreach, 36% baseline population), non-English language preference (10%, 12%, 15%, respectively), and SVI (0.35, 0.37, 0.38, respectively). CONCLUSIONS Phone outreach for a population-based survey in a pragmatic trial concerning a potentially sensitive topic significantly enhanced recruitment of underrepresented seriously ill patients.
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Affiliation(s)
- Aaron J Chau
- Division of Geriatric Medicine, Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Rebecca L Sudore
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Ron D Hays
- UCLA Division of General Internal Medicine and Health Services Research, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- UCLA Division of General Internal Medicine and Health Services Research, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Anne M Walling
- UCLA Division of General Internal Medicine and Health Services Research, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
- VA Greater Los Angeles Health System, Los Angeles, CA, USA
| | - Maryam Rahimi
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Lisa Gibbs
- Division of Geriatric Medicine, Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Kanan Patel
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Fernando Javier Sanz Vidorreta
- UCLA Division of General Internal Medicine and Health Services Research, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Neil S Wenger
- UCLA Division of General Internal Medicine and Health Services Research, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA.
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McCloskey C, Zeller J, Berk A, Patil N, Ajayakumar J, Curtis A, Curtis J. Prevalence and Geographic Features of Patients Eligible for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation 2023; 188:109837. [PMID: 37207873 DOI: 10.1016/j.resuscitation.2023.109837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This study sought to identify Out of Hospital Cardiac Arrests (OHCA) eligible for Extracorporeal Cardiopulmonary Resuscitation (ECPR), use Geographic Information Systems (GIS) to investigate geographic patterns, and investigate if correlation between ECPR candidacy and Social Determinants of Health (SDoH) exist. METHODS This study is of emergency medical service (EMS) runs for OHCA to an urban medical center from January 1, 2016 to December 31, 2020. All runs were filtered to inclusion criteria for ECPR: age 18-65, initial shockable rhythm, and no return of spontaneous circulation within initial defibrillations. Address level data were mapped in a GIS. Cluster detection assessed for granular areas of high concentration. The Center for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) was overlaid. The SVI ranges from 0-1 with higher values indicating increasing social vulnerability. RESULTS There were 670 EMS transports for OHCA during the study period. 12.7% (85/670) met inclusion criteria for ECPR. 90% (77/85) had appropriate addresses for geocoding. Three geographic clusters of events were detected. Two were residential areas and one was concentrated over a public use area of downtown Cleveland. The SVI for these locations was 0.79, indicative of high social vulnerability. Nearly half (32/77, 41.5%) occurred in neighborhoods with the highest level of social vulnerability (SVI ≥0.9). CONCLUSION A significant proportion of OHCAs were eligible for ECPR based on prehospital criteria. Utilizing GIS to map and analyze ECPR patients provided insights into the locations of these events and the SDoH that may be driving risk in these places.
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Affiliation(s)
- Colin McCloskey
- University Hospitals- Cleveland Medical Center, Department of Emergency Medicine, 11100 Euclid Avenue, Cleveland, OH 44106.
| | - Jason Zeller
- University Hospitals- Cleveland Medical Center, Department of Emergency Medicine, 11100 Euclid Avenue, Cleveland, OH 44106.
| | - Andrew Berk
- Case Western Reserve University School of Medicine, Health Education Campus, 9501 Euclid Avenue, Cleveland, OH 44106.
| | - Nirav Patil
- University Hospitals Center for Clinical Research, 11100 Euclid Avenue, Cleveland OH 44106.
| | - Jayakrishnan Ajayakumar
- Case Western Reserve University School of Medicine, Department of Population and Quantitative Health Sciences, GIS Health and Hazards Lab. 10900 Euclid Avenue. Cleveland, OH 44106.
| | - Andrew Curtis
- Case Western Reserve University School of Medicine, Department of Population and Quantitative Health Sciences. GIS Health and Hazards Lab. 10900 Euclid Avenue. Cleveland, OH 44106.
| | - Jacqueline Curtis
- Case Western Reserve University School of Medicine, Department of Population and Quantitative Health Sciences. GIS Health and Hazards Lab. 10900 Euclid Avenue. Cleveland, OH 44106.
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Lamar M, Kershaw KN, Leurgans SE, Mukherjee RR, Lange-Maia BS, Marquez DX, Barnes LL. Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults. Front Hum Neurosci 2023; 17:1125906. [PMID: 37250695 PMCID: PMC10213534 DOI: 10.3389/fnhum.2023.1125906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes. Methods We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group. Results For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning. Discussion Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - R. Reshmi Mukherjee
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Claremont McKenna College, Claremont, CA, United States
| | - Brittney S. Lange-Maia
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - David X. Marquez
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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11
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Geldermann A, Falge C, Betscher S, Jünger S, Bertram C, Woopen C. Diversitäts- und kultursensible Gesundheitsinformationen für mehr digitale Gesundheitskompetenz: Eine kollaborative Community-Forschung zu Barrieren und Bedarfen. PRA¨VENTION UND GESUNDHEITSFO¨RDERUNG 2023. [PMCID: PMC9924178 DOI: 10.1007/s11553-023-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Hintergrund Bei Gesundheitsfragen spielt das Internet eine zentrale Rolle, wobei Verbraucher:innen vor der Herausforderung stehen, geeignete Such- und Bewertungsstrategien zu entwickeln. Damit Informationen zur Gesundheit im Internet gefunden, verstanden, beurteilt und angewendet werden können, bedarf es digitaler Gesundheitskompetenz auf individueller und auf organisationaler Ebene. Vor dem Hintergrund gesellschaftlicher Pluralität und Diversität wurden Fähigkeiten und Zugänge marginalisierter Communities in diesem Zusammenhang bisher wenig beforscht. Ziel Diese Studie untersuchte die Nutzung von Online-Gesundheitsinformationen im Alltag aus einer postmigrantischen Perspektive, welche nicht Migrationshintergründe, sondern lokale Kontexte von Migrant:innen in Deutschland als Vulnerabilitätsvariable versteht. Ziel dieser Studie war es, sowohl das digitale Gesundheitsinformationsverhalten marginalisierter Communities ethnografisch und kollaborativ zu erforschen als auch praxisnahe und kultursensible Ansätze für Akteur:innen der Gesundheitskommunikation zu entwickeln ohne migrantisierende Zuschreibungen zu reproduzieren. Methoden Im Rahmen einer kollaborativen ethnografischen Feldforschung im Stadtteillabor der Bochumer Hustadt von 10/2020–01/2021 führten Community-Forscher:innen online leitfadengestützte Interviews in ihrem Umfeld durch. Die Interviews wurden mittels einer qualitativen Inhaltsanalyse ausgewertet. Ergebnisse und Diskussion Die Ergebnisse machen deutlich, dass sprachliche, inhaltliche und mediale Aspekte von Online-Gesundheitsinformationen den Zugang zu und Umgang mit diesen für marginalisierte Communities bedingen. Die postmigrantische Perspektive stellt einerseits Migration als hinreichende Analyse- und Erklärungskategorie in Frage und begründet zugleich Diversitäts- und Kultursensibilität als zentrale Komponenten des Zugangs zu Gesundheitsinformationen und der Entwicklung von Maßnahmen zur Stärkung der digitalen Gesundheitskompetenz in pluralen Gesellschaften. Es bedarf sowohl vielsprachiger, transkulturell resonierender und technisch barrierearmer Online-Gesundheitsinformationen als auch gestärkter Interaktion zwischen Individuen einer pluralen postmigrantischen Gesellschaft und der Online-Gesundheitskommunikation.
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Affiliation(s)
- Anna Geldermann
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Universität zu Köln, Köln, Nordrhein-Westfalen Deutschland ,Center for Life Ethics, Universität Bonn, Bonn, Nordrhein-Westfalen Deutschland
| | - Christiane Falge
- Department of Community Health, Hochschule Gesundheit Bochum, Bochum, Nordrhein-Westfalen Deutschland
| | - Silke Betscher
- Department Social Work, Hochschule Angewandte Wissenschaften Hamburg, Hamburg, Hamburg Deutschland
| | - Saskia Jünger
- Department of Community Health, Hochschule Gesundheit Bochum, Bochum, Nordrhein-Westfalen Deutschland
| | - Caren Bertram
- Center for Life Ethics, Universität Bonn, Bonn, Nordrhein-Westfalen Deutschland
| | - Christiane Woopen
- Center for Life Ethics, Universität Bonn, Bonn, Nordrhein-Westfalen Deutschland
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12
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Molenaar JM, van der Meer L, Bertens LCM, de Vries EF, Waelput AJM, Knight M, Steegers EAP, Kiefte-de Jong JC, Struijs JN. Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis. Eur J Public Health 2023; 33:25-34. [PMID: 36515418 PMCID: PMC10263266 DOI: 10.1093/eurpub/ckac170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. METHODS We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. RESULTS In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. CONCLUSIONS Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.
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Affiliation(s)
- J M Molenaar
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - L van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - E F de Vries
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - A J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Knight
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - J C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - J N Struijs
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
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13
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Kondracki AJ, Reddick B, Smith BE, Geller PA, Callands T, Barkin JL. Sociodemographic disparities in preterm birth and low birthweight in the State of Georgia: Results from the 2017-2018 Pregnancy Risk Assessment Monitoring System. J Rural Health 2023; 39:91-104. [PMID: 35504850 DOI: 10.1111/jrh.12668] [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: 02/01/2023]
Abstract
PURPOSE To update the overall prevalence of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2,500 g) in the State of Georgia, including rural and urban counties. METHODS A sample was drawn from the 2017-2018 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS). In the complete-case data of singleton births (n=1,258), we estimated the weighted percentage prevalence of PTB, LBW, early/late PTB, and moderately/very LBW subcategories in association with maternal sociodemographic characteristics, and the prevalence stratified by rural/urban county of residence. Univariate and multivariate logistic regression models were fitted to estimate the odds ratios (ORs) of PTB and LBW adjusting for selected covariates. Logistic regression results from multiple imputation by chained equations (MICE) were used for comparison. FINDINGS The overall rate for PTB was 9.3% and 6.8% for LBW and among them, 2.3% were early PTB, 7.0% were late PTB, 5.4% were moderately LBW (MLBW), and 1.3% were very LBW (VLBW). Non-Hispanic Black women had the highest prevalence of PTB, LBW, early PTB, MLBW, and VLBW, as well as PTB and LBW in urban counties and LBW in rural counties. The odds of PTB (aOR 1.38; 95% CI: 0.81, 2.35) and LBW (aOR 2.68; 95% CI: 1.32, 5.43) were also higher among non-Hispanic Black relative to non-Hispanic White women and among women who received adequate-plus prenatal care compared to inadequate prenatal care. CONCLUSIONS Socioeconomic and health disparities created by disadvantage should be a focus of state policy to improve neonatal outcomes in the State of Georgia.
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Affiliation(s)
- Anthony J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, Georgia, USA
| | - Bonzo Reddick
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, Georgia, USA
| | - Betsy E Smith
- Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Pamela A Geller
- Department of Psychological and Brain Sciences, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Tamora Callands
- Department of Health Promotion & Behavior College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, Georgia, USA
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Contreras-Hernández I, Bonifaz-Alfonzo LC. [Transversal Health Research Networks, a strategy for translational medicine]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2022; 60:S110-S118. [PMID: 36796024 PMCID: PMC10627501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 02/18/2023]
Abstract
Translational research, in its regulatory function as a current policy for the research activities being performed at the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social: IMSS), demands a collaborative work among people involved in the generation of knowledge and in those who consume such knowledge. Being an organization who has among its major objectives for almost 80 years the health care of Mexican population, the Institute has an important human capital represented by its physician leaders, researchers and directors, who, by working closely together, will be able to find a better respond to the health care needs of the Mexican population. Through collaborative groups, transversal research networks oriented to the priority health problems of Mexican people are being organized as a strategy whose purpose is making research more efficient and ensuring rapidly applicable results, in order to improve the quality of health care services offered by the Institute, whose commitment is primarily to Mexican society, although the results of this strategy could also be shown to the world, considering that the Institute is one of the largest public health service organizations, at least in Latin America, and its results could be a benchmark for the region. Collaborative work in research networks began more than 15 years ago at IMSS, but today it is being consolidated and its objectives are being reoriented, aligning them with both national policies and those of the Institute itself.
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Affiliation(s)
- Iris Contreras-Hernández
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, División de Investigación Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Laura Cecilia Bonifaz-Alfonzo
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Khalil H, Peters MDJ, McInerney PA, Godfrey CM, Alexander L, Evans C, Pieper D, Moraes EB, Tricco AC, Munn Z, Pollock D. The role of scoping reviews in reducing research waste. J Clin Epidemiol 2022; 152:30-35. [PMID: 36179936 DOI: 10.1016/j.jclinepi.2022.09.012] [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: 05/09/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Scoping reviews and evidence map methodologies are increasingly being used by researchers. The objective of this article is to examine how scoping reviews can reduce research waste. STUDY DESIGN AND SETTING This article summarizes the key issues facing the research community regarding research waste and how scoping reviews can make an important contribution to the reduction of research waste in both primary and secondary research. RESULTS The problem of research waste is an enduring challenge for global health, leading to a waste of human and financial resources and producing research outputs that do not provide answers to the most pressing research questions. Research waste occurs within primary research but also in secondary research such as evidence syntheses. The focus of scoping reviews on characterizing the nature of existing evidence on a topic and including all types of evidence, potentially reduces research waste in five ways: (1) identifying key research gaps on a topic, (2) determining appropriate outcome measures, (3) mapping existing methodological approaches, (4) developing a consistent understanding of terms and concepts used in existing evidence, and (5) ensuring scoping reviews do not exacerbate the issue of research waste. CONCLUSION To ensure that scoping reviews do not themselves end up contributing to research waste, it is important to register the scoping review and to ensure that international reporting standards and methodological guidance are followed.
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Affiliation(s)
- Hanan Khalil
- School of Psychology and Public Health, Department of Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria 3086, Australia.
| | - Micah D J Peters
- University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, South Australia, Australia; Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, The University of Adelaide, Adelaide, South Australia, Australia
| | - Patricia A McInerney
- The Wits-JBI Centre for Evidence-Based Practice: A JBI Centre of Excellence, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Christina M Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Aberdeen, UK; The Scottish Centre for Evidence-based Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK
| | - Catrin Evans
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Erica B Moraes
- Federal Fluminense University, Nursing School, Department of Nursing Fundamentals and Administration, Rio de Janeiro, Brazil; The Brazilian Centre of Evidence-based Healthcare: A JBI Centre of Excellence (JBI Brazil), São Paulo, São Paulo, Brazil
| | - Andrea C Tricco
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zachary Munn
- JBI, Faculty of Health and Medical Science, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Science, School of Public Health, University of Adelaide, Adelaide, Australia
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The challenge for general practitioners to keep in touch with vulnerable patients during the COVID-19 lockdown: an observational study in France. BMC PRIMARY CARE 2022; 23:82. [PMID: 35436865 PMCID: PMC9014789 DOI: 10.1186/s12875-022-01694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
Background In France, the first COVID-19-related lockdown (17th March to 10th May 2020) resulted in a major decrease in healthcare service utilization. This raised concerns about the continuity of care for vulnerable patients. Objectives To identify individual and organizational factors associated with the initiatives taken by French GPs to contact vulnerable patients during the lockdown. Methods A national observational survey using an online questionnaire was conducted to document French GPs’ adaptations to the COVID-19 situation, their individual and organizational characteristics, including practice type (individual, group, multidisciplinary) and size. Data were collected from 7th to 20th May 2020 using mailing lists of GPs from the study partners and GPs who participated in a previous survey. This paper analysed answers to the question exploring whether and how GPs took initiatives to contact vulnerable patients. Responses were categorized in: no initiative; selection of patients to contact with a criteria-based strategy; initiative of contact without criteria-based strategy. Multivariate multinomial logistic regression identified factors associated with each category. Key components of the reported initiatives were described by inductive analysis of verbatim material. Results Among the 3012 participant GPs (~ 5.6% of French GPs), 1419 (47.1%) reported initiatives to contact some patients without criteria-based strategy, and 808 (26.8%) with a strategy using various clinical/psychological/social criteria. Women GPs more often declared initiatives of contacts with a criteria-based strategy (OR = 1.41, 95% CI [1.14-1.75]) as well as GPs with more than two patients who died due to COVID-19 in comparison with those having none (OR = 1.84, 95% CI [1.43-2.36]). Teaching GPs more often used criteria-based strategies than the other GPs (OR = 1.94, 95% CI [1.51-2.48]). Compared with those working in small monodisciplinary practice, GPs working alone were less likely to implement criteria-based initiatives of contacts (OR = 0.70, 95% CI [0.51-0.97]), while GPs working in multidisciplinary practice were more likely (OR = 1.94, 95% CI [1.26-2.98] in practices > 20 professionals). Conclusion French GPs took various initiatives to keep in touch with vulnerable patients, more frequently when working in group practices. These findings confirm the importance of primary care organization to ensure continuity of care for vulnerable people. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01694-y.
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Kaur H, Siwal SS, Saini RV, Singh N, Thakur VK. Significance of an Electrochemical Sensor and Nanocomposites: Toward the Electrocatalytic Detection of Neurotransmitters and Their Importance within the Physiological System. ACS NANOSCIENCE AU 2022; 3:1-27. [PMID: 37101467 PMCID: PMC10125382 DOI: 10.1021/acsnanoscienceau.2c00039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
A prominent neurotransmitter (NT), dopamine (DA), is a chemical messenger that transmits signals between one neuron to the next to pass on a signal to and from the central nervous system (CNS). The imbalanced concentration of DA may cause numerous neurological sicknesses and syndromes, for example, Parkinson's disease (PD) and schizophrenia. There are many types of NTs in the brain, including epinephrine, norepinephrine (NE), serotonin, and glutamate. Electrochemical sensors have offered a creative direction to biomedical analysis and testing. Researches are in progress to improve the performance of sensors and develop new protocols for sensor design. This review article focuses on the area of sensor growth to discover the applicability of polymers and metallic particles and composite materials as tools in electrochemical sensor surface incorporation. Electrochemical sensors have attracted the attention of researchers as they possess high sensitivity, quick reaction rate, good controllability, and instantaneous detection. Efficient complex materials provide considerable benefits for biological detection as they have exclusive chemical and physical properties. Due to distinctive electrocatalytic characteristics, metallic nanoparticles add fascinating traits to materials that depend on the material's morphology and size. Herein, we have collected much information on NTs and their importance within the physiological system. Furthermore, the electrochemical sensors and corresponding techniques (such as voltammetric, amperometry, impedance, and chronoamperometry) and the different types of electrodes' roles in the analysis of NTs are discussed. Furthermore, other methods for detecting NTs include optical and microdialysis methods. Finally, we show the advantages and disadvantages of different techniques and conclude remarks with future perspectives.
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Affiliation(s)
- Harjot Kaur
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Samarjeet Singh Siwal
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Reena V. Saini
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Nirankar Singh
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Vijay Kumar Thakur
- Biorefining and Advanced Materials Research Center, Scotland’s Rural College (SRUC), Kings Buildings, Edinburgh EH9 3JG, United Kingdom
- School of Engineering, University of Petroleum & Energy Studies (UPES), Dehradun, Uttarakhand 248007, India
- Centre for Research & Development, Chandigarh University, Mohali, Punjab 140413, India
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18
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Bérubé A, Tapp D, Dupéré S, Plaisance A, Bravo G, Downar J, Couture V. Do Socioeconomic Factors Influence Knowledge, Attitudes, and Representations of End-of-Life Practices? A Cross-Sectional Study. J Palliat Care 2022:8258597221131658. [PMID: 36237145 DOI: 10.1177/08258597221131658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Access to palliative and end-of-life (EOL) care might be influenced by knowledge, attitudes, and representations of these practices. Socioeconomic factors might then affect what people know about EOL care practices, and how they perceive them. This study aims to compare knowledge, attitudes, and representations regarding EOL practices including assisted suicide, medical assistance in dying, and continuous palliative sedation of adults, according to socioeconomic variables. METHODS A cross-sectional community-based questionnaire study featuring two evolving vignettes and five end-of-life practices was conducted in Quebec, Canada. Three sample subgroups were created according to the participants' perceived financial situation and three according to educational attainment. Descriptive analysis was used to compare levels of knowledge, attitudes, and representations between the subgroups. RESULTS Nine hundred sixty-six (966) people completed the questionnaire. Two hundred and seventy participants (28.7%) had a high school diploma or less, and 42 participants (4.4%) were facing financial hardship. The majority of respondents supported all end-of-life options and the loosening of eligibility requirements for medical assistance in dying. Differences between subgroups were minor. While respondents in socioeconomically disadvantaged subgroups had less knowledge about EOL practices, those with lower educational attainment were more likely to be in favor of medical assistance in dying, and less likely to favor continuous palliative sedation. CONCLUSIONS People living with situational social and economic vulnerabilities face multiple barriers in accessing health care. While they may have poorer knowledge about EOL practices, they have a positive attitude towards medical assistance in dying and assisted suicide, and a negative attitude towards continuous palliative sedation. This highlights the need for future research and interventions aimed at empowering this population and enhancing their access to EOL care.
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Affiliation(s)
- A Bérubé
- Faculty of Nursing, 4440Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada
- Cardiology Department, Quebec Heart and Lung Institute Research Center-Laval University, Quebec City, QC, Canada
| | - D Tapp
- Faculty of Nursing, 4440Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada
- Cardiology Department, Quebec Heart and Lung Institute Research Center-Laval University, Quebec City, QC, Canada
| | - S Dupéré
- Faculty of Nursing, 4440Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada
| | - A Plaisance
- Faculty of Nursing, 4440Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada
- Cardiology Department, Quebec Heart and Lung Institute Research Center-Laval University, Quebec City, QC, Canada
| | - G Bravo
- Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC, Canada
| | - J Downar
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - V Couture
- Faculty of Nursing, 4440Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Axis, Research Center of the CHU de Québec-Université Laval, Quebec, QC, Canada
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19
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Kobashi Y, Srou L, Tsubokura M, Nishikawa Y, Laymithuna N, Hok S, Okawada M. Vulnerable groups and protective habits associated with the number of symptoms caused by pesticide application in Kratie, Cambodia: a cross-sectional questionnaire study. J Rural Med 2022; 17:214-220. [PMID: 36397790 PMCID: PMC9613370 DOI: 10.2185/jrm.2022-019] [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: 04/23/2022] [Accepted: 06/16/2022] [Indexed: 02/18/2023] Open
Abstract
Objective: The present study aimed to identify pesticide poisoning symptoms and related protective habits to effectively prevent pesticide poisoning among farmworkers in Kratie, Cambodia, where pesticide poisoning is an urgent public health problem. Materials and Methods: This cross-sectional study based on a questionnaire survey analyzing social demographics, number of symptoms, and protective behavior regarding pesticide application was conducted in Kratie Province from January 25 to 31, 2021. In total, 210 farmworkers completed the survey. The effects of social demographics and pesticide-protective behavioral scores on the number of symptoms were investigated using multivariable regression analysis. Results: The observed number of symptoms was 1.16 times higher among women (P=0.004), increased with the duration of work, and decreased with age. In addition, we identified five significant pesticide-protective behaviors: 1) preparing using gloves, 2) using protective equipment, 3) avoiding wiping sweat, 4) avoiding leaking, and 5) resting when feeling ill. Pesticide-protective behaviors tended to decrease with the duration of working years in the low-education group (B=-0.04, SE=0.01), whereas no association was observed in the high-education group (B=0.01, SE=0.01). Conclusion: Pesticide-protective behaviors significantly correlated with fewer symptoms. The female and aging groups required continuous special education or instructions for implementing pesticide-protective actions, especially the aforementioned five protective actions.
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Affiliation(s)
| | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Japan
| | | | - Songhy Hok
- Sunrise Japan Hospital Phnom Penh, Cambodia
| | - Manabu Okawada
- Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Cambodia
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20
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Campillay-Campillay M, Calle-Carrasco A, Dubo P, Moraga-Rodríguez J, Coss-Mandiola J, Vanegas-López J, Rojas A, Carrasco R. Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12439. [PMID: 36231740 PMCID: PMC9564706 DOI: 10.3390/ijerph191912439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.
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Affiliation(s)
- Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Ana Calle-Carrasco
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Pablo Dubo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Jorge Moraga-Rodríguez
- Programa de Magíster en Metodología de Investigación Cualitativa para la Salud, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Univerdidad de Las Américas, Santiago 3981000, Chile
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21
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Laranjeira C, Piaça I, Vinagre H, Vaz AR, Ferreira S, Cordeiro L, Querido A. Vulnerability through the Eyes of People Attended by a Portuguese Community-Based Association: A Thematic Analysis. Healthcare (Basel) 2022; 10:healthcare10101819. [PMID: 36292265 PMCID: PMC9601330 DOI: 10.3390/healthcare10101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Vulnerability is associated with the individual’s social and biological conditions, but also the conditions of their enveloping environment and society, leading to terms such as vulnerable populations or risk groups. This study aimed to give a voice to people with experiences of vulnerability and explore their perspectives, using a descriptive qualitative design. Purportedly vulnerable adults were recruited and interviewed with semi-structured questions on vulnerability. Data were organized, using WebQDA software, and submitted to thematic content analysis, as proposed by Clark and Braun, which generated a thematic tree. The study included six men and six women with a mean age of 43.8 [SD = 14.17] years old. Thematic analysis generated three themes: (1) Conceptions about vulnerability, (2) Barriers imposed by vulnerability, and (3) Strategies for dealing with vulnerability. The results highlight that vulnerability is a highly dynamic process of openness to circumstances that influence individual outcomes. However, there is a lack of conceptual clarity. Although being vulnerable is perceived as something negative, we need to transform the social mindset, because vulnerability also has the potential to change priorities in life for the better.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Campus 5, Rua de Santo André—66–68, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention (RECI I&D), Piaget Institute, 3515-776 Viseu, Portugal
- Correspondence:
| | - Inês Piaça
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Henrique Vinagre
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Ana Rita Vaz
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Sofia Ferreira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Lisete Cordeiro
- InPulsar (Associação para o Desenvolvimento Comunitário), Rua José Gonçalves LT 55—LJ 3 PISO-1, 2410-121 Leiria, Portugal
| | - Ana Querido
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Campus 5, Rua de Santo André—66–68, 2410-541 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
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22
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Killian AC, Carter AJ, Reed RD, Shelton BA, Qu H, McLeod MC, Orandi BJ, Cannon RM, Anderson D, MacLennan PA, Kumar V, Hanaway M, Locke JE. Greater community vulnerability is associated with poor living donor navigator program fidelity. Surgery 2022; 172:997-1004. [PMID: 35831221 PMCID: PMC9633042 DOI: 10.1016/j.surg.2022.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation-friends/family are encouraged to participate as the patients' advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate. We sought to evaluate the relationship between the patients' community-level vulnerability and living donor navigator self-advocacy as a surrogate for program fidelity. METHODS This single-center, retrospective study included 110 Living Donor Navigator participants (April 2017-June 2019). Program fidelity was assessed using the participants' advocacy status. Measures of community vulnerability were obtained from the Centers for Disease Control and Prevention Social Vulnerability Index. Modified Poisson regression was used to evaluate the association between community-level vulnerability and living donor navigator self-advocacy. RESULTS Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted relative risk 1.17, 95% confidence interval: 1.03-1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18, 95% confidence interval: 1.04-1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval: 1.06-1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval: 1.04-1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval: 1.02-1.35, P = .02) were associated with increased risk of self-advocacy. CONCLUSION Having a greater community-level vulnerability was associated with poor Living Donor Navigator Program fidelity. The potential barriers identified using the Social Vulnerability Index may direct resource allocation and program refinement to optimize program fidelity and efficacy for all participants.
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Affiliation(s)
- A Cozette Killian
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/CozetteKale
| | - Alexis J Carter
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/carteraj21
| | - Rhiannon D Reed
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/rhiruns
| | - Brittany A Shelton
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Haiyan Qu
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - M Chandler McLeod
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Babak J Orandi
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Robert M Cannon
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Douglas Anderson
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Paul A MacLennan
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Michael Hanaway
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Jayme E Locke
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL.
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23
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Platt C, Gephart SM. Placement disruption of children with disabilities in foster care. J Pediatr Nurs 2022; 66:30-35. [PMID: 35605440 DOI: 10.1016/j.pedn.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate and describe available data on children with disabilities in the United States foster care system and examine placement disruptions. DESIGN This quantitative descriptive study was a secondary data analysis of the Adoption and Foster Care Analysis and Reporting System (AFCARS) and included 680,611 children. METHODS Descriptive and regression analyses were conducted. FINDINGS Of 680,611 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis, requiring additional or specialized care. Children with disabilities in foster care (CDFC) had a mean of 4.0 disruptions-significantly higher than the mean 2.37 disruptions among those without a disability (p < .001, d = 0.51). CDFC spent an average of 915 days in foster care compared to 514 days for children without a disability (p < .001, d = 0.59). Predictive risk factors for disruptions were increased child age, race (American Indian or Black), and increased foster parent age. Protective factors against disruptions included married foster parents and a child being placed outside of the child's initial state of residence. CONCLUSIONS CDFC have significantly more disruptions and longer stays in foster care. While risk and protective factors affect all foster children similarly, they have significantly greater effect on foster children with disabilities. PRACTICE IMPLICATIONS Increased disruptions compound the vulnerability of CDFC as relationships and support systems are broken. Understanding the extent to which childhood disabilities play a role allows school nurses, healthcare providers, and child advocates to better design interventions to improve lifelong health outcomes.
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Affiliation(s)
- Christine Platt
- The University of Arizona, College of Nursing, PO Box 210203, Tucson, AZ 85721, United States of America.
| | - Sheila M Gephart
- The University of Arizona, College of Nursing, PO Box 210203, Tucson, AZ 85721, United States of America.
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24
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Hudon É, Hudon C, Chouinard MC, Lafontaine S, de Jordy LC, Ellefsen É. The Prenatal Primary Nursing Care Experience of Pregnant Women in Contexts of Vulnerability: A Systematic Review With Thematic Synthesis. ANS Adv Nurs Sci 2022; 45:274-290. [PMID: 35404308 PMCID: PMC9345523 DOI: 10.1097/ans.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The contexts of vulnerability are diversified and cover a wide range of situations where pregnant women are likely to experience threats or disparities. Nurses should consider the particular circumstances of women in contexts of vulnerability. We used a qualitative thematic synthesis to describe the experience of these women regarding their prenatal primary nursing care. We identified that the women's experience is shaped by the prenatal care. The fulfillment of their needs and expectations will guide their decision regarding the utilization of their prenatal care. We propose a theoretical model to guide nurses, promoting person-centered delivery of prenatal care.
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Affiliation(s)
- Émilie Hudon
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Catherine Hudon
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Maud-Christine Chouinard
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Sarah Lafontaine
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Louise Catherine de Jordy
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Édith Ellefsen
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
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25
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Henderson KH, Helmkamp LJ, Steiner JF, Havranek EP, Vupputuri SX, Hanratty R, Blair IV, Maertens JA, Dickinson M, Daugherty SL. Relationship Between Social Vulnerability Indicators and Trial Participant Attrition: Findings From the HYVALUE Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e007709. [PMID: 35418247 PMCID: PMC9117483 DOI: 10.1161/circoutcomes.120.007709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Social vulnerability indicators are associated with health care inequities and may similarly impede ongoing participation in research studies. We evaluated the association of social vulnerability indicators and research participant attrition in a trial focused on reducing health disparities. METHODS Self-identified White or Black adults enrolled in the HYVALUE trial (Hypertension and VALUEs), a randomized trial testing a values-affirmation intervention on medication adherence, from February 2017 to September 2019 were included. The self-reported measures of social vulnerability indicators included: (1) Black race; (2) female gender; (3) no health insurance; (4) unemployment; (5) a high school diploma or less; and (6) financial-resource strain. Full attrition was defined as not completing at least one 3- or 6-month follow-up study visit. Log-binomial regression models adjusted for age, gender, race, medical comorbidities, and the other social vulnerability indicators to estimate the relative risk of each social vulnerability indicator with study attrition. RESULTS Among 825 participants, the mean age was 63.3 years (±11.7 years), 60% were women, 54% were Black, and 97% reported at least one social vulnerability. Overall, 21% participants had full attrition after study enrollment. After adjustment for all other social vulnerabilities, only financial-resource strain remained consistently associated with full attrition (relative risk, 1.71 [95% CI, 1.28-2.29]). In a secondary analysis of partial attrition (completed only one follow-up visit), financial-resource strain (relative risk, 1.40 [95% CI, 1.09-1.81]) and being uninsured (relative risk, 1.54 [95% CI, 1.01-2.34]) were associated with partial attrition. CONCLUSIONS In a trial aimed at reducing disparities in medication adherence, participants who reported financial-resource strain had a higher risk of participant attrition independent of race or gender. Our findings suggest that efforts to retain diverse populations in clinical trials should extend beyond race and gender to consider other social vulnerability indicators. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03028597.
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Affiliation(s)
- Kamal H Henderson
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO (K.H.H.).,Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Laura J Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - John F Steiner
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO (J.F.S.)
| | - Edward P Havranek
- Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Denver Health and Hospital Authority, CO (E.P.H., R.H.)
| | - Suma X Vupputuri
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD (S.X.V.)
| | - Rebecca Hanratty
- Department of Medicine, Denver Health and Hospital Authority, CO (E.P.H., R.H.)
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder (I.V.B.)
| | - Julie A Maertens
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Stacie L Daugherty
- Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
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26
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Notley C, Belderson P, Hanson S, Ward E, Brown TJ, Naughton F. Disruption and adaptation in response to the coronavirus pandemic - Assets as contextual moderators of enactment of health behaviours. Br J Health Psychol 2022; 27:1153-1171. [PMID: 35319145 PMCID: PMC9111661 DOI: 10.1111/bjhp.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE During the COVID-19 UK first national lockdown (March-July 2020) enactment of healthy behaviours was fundamentally changed due to social restrictions. This study sought to understand perspectives on health behaviour change, as part of a wider study tracking reported health behaviour change over time. METHODS A purposive sample was selected. N = 40 qualitative interviews were conducted remotely (phone/video) from participants across England and Wales, and transcribed verbatim. Descriptive case studies were shared at regular analysis meetings. Inductive reflexive thematic coding was undertaken and coding was discussed using a team approach to agreeing analytical codes. A multiple lens theoretical perspective was adopted to illuminate the perceived influences and restrictions on participants' reports of health behaviour change. RESULTS There was a clear progressive narrative for all participants, through initial responses and reactions to the pandemic, framed as 'disruption', then, as lockdown was acclimatized to, evidence of 'adaptation'. Adaptation was seen in terms of modification, substitution, adoption, discontinuation/cessation, stultification, maintenance and recalibration of health behaviours. An illustrative case study exemplifies the narrative encompassing these features and demonstrating the complex non-linear interactions between context and enacted health behaviours. CONCLUSIONS Individuals responded to pandemic-related social restrictions in complex ways. Those in contexts with existing social assets, community links and established patterns of healthy behaviours were able to respond positively, adapting by modifying behaviour and using technology to engage in healthy behaviours in new and innovative ways. For those in more vulnerable contexts, enacting (negative) health behaviour change was an expression of frustration at the limitations imposed by social restrictions.
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Affiliation(s)
- Caitlin Notley
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Emma Ward
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tracey J Brown
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
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Nordenskiöld KY, Olsson JE, Bertilson BC. Diagnosis and treatment of vulnerable migrants: a retrospective study at a Doctors of the World clinic in Stockholm. BMC Health Serv Res 2022; 22:212. [PMID: 35177047 PMCID: PMC8851765 DOI: 10.1186/s12913-021-07410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background At Doctors of the World Medical Clinic in Stockholm (DWMCS), medical care is offered to migrants who live under particularly vulnerable conditions and who lack access to subsidized care. The demographic, diagnostic and therapeutic panorama of vulnerable migrants is unknown. Methods A quantitative, retrospective study mapping gender, age, diagnostic group, primary diagnosis, therapeutics, referrals, and session timing (whether the care session took place in summer -April to September, or winter - October to March) by reading all patients’ electronic journals at DWMCS between 2014-04-01 and 2017-12-31. Diagnostic groups were classified according to the classification system ICPC-2 which contains six diagnostic groups: symptoms/complaints, infections, neoplasms, injuries, congenital anomalies and other diagnoses. Primary diagnosis was defined as the diagnosis that was first in the diagnosis list for the visit. Difference in median age was calculated with the Mann-Whitney test (MW), and two-group analysis of nominal data was performed with Monte Carlo simulations (MC) and chi square test´s (X2). Results The study included 1323 patients: 838 women and 485 men. The median age for women 37 years (29-47) was slightly lower than for men, 40 years (31-47) MW (p = 0.002). The largest diagnostic group was symptoms / complaints. The five most common primary diagnoses were cough (4%), back symptom / complaint (4%), cystitis (3%), upper respiratory infection acute (3%) and abdominal pain epigastric (2%). The most common therapeutic (55%) was pharmaceutical. Referrals accounted for 12% of the therapeutics and 25% of the referrals were to an emergency room. Tests of significance indicated an uneven distribution of diagnostic groups MC (p = 0.003), infectious primary diagnoses MC (p = 0.0001) and referrals MC (p = 0.006) between men and women and an uneven seasonal distribution among the Other diagnoses MC (0.04) and ten most common drug treatments MC (p=0.002). Conclusions The demographic, diagnostic and therapeutic panorama of vulnerable migrants at DWMCS was elucidated. Vulnerable migrants have differences in morbidity depending on gender and season, differences in therapeutics depending on gender and differences among their most common drug treatments depending on season. This knowledge is important when addressing the health problems of vulnerable migrants.
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Affiliation(s)
- Klas Ytterbrink Nordenskiöld
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden.,Doctors of the World Sweden, Hantverkargatan 2c, 11221, Stockholm, Sweden
| | - Jan-Eric Olsson
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden
| | - Bo C Bertilson
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden.
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Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:1009-1026. [PMID: 35077194 DOI: 10.1200/jco.21.01681] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The call to integrate prospective surveillance for lymphedema into cancer care pathways is building momentum to enable early intervention and prevent the progression of the condition. We offer a critical evaluation of the literature on prospective surveillance and early management for cancer-related lymphedema and evaluate the effect of such programs in preventing chronic lymphedema (CRD42019137965). METHODS Five databases and two registries were searched for randomized controlled trials or observational studies that assessed the incidence or prevalence of lymphedema associated with participation in a prospective surveillance program, published until February 26, 2021. Numbers triggered for early lymphedema management, resolved, and chronic lymphedema were extracted. Pooled relative risk (trials) and pooled rate (cumulative incidence; observational studies) of chronic lymphedema was calculated. Subgroup analyses assessed the effect of study design, length of follow-up, and extent of axillary surgery. RESULTS Twenty-three studies were included, of which 21 studies evaluated breast cancer-related arm lymphedema (BCRaL). Participation in prospective surveillance with early management reduced the risk of chronic BCRaL versus usual care (relative risk 0.31; 95% CI, 0.10 to 0.95; two randomized controlled trials; N = 106). The pooled rate of chronic BCRaL was 4% (95% CI, 3 to 6; 15 observational studies; N = 3,545), and 6% (95% CI, 4 to 9) when restricted to participants with axillary lymph node dissection (12 studies; N = 1,527). CONCLUSION The findings suggest that participation in prospective surveillance with early management reduces the risk of chronic BCRaL. Only a minority of patients at high risk of lymphedema because of axillary surgery developed chronic lymphedema. More robust research is needed to determine whether prospective surveillance with early management can reduce the risk of chronic lymphedema, particularly among cancer survivors other than breast cancer.
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Affiliation(s)
- Bolette S Rafn
- Cancer Survivorship and Treatment Late Effects Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
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Feryn N, De Corte J, Roose R. Interprofessional primary care practice including social workers: exploring the experiences of patients in vulnerable situations. J Interprof Care 2022; 36:793-800. [PMID: 35050834 DOI: 10.1080/13561820.2021.2015302] [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: 10/19/2022]
Abstract
The link between social inequality and health has been widely recognized, as there are systematic differences in health between people from lower and higher social classes. Furthermore, the complexity and multidimensionality of health and social problems has resulted in primary health care services that are increasingly integrating the approach of interprofessional collaboration between medical professionals and social workers. Despite this current focus, there is a lack of empirical insights into patients' experience of the quality of care resulting from these collaborations. This paper aims to contribute to knowledge by adopting a research approach that captures the narratives of patients in vulnerable situations from a primary care center by conducting semi-structured interviews. Through content analysis, data was analyzed according to five themes: (1) availability, (2) accessibility, (3) affordability, (4) comprehensibility, and (5) usefulness. The results suggest a positive role for interprofessional collaboration between medical professionals and social workers within a primary health care setting. This includes the opportunity for giving greater attention to social rights and collaboration within the local community.
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Affiliation(s)
- Nele Feryn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Joris De Corte
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Rudi Roose
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
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Marzà-Florensa A, Boateng D, Agyemang C, Beune E, Meeks KAC, Bahendeka S, Levitt N, Klipstein-Grobusch K. Multimorbidity Among Migrant and Non-Migrant Ghanaians: The RODAM Study. Int J Public Health 2022; 66:1604056. [PMID: 35035346 PMCID: PMC8759292 DOI: 10.3389/ijph.2021.1604056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Multimorbidity is a growing public health concern due to the increasing burden of non-communicable diseases, yet information about multimorbidity in low- and middle-income countries and migrant populations is scarce. We aimed to investigate the distribution and patterns of multimorbidity in rural and urban areas in Ghana and Ghanaian migrants in Europe. Methods: The RODAM cross-sectional study included 4,833 participants. Multimorbidity was defined as presence of multiple non-communicable chronic conditions. Patterns were determined from frequent combination of conditions. Prevalence ratios were estimated by logistic regression. Results: Prevalence of multimorbidity was higher in women and in urban Ghana and Europe. We observed a cardiometabolic pattern in all sites as well as circulatory-musculoskeletal and metabolic-musculoskeletal combinations in Ghana. Multimorbidity prevalence ratios were higher in Europe (men 1.47, 95% CI 1.34-1.59, women 1.18, 1.10-1.26) and urban Ghana (men 1.46, 1.31-1.59, women 1.27, 1.19-1.34). Conclusion: Distribution and patterns of multimorbidity differed by sex and site. With a higher burden of multimorbidity in urban areas, prevention strategies should focus on forestalling its increase in rapidly growing rural areas.
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Affiliation(s)
- Anna Marzà-Florensa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Karlijn A C Meeks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Silver Bahendeka
- Department of Internal Medicine, Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Nkozi, Uganda
| | - Naomi Levitt
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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31
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Ngo Bikoko Piemeu CS, Loignon C, Dionne É, Paré-Plante AA, Haggerty J, Breton M. Expectations and needs of socially vulnerable patients for navigational support of primary health care services. BMC Health Serv Res 2021; 21:999. [PMID: 34551747 PMCID: PMC8456577 DOI: 10.1186/s12913-021-06811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary healthcare is the main entry to the health care system for most of the population. In 2008, it was estimated that about 26% of the population in Quebec (Canada) did not have a regular family physician. In early 2017, about 10 years after the introduction of a centralized waiting list for patients without a family physician, Québec had 25% of its population without a family physician and nearly 33% of these or 540,000, many of whom were socially vulnerable (SV), remained registered on the list. SV patients often have more health problems. They also face access inequities or may lack the skills needed to navigate a constantly evolving and complex healthcare system. Navigation interventions show promise for improving access to primary health care for SV patients. This study aimed to describe and understand the expectations and needs of SV patients. METHODS A descriptive qualitative study rooted in a participatory study on navigation interventions implemented in Montérégie (Quebec) addressed to SV patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited in three primary health care clinics, some of whom received the navigation intervention. A thematic analysis was performed using NVivo 11 software. RESULTS Sixteen patients living in socially deprived contexts agreed to participate in this qualitative study. Three main expectations and needs of patients for navigation interventions were identified: communication expectations (support to understand providers and to be understood by them, discuss about medical visit, and bridge the communication cap between patients and PHC providers); relational expectations regarding emotional or psychosocial support; and pragmatic expectations (information on available resources, information about the clinic, and physical support to navigate the health care system). CONCLUSIONS Our study contributes to the literature by identifying expectations and needs specified to SV patients accessing primary health care services, that relate to navigation interventions. This information can be used by decision makers for navigation interventions design and inform health care organizational policies.
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Affiliation(s)
- Carine Sandrine Ngo Bikoko Piemeu
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
| | - Christine Loignon
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
| | - Émilie Dionne
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
| | - Andrée-Anne Paré-Plante
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
- Charles-Lemoyne University Medicine Group, Saint-Lambert, Canada
| | - Jeannie Haggerty
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada.
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada.
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The Increase in Frequency of Protective Behavior against Pesticide Poisoning in Narail, Bangladesh through Use of an Easy Paper Checklist; an Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179349. [PMID: 34501938 PMCID: PMC8431624 DOI: 10.3390/ijerph18179349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
Protecting the health of farmworkers is a crucial issue. Previous studies report that safety training and educational interventions might increase farmworkers’ protective behaviors. The present study aimed to investigate the effectiveness of distributing a checklist as an interventional measure for pesticide protection in rural Asia, where pesticide poisoning is a major problem. This study was a community-based interventional study, using the distribution of a checklist with pesticide protective habits in Narail district, Bangladesh, with a total of 100 eligible males. Two questionnaire surveys were conducted before distributing the checklist and 25 days after. Change between the baseline and follow-up surveys was measured by frequency scores of protective behavior. The average pesticide-protective behavioral score increased from 4.58 in the baseline survey to 8.11 in the follow-up. Additionally, the checklist was more effective in the group with higher education, the younger group, and the group with lower pesticide-protective behavioral scores in the baseline survey. The paper checklist on protective behaviors against pesticide poisoning was effective because of the increase in the frequency of such positive behavior among farmworkers. Thus, intervention measures should be implemented to increase the knowledge and awareness regarding pesticide protection habits to protect the health of farmworkers.
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33
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Regmi MR, Tandan N, Parajuli P, Bhattarai M, Maini R, Kulkarni A, Robinson R. Social Vulnerability Indices as a Risk Factor for Heart Failure Readmissions. Clin Med Res 2021; 19:116-122. [PMID: 34531268 PMCID: PMC8445658 DOI: 10.3121/cmr.2021.1603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.
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Affiliation(s)
- Manjari Rani Regmi
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nitin Tandan
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Priyanka Parajuli
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mukul Bhattarai
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ruby Maini
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Abhishek Kulkarni
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Robert Robinson
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Hsueh L, Hirsh AT, Zapolski T, de Groot M, Mather KJ, Stewart JC. Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study. J Behav Med 2021; 44:662-672. [PMID: 33860913 DOI: 10.1007/s10865-021-00224-y] [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: 10/14/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
To determine the effect of patient immigrant status on physician trainees' diabetes treatment decisions. Participants were 140 physician trainees ('providers'). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group and individual levels. Providers were less likely to refer foreign-born (vs. U.S.-born) patients to endocrinology. Individual-level results showed an almost even split between treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add oral hypoglycemic agent, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). Physician trainees are less likely to refer foreign-born patients to endocrinology. Half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.
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Affiliation(s)
- Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, Indianapolis, IN, 46202, USA
| | - Tamika Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, Indianapolis, IN, 46202, USA
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, 410 W. 10th St., Suite 3100, HS 1140, Indianapolis, IN, 46202, USA
| | - Kieren J Mather
- Department of Medicine, Indiana University School of Medicine, 410 W. 10th St., Suite 3100, HS 1140, Indianapolis, IN, 46202, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, Indianapolis, IN, 46202, USA.
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Murillo-Pedrozo AM, Martínez-Herrera E, Ronda-Pérez E, Agudelo-Suárez AA. A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3897. [PMID: 33917688 PMCID: PMC8068052 DOI: 10.3390/ijerph18083897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.
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Affiliation(s)
| | - Eliana Martínez-Herrera
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín 050010, Colombia;
- Research Group on Health Inequalities, Environment, Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
- CIBERESP, 28029 Madrid, Spain
| | - Andrés A. Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Medellín 050010, Colombia;
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
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Grenier A, Hatzifilalithis S, Laliberte-Rudman D, Kobayashi K, Marier P, Phillipson C. Precarity and Aging: A Scoping Review. THE GERONTOLOGIST 2021; 60:620-632. [PMID: 31675418 DOI: 10.1093/geront/gnz135] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The concept of precarity holds the potential to understand insecurities and risks experienced by older people in the contemporary social, economic, political and cultural context. This study maps existing conceptualizations of precarity in relation to aging and later life, identifies key themes, and considers the use of precarity in two subfields. RESEARCH DESIGN AND METHODS This article presents the findings of a two-phase scoping study of the international literature on precarity in later life. Phase I involved a review of definitions and understandings of precarity and aging. Phase II explored two emerging subthemes of disability and im/migration as related to aging and late life. RESULTS A total of 121 published studies were reviewed across Phase I and Phase II. Findings reveal that the definition of precarity is connected with insecurity, vulnerability, and labor and that particular social locations, trajectories, or conditions may heighten the risk of precarity in late life. IMPLICATIONS AND DISCUSSION The article concludes by outlining the need for conceptual clarity, research on the unique multidimensional features of aging and precarity, the delineation of allied concepts and emerging applications, and the importance of linking research results with processes of theory building and the development of policy directives for change.
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Affiliation(s)
- Amanda Grenier
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada.,Baycrest Hopsital, Toronto, Ontario, Canada
| | - Stephanie Hatzifilalithis
- Health, Aging and Society, Hamilton, Ontario, Canada.,Gilbrea Centre for Studies in Aging, McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Kobayashi
- Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Patrik Marier
- Department of Political Science, Concordia University, Montreal, Quebec, Canada.,Centre de recherche et d'expertise en gérontologie sociale, Integrated Health and Social Services University Network for West-Central Montréal, Québec, Canada
| | - Chris Phillipson
- Manchester Institute for Collaborative Research on Ageing (MICRA), University of Manchester, United Kingdom
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Colmenares-Roa T, Figueroa-Perea JG, Pelcastre-Villafuerte B, Cervantes-Molina L, Juárez-Ramirez C, Guadarrama J, Ramirez-Hernández N, Pérez Zepeda MU, Peláez-Ballestas I. Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting. Health (London) 2021; 26:753-776. [PMID: 33467946 DOI: 10.1177/1363459320988879] [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: 11/15/2022]
Abstract
Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.
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Nielsen DS, Hansen RF, Beck SH, Wensien J, Masud T, Ryg J. Older patients' perspectives and experience of hospitalisation during the COVID-19 pandemic: a qualitative explorative study. Int J Older People Nurs 2021; 16:e12362. [PMID: 33389798 PMCID: PMC7883232 DOI: 10.1111/opn.12362] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/07/2020] [Accepted: 11/26/2020] [Indexed: 02/02/2023]
Abstract
Background and Objectives The aim of this study was to gain in‐depth knowledge and an increased understanding on how isolation from close relatives and carers, during the COVID‐19 pandemic, impacted older patients during hospitalisation in a Geriatric department. Method We conducted a qualitative study using semi‐structured interviews and a phenomenological‐hermeneutic approach, to get an understanding of the older participants' perspectives and lived experiences. Complete interviews were available for 11 patients—six men and five women, between 69 and 91 years of age. Results The participants' narratives identified several themes. Feeling isolated from and having no contact with close relatives or carers was prominent. The COVID‐19 pandemic created fear and anxiety among hospitalized patients. Relationships with family members and some staff became strained. The transformation from being “a person” to being “a patient” and loss of dignity, autonomy and a “sense of self” were themes identified in the analysis. Although virtual contact can't replace the real world, the use of technology to maintain contact with family and carers, and the need for help from hospital staff in facilitating this contact was deemed important. The environment of care was a prominent theme. The attitude of staff made a difference to how patients felt and some patients expressed a loss of decision‐making capability. The interviews were challenging in some cases because the interviews had to be interrupted or shortened due to ethical considerations around the individual person's needs and condition. Conclusions and implication for practice Our study provided in‐depth knowledge on how older patients experienced hospitalisation during the COVID‐19 pandemic in a Danish hospital. The results emphasise that compassionate care includes a willingness to listen to older patients' narratives and to imagine life as depicted by them. This can lead to better understanding of an individual person's needs and increase the quality of care provided.
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Affiliation(s)
- Dorthe Susanne Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Sanne Have Beck
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Jette Wensien
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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García-Sierra R, Fernández-Cano MI, Manresa-Domínguez JM, Feijoo-Cid M, Moreno Gabriel E, Arreciado Marañón A, Ramos-Roure F, Segura-Bernal J, Torán-Monserrat P. Psychological Distress and Somatization in Immigrants in Primary Health Care Practices. Healthcare (Basel) 2020; 8:healthcare8040557. [PMID: 33322209 PMCID: PMC7763568 DOI: 10.3390/healthcare8040557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/02/2022] Open
Abstract
The process of international migration causes a situation of vulnerability in people’s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.
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Affiliation(s)
- Rosa García-Sierra
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain; (R.G.-S.); (J.M.M.-D.); (E.M.G.); (F.R.-R.); (P.T.-M.)
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.F.-C.); (A.A.M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
| | - María Isabel Fernández-Cano
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.F.-C.); (A.A.M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Correspondence:
| | - Josep María Manresa-Domínguez
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain; (R.G.-S.); (J.M.M.-D.); (E.M.G.); (F.R.-R.); (P.T.-M.)
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.F.-C.); (A.A.M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
| | - María Feijoo-Cid
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.F.-C.); (A.A.M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
| | - Eduard Moreno Gabriel
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain; (R.G.-S.); (J.M.M.-D.); (E.M.G.); (F.R.-R.); (P.T.-M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
| | - Antonia Arreciado Marañón
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.F.-C.); (A.A.M.)
| | - Francesc Ramos-Roure
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain; (R.G.-S.); (J.M.M.-D.); (E.M.G.); (F.R.-R.); (P.T.-M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
| | - Jordi Segura-Bernal
- Faculty of Psychology, Education Sciences and Sport, Ramon Llull University, 08022 Barcelona, Spain;
| | - Pere Torán-Monserrat
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain; (R.G.-S.); (J.M.M.-D.); (E.M.G.); (F.R.-R.); (P.T.-M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17071 Girona, Spain
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Méndez M, Flores-Haro G, Zucker L. The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants. GEOFORUM; JOURNAL OF PHYSICAL, HUMAN, AND REGIONAL GEOSCIENCES 2020; 116:50-62. [PMID: 32834081 PMCID: PMC7413658 DOI: 10.1016/j.geoforum.2020.07.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 05/05/2023]
Abstract
As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.
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Affiliation(s)
- Michael Méndez
- School of Social Ecology, Department of Urban Planning and Public Policy, University of California, Irvine, 300 Social Ecology I, Irvine, CA 92697-7075, United States
| | - Genevieve Flores-Haro
- Mixteco/Indígena Community Organizing Project, 520 W. 5th St., Suite G Oxnard, CA 93030, United States
| | - Lucas Zucker
- Central Coast Alliance United for a Sustainable Economy (CAUSE), 2021 Sperry Ave. #9, Ventura, CA 93003, United States
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Haj-Younes J, Strømme EM, Igland J, Kumar B, Abildsnes E, Hasha W, Diaz E. Changes in self-rated health and quality of life among Syrian refugees migrating to Norway: a prospective longitudinal study. Int J Equity Health 2020; 19:188. [PMID: 33109202 PMCID: PMC7590794 DOI: 10.1186/s12939-020-01300-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background Forced migrants can be exposed to various stressors that can impact their health and wellbeing. How the different stages in the migration process impacts health is however poorly explored. The aim of this study was to examine changes in self-rated health (SRH) and quality of life (QoL) among a cohort of adult Syrian refugees before and after resettlement in Norway. Method We used a prospective longitudinal study design with two assessment points to examine changes in health among adult Syrian resettlement refugees in Lebanon accepted for resettlement in Norway. We gathered baseline data in 2017/2018 in Lebanon and subsequently at follow-up one year after arrival. The main outcomes were good SRH measured by a single validated item and QoL measured by WHOQOL-BREF. We used generalized estimating equations to investigate changes in outcomes over time and incorporated interaction terms in the models to evaluate effect modifications. Results In total, 353 subjects participated in the study. The percentage of participants reporting good SRH showed a non-significant increase from 58 to 63% RR, 95%CI: 1.1 (1.0, 1.2) from baseline to follow-up while mean values of all four QoL domains increased significantly from baseline to follow-up; the physical domain from 13.7 to 15.7 B, 95%CI: 1.9 (1.6, 2.3), the psychological domain from 12.8 to 14.5 B, 95%CI: 1.7 (1.3, 2.0), social relationships from 13.7 to 15.3 B, 95%CI: 1.6 (1.2, 2.0) and the environmental domain from 9.0 to 14.0 5.1 B, 95%CI: (4.7, 5.4). Positive effect modifiers for improvement in SRH and QoL over time include male gender, younger age, low level of social support and illegal status in transit country. Conclusion Our results show that good SRH remain stable while all four QoL domains improve, most pronounced in the environment domain. Understanding the dynamics of migration and health is a fundamental step in reaching health equity. Supplementary information Supplementary information accompanies this paper at 10.1186/s12939-020-01300-6.
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Affiliation(s)
- Jasmin Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway.
| | - Elisabeth Marie Strømme
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway
| | - Bernadette Kumar
- Unit for Migration and health. Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
| | - Eirik Abildsnes
- Department of Psychosocial Health, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Wegdan Hasha
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway.,Unit for Migration and health. Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
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Freund KS, Guassora AD, Hegelund T, Hvas L, Lous J. Resources in vulnerable young adults: self-assessments during preventive consultation with their general practitioner in Denmark. Health Promot Int 2020; 35:1180-1189. [PMID: 31750922 PMCID: PMC7585525 DOI: 10.1093/heapro/daz114] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inequality in health is increasing. People with many problems often lack energy to improve well-being and reduce their problems. This study analyses how psycho-socially challenged younger (20- to 44-year-old) patients described their own resources to reach lifestyle goals or alter life circumstances. Within the context of a randomized controlled trial, Danish participants had two structured preventive person-centred consultations with their general practitioner. Consultations focused on well-being, salutogenesis, resources, barriers and support of autonomy. Using the qualitative method: Systematic Text Condensation, we made thematic cross-analysis of patients' goal-specific resource statements described at the first consultation. Of the 209 patients, 191 (91%) chose one or two goals for a better life next year; nearly all (179) could recall and describe which resources they would use to reach their goal. We categorized resource statements into (i) personal constitution as 'willpower' and 'tenacity'; (ii) network, e.g. family; (iii) personal experience with identical or similar problems. Some patients needed to free up resources by handling psychological problems before being able to focus on lifestyle goals. The study demonstrates that patients with particular psycho-social problems could describe essential resources in a structured, salutogenic, preventive consultation with their general practitioner. Reflecting intrinsic and extrinsic motivation, these resources reflected dimensions of essential health theories like sense of coherence, self-efficacy and self-determination theory. Increased awareness of these resources seems essential for vulnerable patients by improving psychological well-being and optimism, thereby facilitating health-related changes. This may be an important step to reducing inequality in health.
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Affiliation(s)
| | - Ann Dorrit Guassora
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Ø. Farimagsgade 5,opg.Q, DK-1014 Copenhagen, Denmark
| | | | - Lotte Hvas
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Ø. Farimagsgade 5,opg.Q, DK-1014 Copenhagen, Denmark
| | - Jørgen Lous
- Research Unit of General Practice, Southern University, J. B. Winsløvs Vej 9A, DK-5000 Odense, Denmark
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43
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van Minde MRC, Remmerswaal M, Raat H, Steegers EAP, de Kroon MLA. Innovative postnatal risk assessment in preventive child health Care: A study protocol. J Adv Nurs 2020; 76:3654-3661. [PMID: 32996632 DOI: 10.1111/jan.14547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
AIM To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways. DESIGN This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways. METHODS The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N = 2,650). Additional data of a historical control group (N = 2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2 months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation. DISCUSSION The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians. IMPACT This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.
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Affiliation(s)
- Minke R C van Minde
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marianne Remmerswaal
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marlou L A de Kroon
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.,University Medical Center Groningen, Department of Health Sciences, University of Groningen, Groningen, The Netherlands
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Haggerty J, Levesque JF, Harris M, Scott C, Dahrouge S, Lewis V, Dionne E, Stocks N, Russell G. Does healthcare inequity reflect variations in peoples' abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries. Int J Equity Health 2020; 19:167. [PMID: 32977813 PMCID: PMC7517796 DOI: 10.1186/s12939-020-01281-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022] Open
Abstract
Background Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare. Methods This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access. Results The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability. Conclusions We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.
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Affiliation(s)
- Jeannie Haggerty
- St. Mary's Research Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
| | - Jean-Frederic Levesque
- Agency for Clinical Innovation and Centre for Primary Healthcare and Equity, University of NSW, Sydney, Australia
| | - Mark Harris
- Centre for Primary Healthcare and Equity, University of NSW, Sydney, Australia
| | | | - Simone Dahrouge
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Emilie Dionne
- St. Mary's Research Centre, McGill University, Montreal, Canada
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, Australia
| | - Grant Russell
- Department of General Practice, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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Rosati GF, Olego TA, Vazquez Brust HA. Building a sanitary vulnerability map from open source data in Argentina (2010-2018). Int J Equity Health 2020; 19:204. [PMID: 33176786 PMCID: PMC7656773 DOI: 10.1186/s12939-020-01292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Designing public health policies to target the needs of specific places requires highly granular data. When geographic health statistics from official sources are absent or lacking in spatial detail, Sanitary Vulnerability metrics derived from Census and other georeferenced public data can be used to identify areas in particular need of attention. With that aim, a Vulnerability Map was developed, identifying areas with a substantial deficit in its population health coverage. As a result a novel methodology for measuring Sanitary Vulnerability is presented, that can potentially be applied to different time periods or geographies. Methods Census, official listings of public health facilities and crowdsourced georeferenced data are used. The Vulnerability Index is built using dimensionality reduction techniques such as Autoencoders and Non-parametric PCA. Main results The high resolution map shows the geographical distribution of a Sanitary Vulnerability Index, produced using official and crowdsourced open data sources, overcoming the lack of official sources on health indicators at the local level. Conclusions The Sanitary Vulnerability Map’s value as a tool for place specific policymaking was validated by using it to predict local health related metrics such as health coverage. Further lines of work contemplate using the Map to study the interaction between Sanitary Vulnerability and the prevalence of different diseases, and also applying its methodology in the context of other public services such as education, security, housing, etc.
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Affiliation(s)
- Germán Federico Rosati
- National Council of Scientific and Technical Research, CONICET, Godoy Cruz 2290, Buenos Aires, C1425FQB, Argentina. .,Institute for High Social Studies, University of San Martín, Av. 25 de Mayo 1021, San Martín, B1650HMI, Argentina.
| | - Tomás Alberto Olego
- Bunge & Born Foundation, 25 de Mayo 501 6∘ Piso, Buenos Aires, C1002ABK, Argentina.,Faculty of Social Science, University of Buenos Aires, Santiago del Estero y Carlos Calvo, Buenos Aires, C1075AAU, Argentina
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Rafn BS, Midtgaard J, Camp PG, Campbell KL. Shared concern with current breast cancer rehabilitation services: a focus group study of survivors' and professionals' experiences and preferences for rehabilitation care delivery. BMJ Open 2020; 10:e037280. [PMID: 32723743 PMCID: PMC7389511 DOI: 10.1136/bmjopen-2020-037280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Breast cancer survivors experience a wide spectrum of physical sequelae from cancer treatment. National and international guidelines recommend that rehabilitation is offered from the point of diagnosis. However, there is a lack of data on the translation of these recommendations into clinical care. The objective of this study was to explore the experiences of breast cancer survivors, rehabilitation professionals and breast surgeons on current rehabilitation services including preferences for care delivery, specific ways to promote early detection and timely management of upper body issues and attitudes towards self-managed surveillance and rehabilitation. DESIGN Qualitative focus groups. Breast cancer survivors completed a questionnaire about rehabilitation services received and experience of upper body issues. These quantitative data were collected to provide context for the qualitative data and increase transferability. Transcripts were analysed using content analysis. SETTING Five geographically distinct health authorities in British Columbia, Canada. PARTICIPANTS Eleven focus groups were conducted with 35 breast cancer survivors, 29 rehabilitation professionals and 5 breast surgeons. RESULTS Three categories captured participants' concern and wish for improved care: (1) cut the cancer out and goodbye; (2) you have to look out for yourself and (3) in a perfect world. All breast cancer survivors reported chronic upper body issues (mean 4.5 unique issues). Breast cancer survivors expressed worry and uncertainty in their solo management of the rehabilitation. The current services were reported to not enable early detection and timely management. Suggestions included reorganising the timing of patient education and improving the quality of and access to rehabilitation services by elevating the knowledge among healthcare professionals and providing multimodal self-management resources. CONCLUSIONS The results revealed a gap between oncology guidelines and the current clinical reality. The rehabilitation services were reported in need of revamping to increase equity of care. Multiple upper body issues were reported by many breast cancer survivors.
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Affiliation(s)
- Bolette Skjødt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pat G Camp
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Grossi AA, Maggiore U, Puoti F, Grossi PA, Picozzi M, Cardillo M. Association of immigration background with kidney graft function in a publicly funded health system: a nationwide retrospective cohort study in Italy. Transpl Int 2020; 33:1405-1416. [PMID: 32621764 DOI: 10.1111/tri.13688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 ml/min/year (95% confidence interval: -1.48 to -0.45; P < 0.001), whereas it was similar in Eastern European-born KTRs [+0.02 ml/min/year (-0.77 to +0.81; P = 0.96)]. Adjusted 5-year transplant survival did not statistically differ between non-European-born, Eastern European-born, and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1-96.8), 92.5% in Eastern European-born (86.1-99.4), and 89.3% in non-European-born KTRs (83.0-96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.
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Affiliation(s)
- Alessandra Agnese Grossi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Paolo Antonio Grossi
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy.,Infectious Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mario Picozzi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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Midboe AM, Gray C, Cheng H, Okwara L, Gale RC. Implementation of health-focused interventions in vulnerable populations: protocol for a scoping review. BMJ Open 2020; 10:e036937. [PMID: 32690530 PMCID: PMC7371133 DOI: 10.1136/bmjopen-2020-036937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Vulnerable populations face significant challenges in navigating the care continuum, ranging from diagnosis of illness to linkage and retention in healthcare. Understanding how best to move individuals within these vulnerable populations across the care continuum is critical to improving their health. A large body of literature has focused on evaluation of implementation of various health-focused interventions in this population. However, we do not fully understand the unique challenges to implementing healthcare interventions for vulnerable populations. This study aims to examine the literature describing implementation of health service interventions among vulnerable populations to identify how implementations using the Consolidated Framework for Implementation Research are adapted. Findings from this review will be useful to implementation scientists to identify gaps in evidence and for adapting similar interventions in unique settings. METHODS AND ANALYSIS This study protocol outlines a scoping review of the peer-reviewed and grey literature, using established approaches delineated in Arksey and O'Malley's scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Search strategies will be developed and refined by a medical librarian in collaboration with the research team. Searches will be conducted in electronic databases (CINAHL, Cochrane, PsychINFO, PubMed, Social Services Abstracts, Web of Science, Google and Google Scholar) and limited to studies published between 1 August 2009 and 1 June 2020. Additionally, hand searches will be conducted in three relevant journals-Implementation Science, Systematic Reviews and BMJ Open. English-language studies and reports meeting inclusion criteria will be screened independently by two reviewers and the final list will be abstracted and charted in duplicate. ETHICS AND DISSEMINATION This is a review of the literature; ethics approval is not indicated. We will disseminate findings from this study in peer-reviewed journals as well as presentations to relevant stakeholders and conferences.
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Affiliation(s)
- Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Gray
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Hannah Cheng
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Leonore Okwara
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Randall C Gale
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
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Colciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women's vulnerability within the childbearing continuum: A scoping review. Eur J Midwifery 2020; 4:18. [PMID: 33537620 PMCID: PMC7839125 DOI: 10.18332/ejm/120003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The aim of this scoping review is to explore the concept of ‘vulnerability’ affecting pregnant women and to identify an appropriate definition of this term. METHODS Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue. RESULTS Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers. CONCLUSIONS The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.
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Affiliation(s)
| | - Beatrice Merazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Smith KA, Gehricke JG, Iadarola S, Wolfe A, Kuhlthau KA. Disparities in Service Use Among Children With Autism: A Systematic Review. Pediatrics 2020; 145:S35-S46. [PMID: 32238530 DOI: 10.1542/peds.2019-1895g] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services. OBJECTIVE We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status. DATA SOURCES Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services. STUDY SELECTION Included studies addressed at least one key question and met eligibility criteria. DATA EXTRACTION Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate. RESULTS Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care. LIMITATIONS The body of literature on this topic is small; hence it served as a limitation to this review. CONCLUSIONS The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions.
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Affiliation(s)
- Kathryn A Smith
- Children's Hospital Los Angeles, Los Angeles, California; .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jean-G Gehricke
- Center for Autism & Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, California
| | - Suzannah Iadarola
- Department of Developmental Behavioral Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Audrey Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Departments of Physical Medicine and Rehabilitation and
| | - Karen A Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
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