Projecting the chronic disease burden among the adult population in the United States using a multi-state population model

Use of telehealth simulation to teach the enhanced primary care RN role through community/public health-focused simulations

America is facing a primary care provider shortage. Enhanced primary care RNs (EPC-RNs), registered nurses working at the top of their practice scope, can be an important part of community-based primary care provision. Typically, community health nursing education has not included primary care-based clinical experiences, and there is a clinical site shortage. Teaching students about EPC-RN roles can be an important domain of community/public health nursing education. Simulation is a creative pedagogical approach to learning about the EPC-RN role. The purpose of this manuscript is to 1) describe EPC-RN Telehealth Simulation development; and 2) describe student simulation feedback. Nursing faculty and simulation experts designed five simulations for community health students to teach about the EPC-RN role, incorporating recommendations from the Quad Council Coalition of Public Health Nursing Organizations community/public health nursing competencies and the National Competencies for Registered Nurses in Primary Care. Retrospective, descriptive quantitative, and qualitative student feedback data (n = 519) was collected through QuestionPro over multiple semesters. Student feedback data demonstrated support of the use of the simulations in community/public health nursing education. The EPC-RN Telehealth Simulations prepared pre-licensure nursing students to practice in community-based primary care settings. Innovative, sustainable experiences such as this can improve community/public health nursing education.

US Primary Care Workforce Growth: A Decade of Limited Progress, and Projected Needs Through 2040

BACKGROUND

Despite efforts to mitigate a projected primary care physician (PCP) shortage required to meet an aging, growing, and increasingly insured population, shortages remain, compounded by the COVID-19 pandemic, growing inequity, and persistent underinvestment.

OBJECTIVE

We examined primary care workforce trends over the past decade and revisited projected primary care clinician workforce needs through the year 2040.

DESIGN AND PARTICIPANTS

Using data from the AMA Masterfile and Medical Expenditure Panel Survey (MEPS), we analyzed trends in the number of primary care physicians (PCPs) and in outpatient PCP visits by age and gender over the past decade. We then used the Medicare PECOS and Physician & Other Practitioners datasets to identify nurse practitioners (NPs) and physician assistants (PAs) in primary care.

MEASURES

Using these baseline clinician enumerations and projected population growth estimates from the US Census Bureau for the years 2020-2040, we calculated estimated primary care workforce needs by 2040.

KEY RESULTS

The effects of aging and population growth and baseline shortages in the primary care workforce call for significant increases in the primary care workforce to accommodate rising demands. Office visits to primary care clinicians are projected to increase from 773,606 in 2020 to 893,098 in 2040. We project a need for an additional 57,559 primary care clinicians by 2040.

CONCLUSIONS

Workforce shortages in primary care continue to expand due to population aging, growth, and heightened rates of clinician burnout & egress.

Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality

BACKGROUND

There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes.

METHODS

All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed.

RESULTS

A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%.

CONCLUSION

VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.

Noninferior Immunogenicity and Consistent Safety of Respiratory Syncytial Virus Prefusion F Protein Vaccine in Adults 50-59 Years Compared to ≥60 Years of Age

BACKGROUND

The adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) is approved in adults aged ≥60 years. We evaluated RSVPreF3 OA immunogenicity and safety in adults aged 50-59 years without or with increased risk for RSV disease due to specific chronic medical conditions.

METHODS

This observer-blind, phase 3, noninferiority trial included adults aged 50-59 years, stratified into 2 subcohorts: those with and those without predefined, stable, chronic medical conditions leading to an increased risk for RSV disease. Participants in both subcohorts were randomized 2:1 to receive RSVPreF3 OA or placebo. A control group of adults aged ≥60 years received RSVPreF3 OA. Primary outcomes were RSV-A and RSV-B neutralization titers (geometric mean titer ratios and sero-response rate differences) 1 month post-vaccination in 50-59-year-olds versus ≥60-year-olds. Cell-mediated immunity and safety were also assessed.

RESULTS

The exposed population included 1152 participants aged 50-59 years and 381 participants aged ≥60 years. RSVPreF3 OA was immunologically noninferior in 50-59-year-olds versus ≥60-year-olds; noninferiority criteria were met for RSV-A and RSV-B neutralization titers in those with and those without increased risk for RSV disease. Frequencies of RSVPreF3-specific polyfunctional CD4+ T cells increased substantially from pre- to 1 month post-vaccination. Most solicited adverse events had mild-to-moderate intensity and were transient. Unsolicited and serious adverse event rates were similar in all groups.

CONCLUSIONS

RSVPreF3 OA was immunologically noninferior in 50-59-year-olds compared to ≥60-year-olds, in whom efficacy was previously demonstrated. The safety profile in 50-59-year-olds was consistent with that in ≥60-year-olds.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT05590403.

Trends in Patient Complexity, Practice Setting, and Surgeon Reimbursement for Urolithiasis: Do Rural Urologists Pay the Price?

OBJECTIVE

To evaluate the relationship between patient complexity, practice setting, and surgeon reimbursement for ureteroscopy and percutaneous nephrolithotomy (PCNL).

METHODS

The "2021 Medicare Physician and Other Provider" file was used to collect Rural-Urban Commuting Area (RUCA) codes and hierarchical condition category (HCC) scores of urologists. Higher HCC score corresponds to higher medical complexity and higher RUCA code corresponds to a more rural area. Medicare reimbursement for ureteroscopy and PCNL were collected. Linear regressions were performed to predict change in reimbursement based on RUCA and HCC scores.

RESULTS

In 2021, 52,816 procedures under Current Procedural Terminology (CPT) code 52356 (ureteroscopy) and 1649 procedures under 50080 or 50081 (PCNL) were billed to Medicare. Mean reimbursement was $338.24 for ureteroscopy and $957.89 for PCNL. For ureteroscopy, higher HCC score predicted lower reimbursement (P <.001). Higher HCC score predicted higher reimbursement for PCNL (P <.01). Average RUCA for ureteroscopy was higher than for PCNL (P = .02). Rural location predicted lower reimbursement for ureteroscopy (P <.001), however, there was no association for PCNL.

CONCLUSION

For ureteroscopy, higher-risk patients are associated with lower reimbursement while the opposite holds true for PCNL. Rural practices were associated with lower reimbursement for ureteroscopy, but there was no association between location and PCNL reimbursement. Together, these findings suggest practice pattern variation between ureteroscopy and PCNL and highlight gaps in reimbursement policy. Risk-adjusted reimbursement should be considered to incentivize urologists to treat complex patients within their practice scope.

The Impact of Multimorbidity on Labor Force Participation Among the Middle-Aged and Older Working Population in the United States

OBJECTIVES

Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50-64 and to explore heterogeneous effects between self-employed and non-self-employed workers.

METHODS

We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours.

RESULTS

50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p < .01, 95% confidence interval [95% CI]: -0.109, -0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p < .01, 95% CI: -0.091, -0.036) in the F.E. model and by 4.9% (p < .01, 95% CI: -0.064, -0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p < .05, 95% CI: -0.233, -0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p < .01, 95% CI: -0.197, -0.070) in PSM estimation.

DISCUSSION

MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market.

Challenges and Coping Strategies in Transitioning From Caregiving to Widowhood: A Systematic Review

Ninety-one percent of surviving spouses in the U.S. cared for their spouses before they died. This review explores the challenges of the transition from caregiving to widowhood and different coping strategies used by widowed spousal caregivers. A systematic review of literature on the transition from caregiving to widowhood was conducted using four major academic search engines. Overall, 280 articles were identified, with 22 meeting the inclusion criteria. Challenges for widowed caregivers included experiencing care burden, letting go of the caregiver role, grief, and triggers. Widowed caregivers' coping strategies included social support and services use, filling the time gap, finding spirituality, and engaging in unhealthy behaviors. Future research is needed to determine the efficacy of widowed caregivers' coping strategies. Concerted and collaborative action by health professionals, community organizations, and policymakers is needed to develop programs and other approaches to support widowed caregivers.

Integrating text mining with network models for successful target identification: in vitro validation in MASH-induced liver fibrosis

An in silico target discovery pipeline was developed by including a directional and weighted molecular disease network for metabolic dysfunction-associated steatohepatitis (MASH)-induced liver fibrosis. This approach integrates text mining, network biology, and artificial intelligence/machine learning with clinical transcriptome data for optimal translational power. At the mechanistic level, the critical components influencing disease progression were identified from the disease network using in silico knockouts. The top-ranked genes were then subjected to a target efficacy analysis, following which the top-5 candidate targets were validated in vitro. Three targets, including EP300, were confirmed for their roles in liver fibrosis. EP300 gene-silencing was found to significantly reduce collagen by 37%; compound intervention studies performed in human primary hepatic stellate cells and the hepatic stellate cell line LX-2 showed significant inhibition of collagen to the extent of 81% compared to the TGFβ-stimulated control (1 μM inobrodib in LX-2 cells). The validated in silico pipeline presents a unique approach for the identification of human-disease-mechanism-relevant drug targets. The directionality of the network ensures adherence to physiologically relevant signaling cascades, while the inclusion of clinical data boosts its translational power and ensures identification of the most relevant disease pathways. In silico knockouts thus provide crucial molecular insights for successful target identification.

Classifying frailty in the ventral hernia population

INTRODUCTION

Frailty is increasingly recognized as a preoperative predictor of adverse outcomes following various surgical procedures. Our study aims to compare validated frailty measures in the ventral hernia population, as this is a common elective procedure with a paucity of data regarding frailty prevalence.

METHODS

Patients aged 18 years or older with planned ventral hernia repairs were prospectively enrolled in our single-institution study from January 2023 through June 2023. After obtaining informed consent, patients completed the Fried Frailty Index (FFI), the FRAIL Scale, and the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaires, as well as the standard completion of the Patient-Reported Outcomes Measurement Information System (PROMIS) measures at their preoperative clinic appointment. Chart review was performed for baseline demographics and comorbidities. The Modified Frailty Index (mFI-11) and the Charleston Comorbidity Index (CCI) were calculated.

RESULTS

A total of 63 patients were enrolled in our study. On average, the population was 60 years old, with a BMI of 32.4 kg/m2, a CCI of 3, and on 10.5 medications preoperatively. Overall, 12 patients (19%) screened positive for frailty by the mFI-11, 17 patients (27%) by the FFI, 15 patients (23.8%) by the FRAIL Scale, and 15 patients (23.8%) screened positive for sarcopenia by SARC-F. The FFI and the FRAIL Scale were strongly correlated with the other measures by Spearman's rank-order correlation (p < 0.05). On multivariate regression analysis, a longer Timed Up and Go test was associated with screening positive for frailty or sarcopenia (OR 1.896, p = 0.016).

CONCLUSION

In this study, we find that frailty is more prevalent than previously reported in the literature by any measure used. Both the FRAIL Scale and FFI strongly correlate with the other tools investigated. Surgeons should consider using these assessments preoperatively to estimate frailty and guide operative planning as well as shared decision-making.

Patient-clinician interactions in shared diabetes/nephrology consultations - A qualitative observation study

BACKGROUND

The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations.

AIM

This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting.

RESEARCH METHODS

We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke's reflexive thematic analysis and Arthur Kleinman's theory of illness and disease.

RESULTS

We found one over-arching theme: 'A consultation which encompassed both illness and disease' and four subthemes: (1) 'The medical focal point' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) 'The possibility of negotiations' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) 'Speaking different languages' displayed how patients used alternative illness-based explanations whereas clinicians tended to use biomedical language. (4) 'Perceptions of everyday life' concerned what patients considered was best for them when managing their illness and everyday lives.

CONCLUSION

Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings.

SHORT PHRASES

Shared Outpatient Clinic, Patient-clinician interactions.

The Trend of Chronic Diseases Among Older Koreans, 2004-2020: Age-Period-Cohort Analysis

OBJECTIVES

This study aimed to examine age, period, and cohort effects contributing to the prevalence of diabetes and hypertension among older Koreans. Additionally, it sought to investigate how sociodemographic characteristics interact with period and cohort effects to influence the disease prevalence.

METHODS

Using the 2004-2020 data from the National Survey of Older Koreans, a nationally representative sample of older adults aged 65 or older, hierarchical age-period-cohort cross-classified random effects models (HAPC-CCREMs) were employed to estimate separate age, period, and cohort components of the recent trends in diabetes and hypertension. Sociodemographic characteristics were tested for their interactions with period and cohort effects.

RESULTS

Significant period effects were observed, indicating a steady increase in the likelihood of being diagnosed with diabetes and hypertension over time. Age effects revealed a quadratic trend, with disease risks generally increasing with age, but the rate of increase diminishing at older ages. Cohort effects exhibited an inverted U-shaped pattern, with higher risks observed in the 1930s and early 1940s cohorts compared to earlier and later cohorts. Gender and educational attainment emerged as significant moderators. Women than men born in the early 1930s exhibited higher risks of diabetes and hypertension, whereas individuals with lower educational attainment showed a steadily increasing risk of hypertension over time.

DISCUSSION

The results underscore the complex interplay of age, period, and cohort effects in shaping disease prevalence among older Koreans. Our findings highlight the importance of considering historical context and sociodemographic factors in understanding disease trends and designing targeted interventions to mitigate health disparities.

Prescription Medication Use Among Older Adults in the US

This survey study describes changes in the use of prescription medications in individuals aged 65 years or older from 1999 through March 2020.

Foreclosure, memory decline, and dementia probability: A longitudinal cohort study

INTRODUCTION

Housing insecurity is rising among older adults; health researchers know little about how this may impact their cognitive health. We investigated links between foreclosure and older adults' memory and probability of dementia.

METHODS

Using the Health and Retirement Study (2008 to 2018), we fit mixed models comparing the memory and dementia probability scores of 249 older adults who experienced foreclosure (treated) with 15,645 who did not. Baseline covariates included sociodemographics and health. Models were stratified by age group.

RESULTS

Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults (-0.007 standard deviations/year, 95% confidence interval: -0.13, -0.001). Compared to average memory decline among middle-aged older adults who were stably housed, foreclosure equated to 3.7 additional years of aging over 10 years. Among those 65+, differences between those who were and were not foreclosed upon were short-lived and less clear, potentially driven by depletion-of-susceptibles bias.

DISCUSSION

Foreclosure may endanger older adults' memory.

HIGHLIGHTS

Housing instability is a key determinant of cognitive aging. We examined foreclosure and levels and changes in memory and dementia probability scores in the US older adult population. Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults, equivalent to 3.7 additional years of cognitive aging over 10 years. Foreclosure yielded sharp memory declines and increases in dementia probability among older adults 65 and above. Foreclosure imposes a greater risk for older adults' cognitive decline.

Total energy expenditure measured using doubly labeled water in adults with major chronic diseases: a systematic review

BACKGROUND

Energy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored.

OBJECTIVES

This systematic review aimed to characterize evidence on TEE among individuals with chronic diseases and describe TEE across chronic diseases and comparison with controls without a chronic disease.

METHODS

A literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics quality criteria checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup.

RESULTS

Fifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 y ago. Thirty-five (70%) studies reported resting energy expenditure, and approximately half (k = 26) reported physical activity level. Methodological quality was neutral (k = 25) or positive (k = 23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/d. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/d) and neurologic (2104 kcal/d) subgroups and highest among cancer (2903 kcal/d), endocrine (2661 kcal/d), and autoimmune (2625 kcal/d) subgroups. Excluding 1 article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/d). Most studies with a control group reported no differences in TEE between controls and patients; however, only 1 study was powered for between-group comparisons.

CONCLUSIONS

Energy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE in patients with chronic disease is different than that in controls. Further research is needed to inform energy requirement recommendations that consider chronic disease. This review was registered at PROSPERO as CRD42022336500 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336500).

Feasibility study of the use of a wearable vital sign patch in an intensive care unit setting

Multiple studies and review papers have concluded that early warning systems have a positive effect on clinical outcomes, patient safety and clinical performances. Despite the substantial evidence affirming the efficacy of EWS applications, persistent barriers hinder their seamless integration into clinical practice. Notably, EWS, such as the National Early Warning Score, simplify multifaceted clinical conditions into singular numerical indices, thereby risking the oversight of critical clinical indicators and nuanced fluctuations in patients' health status. Furthermore, the optimal deployment of EWS within clinical contexts remains elusive. Manual assessment of EWS parameters exacts a significant temporal toll on healthcare personnel. Addressing these impediments necessitates innovative approaches. In this regard, wearable medical technologies emerge as promising solutions capable of continual monitoring of hospitalized patients' vital signs. To overcome the barriers of the use of early warning scores, wearable medical technology has the potential to continuously monitor vital signs of hospitalised patients. However, a fundamental inquiry arises regarding the comparability of their reliability to the current used golden standards. This inquiry underscores the imperative for rigorous evaluation and validation of wearable medical technologies to ascertain their efficacy in augmenting extant clinical practices. This prospective, single-center study aimed to evaluate the accuracy of heart rate and respiratory rate measurements obtained from the Vivalink Cardiac patch in comparison to the ECG-based monitoring system utilized at AZ Maria Middelares Hospital in Ghent. Specifically, the study focused on assessing the concordance between the data obtained from the Vivalink Cardiac patch and the established ECG-based monitoring system among a cohort of ten post-surgical intensive care unit (ICU) patients. Of these patients, five were undergoing mechanical ventilation post-surgery, while the remaining five were not. The study proceeded by initially comparing the data recorded by the Vivalink Cardiac patch with that of the ECG-based monitoring system. Subsequently, the data obtained from both the Vivalink Cardiac patch and the ECG-based monitoring system were juxtaposed with the information derived from the ventilation machine, thereby providing a comprehensive analysis of the patch's performance in monitoring vital signs within the ICU setting. For heart rate, the Vivalink Cardiac patch was on average within a 5% error range of the ECG-based monitoring system during 85.11±10.81% of the measured time. For respiratory rate this was during 40.55±17.28% of the measured time. Spearman's correlation coefficient showed a very high correlation of ρ = 0.9 8 for heart rate and a moderate correlation of ρ = 0.66 for respiratory rate. In comparison with the ventilated respiratory rate (ventilation machine) the Vivalink and ECG-based monitoring system both had a moderate correlation of ρ = 0.68 . A very high correlation was found between the heart rate measured by the Vivalink Cardiac patch and that of the ECG-based monitoring system of the hospital. Concerning respiratory rate the correlation between the data from the Vivalink Cardiac patch, the ECG-based monitoring system and the ventilation machine was found to be moderate.

A scoping review of policies to encourage breastfeeding, healthy eating, and physical activity among rural people and places in the United States

BACKGROUND

Rural U.S. residents experience a disproportionate burden of diet and physical activity (PA) related chronic disease compared to urban residents, due to resource and economic challenges. Diverse policy approaches for chronic disease prevention have been implemented to address barriers to breastfeeding, healthy eating, and PA. Therefore, the purpose of this paper is to describe policy supports for breastfeeding, healthy eating, and/or PA occurring in rural U.S. areas.

METHODS

A scoping review was conducted March-June 2020 to identify policy, systems, and environment change approaches occurring in the rural U.S. for breastfeeding, healthy eating, and PA. Search procedures were guided by the PRISMA-ScR, Arksey and O'Malley's work (2007), and a science librarian. Medline, PubMed, Web of Science, and Agricola were used to identify peer-reviewed research. ProQuest Dissertations and Theses A&I were used to identify dissertation research. Grey literature searches included Google, Google Scholar, government pages, and public health, federal nutrition assistance program, Cooperative Extension Services, and related webpages. Policy results are reported and inclusion criteria were: (1) breastfeeding, healthy eating, and/or PA focus; (2) about policy factors; (3) specific to U.S. rural populations/places; and (4) English language. Outcomes (study/source design, objective(s), methods/measurement, setting, population characteristics, behavioral focus, policy-specific results) were extracted into a standardized Excel document.

RESULTS

Results include 122 total sources: original research, with some sources referencing multiple behaviors, (n = 74 sources: 8 breastfeeding, 41 healthy eating, 42 PA), grey literature (n = 45 sources: 16 breastfeeding, 15 healthy eating, 27 PA), and graduate research (n = 3 sources: 1 breastfeeding, 2 healthy eating, 1 PA). Breastfeeding policy initiatives included policies or programs at hospitals, increasing access to resources, and improving culture or norms at workplaces. Healthy eating policy initiatives included increasing access to healthy foods, reducing financial burden, implementing programs, food assistance programs, and healthy food prescriptions at healthcare facilities. PA policy initiatives focused on Complete Streets, joint or shared use efforts, Safe Routes to Schools, master plans for greenways, trails, and/or transportation, school health plans, and childcare/school standards.

CONCLUSIONS

Results from this scoping review compile and offer commentary on existing policy solutions to improve breastfeeding, healthy eating, and/or PA in the rural U.S.

Grating Bio-Microelectromechanical Platform Architecture for Multiple Biomarker Detection

A label-free biosensor based on a tunable MEMS metamaterial structure is proposed in this paper. The adopted structure is a one-dimensional array of metamaterial gratings with movable and fixed fingers. The moving unit of the optical detection system is a component of the MEMS structure, driven by the surface stress effect. Thus, these suspended optical nanoribbons can be moved and change the grating pattern by the biological bonds that happened on the modified cantilever surface. Such structural variations lead to significant changes in the optical response of the metamaterial system under illuminating angled light and subsequently shift its resonance wavelength spectrum. As a result, the proposed biosensor shows appropriate analytical characteristics, including the mechanical sensitivity of Sm = 11.55 μm/Nm-1, the optical sensitivity of So = Δλ/Δd = 0.7 translated to So = Δλ/Δσ = 8.08 μm/Nm-1, and the quality factor of Q = 102.7. Also, considering the importance of multi-biomarker detection, a specific design of the proposed topology has been introduced as an array for identifying different biomolecules. Based on the conducted modeling and analyses, the presented device poses the capability of detecting multiple biomarkers of disease at very low concentrations with proper precision in fluidic environments, offering a suitable bio-platform for lab-on-chip structures.

Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis

Introduction

Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care.

Methods

We performed a retrospective analysis of the National Inpatient Sample for patients discharged from January 1, 2016, to December 31, 2019, with conditions associated with frequently terminal conditions. We recorded demographic variables, do not resuscitate (DNR) status, and palliative care (PC) status and analyzed the associations between outcomes, mortality, and length of stay (LOS).

Results

A total of 23,402,637 patient records were included in the study, of which 2% were DNR and PC, 5% were DNR only, and 1% was PC only. From 2016 to 2019, the percentage of patients with PC increased from 2.55% to 3.27% and DNR from 6.31% to 7.7%. Black patients were less likely to have DNR status (odds ratio [OR] 0.72 [0.71-0.72]) but had similar PC rates. Male patients were less likely to have a DNR order in place (OR 0.89 [0.89-0.89]) but more likely to be in PC (OR 1.05 [1.04-1.05]). The diagnoses with the highest association with DNR status were lung cancer (OR 4.1 [4.0-4.5]), pancreatic cancer (OR 4.6 [4.5-4.7]), and sepsis (OR 2.9 [2.9-2.9]) The diagnoses most associated with PC were lung cancer (OR 6.3 [6.2-6.4]), pancreatic cancer (OR 8.1 [7.1-8.3]), colon cancer (OR 4.9 [4.8-5.1]), and senile brain degeneration of the brain OR 6.5 [5.3-7.9]). Mortality and LOS decreased between 2016 and 2019, but hospital charges increased (p < 0.001). Black race and male gender were associated with higher inpatient mortality (OR 1.12 [1.12-1.14]), LOS, and hospital charges.

Conclusion

In the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.

Factors and Perceptions Associated with Post-Pandemic Food Sourcing and Dietary Patterns among Urban Corner Store Customers in Baltimore, Maryland

OBJECTIVE

Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality.

DESIGN

Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti.

SETTING

This study was set in Baltimore, Maryland, USA.

PARTICIPANTS

The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store.

RESULTS

The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting.

CONCLUSIONS

This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments.

Burden of Caregivers of Patients with Chronic Diseases in Primary Health Care: A Cross-Sectional Study in Greece

BACKGROUND

In the world of elderly people and people with chronic diseases, caregivers give a solution to caring at home. This study aimed to evaluate the burden of caregivers of patients with chronic diseases in primary health care and identify possible demographic and other determinants of it.

METHODS

This was a cross-sectional study with a convenience sample, which was conducted in two health centers. The sample comprised 291 caregivers who visited the aforementioned health centers in Patra, Greece. A composite questionnaire was utilized: the first part included demographic data and care-related information and the second included the Zarit Burden Interview and the Depression, Anxiety, and Stress Scale-21 (DASS-21).

RESULTS

The highest mean score in the DASS was recorded in the depression subscale and the lowest in the stress subscale. Concerning the Zarit Burden Interview, the highest mean score was recorded in the personal strain subscale and the lowest in the management of care subscale. The highest correlation was recorded between role strain and anxiety and the lowest was between management of care and stress. Similarly, the total score in the Zarit Burden Interview correlated significantly (in a positive direction) with depression, anxiety, and stress.

CONCLUSIONS

Most of the caregivers of patients with chronic diseases in primary health care experienced a moderate to severe burden (especially in the dimension of personal strain) and moderate depression. The experienced burden was positively associated with depression, anxiety, and stress. There were significant differences in the caregivers' burden according to several demographic and care-related characteristics.

Nurse-led remote digital support for adults with chronic conditions: A systematic synthesis without meta-analysis

AIM

The systematic review aims to synthesize the literature examining the effectiveness of nurse-led remote digital support on health outcomes in adults with chronic conditions.

BACKGROUND

Adults with chronic diseases have increased rates of mortality and morbidity and use health care resources at a higher intensity than those without chronic conditions-placing strain on the patient, their caregivers and health systems. Nurse-led digital health disease self-management interventions have potential to improve outcomes for patients with chronic conditions by facilitating care in environments other that the hospital setting.

DESIGN AND METHODS

We searched PubMed/MEDLINE, Embase, PsycINFO and Cochrane Central databases from inception to 7 December 2022. We included randomized controlled trials assessing the impact of nurse-led remote digital support interventions compared to usual care on health-related outcomes in adults with chronic illness. The Cochrane risk-of-bias tool was used to assess bias in studies. Outcomes were organized into four categories: self-management, clinical outcomes, health care resource use and satisfaction with care. Results are presented narratively based on statistical significance.

RESULTS

Forty-four papers pertaining to 40 unique studies were included. Interventions most targeted diabetes (n = 11) and cardiovascular disease (n = 8). Websites (n = 10) and mobile applications (n = 10) were the most used digital modalities. Nurses supported patients either in response to incoming patient health data (n = 14), virtual appointment (n = 8), virtual health education (n = 5) or through a combination of these approaches (n = 13). Positive impacts of nurse-led digital chronic disease support were identified in each outcome category. Mobile applications were the most effective digital modality.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

Results show that nurse-led remote digital support interventions significantly improve self-management capacity, clinical health outcomes, health care resource use and satisfaction with care. Such interventions have potential to support overall health for adults with chronic conditions in their home environments.

A Guide to Measuring Heart and Respiratory Rates Based on Off-the-Shelf Photoplethysmographic Hardware and Open-Source Software

The remote monitoring of vital signs via wearable devices holds significant potential for alleviating the strain on hospital resources and elder-care facilities. Among the various techniques available, photoplethysmography stands out as particularly promising for assessing vital signs such as heart rate, respiratory rate, oxygen saturation, and blood pressure. Despite the efficacy of this method, many commercially available wearables, bearing Conformité Européenne marks and the approval of the Food and Drug Administration, are often integrated within proprietary, closed data ecosystems and are very expensive. In an effort to democratize access to affordable wearable devices, our research endeavored to develop an open-source photoplethysmographic sensor utilizing off-the-shelf hardware and open-source software components. The primary aim of this investigation was to ascertain whether the combination of off-the-shelf hardware components and open-source software yielded vital-sign measurements (specifically heart rate and respiratory rate) comparable to those obtained from more expensive, commercially endorsed medical devices. Conducted as a prospective, single-center study, the research involved the assessment of fifteen participants for three minutes in four distinct positions, supine, seated, standing, and walking in place. The sensor consisted of four PulseSensors measuring photoplethysmographic signals with green light in reflection mode. Subsequent signal processing utilized various open-source Python packages. The heart rate assessment involved the comparison of three distinct methodologies, while the respiratory rate analysis entailed the evaluation of fifteen different algorithmic combinations. For one-minute average heart rates' determination, the Neurokit process pipeline achieved the best results in a seated position with a Spearman's coefficient of 0.9 and a mean difference of 0.59 BPM. For the respiratory rate, the combined utilization of Neurokit and Charlton algorithms yielded the most favorable outcomes with a Spearman's coefficient of 0.82 and a mean difference of 1.90 BrPM. This research found that off-the-shelf components are able to produce comparable results for heart and respiratory rates to those of commercial and approved medical wearables.

Direct-acting antivirals in women of reproductive age infected with hepatitis C virus

Eliminating hepatitis C virus (HCV) infection in the population of women of reproductive age is important not only for the health of women themselves but also for the health of newborns. This study aimed to evaluate the implementation of this goal by analysing the effectiveness of contemporary therapy in a large cohort from everyday clinical practice along with identifying factors reducing therapeutic success. The analysed population consisted of 7861 patients, including 3388 women aged 15-49, treated in 2015-2022 in 26 hepatology centres. Data were collected retrospectively using a nationwide EpiTer-2 database. Females were significantly less often infected with HCV genotype 3 compared to males (11.2% vs. 15.7%) and less frequently showed comorbidities (40.5% vs. 44.2%) and comedications (37.2% vs. 45.2%). Hepatocellular carcinoma, liver transplantation, HIV and HBV coinfections were reported significantly less frequently in women. Regardless of the treatment type, females significantly more often reached sustained virologic response (98.8%) compared to males (96.8%). Regardless of gender, genotype 3 and cirrhosis were independent factors increasing the risk of treatment failure. Women more commonly reported adverse events, but death occurred significantly more frequently in men (0.3% vs. 0.1%), usually related to underlying advanced liver disease. We have demonstrated excellent effectiveness and safety profiles for treating HCV infection in women. This gives hope for the micro-elimination of HCV infections in women, translating into a reduced risk of severe disease in both women and their children.

Dignity in Medicine: Definition, Assessment and Therapy

PURPOSE OF REVIEW

Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions.

RECENT FINDINGS

We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.

Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey

BACKGROUND

Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with many health outcomes, but the association between SDoH and ED visits among older adults with multimorbidity has received limited attention. This study aimed to examine the association between SDoH and ED visits among older adults with multimorbidity.

METHODS

A cross-sectional analysis was conducted among 28,917 adults aged 50 years and older from the 2010 to 2018 National Health Interview Survey. Multimorbidity was defined as the presence of two or more self-reported diseases among 10 common chronic conditions, including diabetes, hypertension, asthma, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and heart, kidney, and liver diseases. The SDoH assessed included race/ethnicity, education level, poverty income ratio, marital status, employment status, insurance status, region of residence, and having a usual place for medical care. Logistic regression models were used to examine the association between SDoH and one or more ED visits.

RESULTS

Participants' mean (± SD) age was 68.04 (± 10.66) years, and 56.82% were female. After adjusting for age, sex, and the number of chronic conditions in the logistic regression model, high school or less education (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.02-1.19), poverty income ratio below the federal poverty level (AOR: 1.44, 95% CI: 1.31-1.59), unmarried (AOR: 1.19, 95% CI: 1.11-1.28), unemployed status (AOR: 1.33, 95% CI: 1.23-1.44), and having a usual place for medical care (AOR: 1.46, 95% CI 1.18-1.80) was significantly associated with having one or more ED visits. Non-Hispanic Black individuals had higher odds (AOR: 1.28, 95% CI: 1.19-1.38), while non-Hispanic Asian individuals had lower odds (AOR: 0.71, 95% CI: 0.59-0.86) of one or more ED visits than non-Hispanic White individuals.

CONCLUSION

SDoH factors are associated with ED visits among older adults with multimorbidity. Systematic multidisciplinary team approaches are needed to address social disparities affecting not only multimorbidity prevalence but also health-seeking behaviors and emergent healthcare access.

Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

BACKGROUND

Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care.

METHODS

We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews.

RESULTS

From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion.

CONCLUSIONS

We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously.

TRIAL REGISTRATION

This study was registered in PROSPERO (CRD42022357583).

Socioeconomic inequalities in accumulation of multimorbidity in England from 2019 to 2049: a microsimulation projection study

BACKGROUND

There are socioeconomic inequalities in the prevalence of multimorbidity and its accumulation across the life course. Estimates of multimorbidity prevalence in English primary care increased by more than two-thirds from 2004 to 2019. We developed a microsimulation model to quantify current and projected multimorbidity inequalities in the English adult population.

METHODS

We used primary care data for adults in England from the Clinical Practice Research Datalink Aurum database between 2004 and 2019, linked to the 2015 English Index of Multiple Deprivation (IMD), to model time individuals spent in four health states (healthy, one chronic condition, basic multimorbidity [two or more chronic conditions], and complex multimorbidity [three or more chronic conditions affecting three or more body systems]) by sex, age, IMD quintile, birth cohort, and region. We applied these transition times in a stochastic dynamic continuous-time microsimulation model to Office for National Statistics population estimates for adults aged 30-90 years. We calculated projected prevalence and cumulative incident cases from 2019 to 2049 by IMD quintile, age group (younger than 65 years vs 65 years and older), and years to be lived without multimorbidity at age 30 years.

FINDINGS

Under the assumption that all chronic conditions were lifelong, and that once diagnosed there was no recovery, we projected prevalence of multimorbidity (basic or complex) increases by 34% from 53·8% in 2019 to 71·9% (95% uncertainty interval 71·8-72·0) in 2049. This rise equates to an 84% increase in the number of people with multimorbidity: from 19·2 million in 2019 to 35·3 million in 2049 (35·3 million to 35·4 million). This projected increase is greatest in the most deprived quintile, with an excess 1·07 million (1·04 million to 1·10 million) cumulative incident basic multimorbidity cases and 0·70 million (0·67 million to 0·74 million) complex multimorbidity cases over and above the projected cases for the least deprived quintile, largely driven by inequalities in those younger than 65 years. The median expected number of years to be lived without multimorbidity at age 30 years in 2019 is 15·12 years (14·62-16·01) in the least deprived IMD quintile and 12·15 years (11·61-12·60) in the most deprived IMD quintile.

INTERPRETATION

The number of people living with multimorbidity will probably increase substantially in the next 30 years, a continuation of past observed increases partly driven by changing population size and age structure. Inequalities in the multimorbidity burden increase at each stage of disease accumulation, and are projected to widen, particularly among the working-age population. Substantial action is needed now to address population health and to prepare health-care and social-care systems for coming decades.

FUNDING

University of Liverpool and National Institute for Health and Care Research School for Public Health Research.

Engaging patients in designing a transmural allied health pathway: A qualitative exploration of hospital-to-home transitions

INTRODUCTION

The transition from hospital to home is often suboptimal, resulting in patients not receiving the necessary allied healthcare after discharge. This may, in turn, lead to delayed recovery, a higher number of readmissions, more emergency department visits and an increase in mortality and healthcare costs. This study aimed to gain insight into patients' experiences, perceptions, and needs regarding hospital-to-home transition, focusing on allied healthcare as a first step towards the development of a transitional integrated allied healthcare pathway for patients with complex care needs after hospital discharge.

METHODS

We conducted semistructured interviews with patients. Participants were recruited from universities and general hospitals in the Amsterdam region between May and July 2023. They were eligible if they (1) were discharged from the hospital minimally 3 and maximally 12 months after admission to an oncologic surgery department, internal medicine department, intensive care unit, or trauma centre, (2) received hospital-based care from at least one allied healthcare provider, who visited the patient at least twice during hospital admission, (3) spoke Dutch or English and (4) were 18 years or older. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis of the interview data.

RESULTS

Nineteen patients were interviewed. Three themes emerged from the analysis. 'Allied healthcare support during transition' depicts patients' positive experiences when they felt supported by allied health professionals during the hospital-to-home transition. 'Patient and family involvement' illustrates how much patients value the involvement of their family members during discharge planning. 'Information recall and processing' portrays the challenges of understanding and remembering overwhelming amounts of information, sometimes unclear and provided at the wrong moment. Overall, patients' experiences of transitional care were positive when they were involved in the discharge process. Negative experiences occurred when their preferences for postdischarge communication were ignored.

CONCLUSIONS

This study suggests that allied health professionals need to continuously collaborate and communicate with each other to provide patients and their families with the personalized support they need. To provide high-quality and person-centred care, it is essential to consider how, when, and what information to provide to patients and their families to allow them to contribute to their recovery actively.

PATIENT OR PUBLIC CONTRIBUTION

The interview guide for this manuscript was developed with the assistance of patients, who reviewed it and provided us with feedback. Furthermore, patients provided us with their valuable lived experiences by participating in the interviews conducted for this study.

Physical Activity Levels, Correlates, and All-Cause Mortality Risk in People Living With Different Health Conditions

BACKGROUND

To better understand physical activity behavior and its health benefits in people living with health conditions, we studied people with and without 20 different self-reported health conditions with regard to (1) their physical activity levels, (2) factors correlated with these physical activity levels, and (3) the association between physical activity and all-cause mortality.

METHODS

We used a subsample (n = 88,659) of the Lifelines cohort study from the Netherlands. For people living with and without 20 different self-reported health conditions, we studied the aforementioned factors in relation to physical activity. Physical activity was assessed with the Short Questionnaire to Assess Health-Enhancing Physical Activity Questionnaire, and mortality data were obtained from the Dutch death register.

RESULTS

People with a reported health condition were less likely to meet physical activity guidelines than people without a reported health condition (odds ratios ranging from 0.55 to 0.89). Higher body mass index and sitting time, and lower self-rated health, physical functioning, and education levels were associated with lower odds of meeting physical activity guidelines across most health conditions. Finally, we found a protective association between physical activity and all-cause mortality in both people living with and without different health conditions.

CONCLUSION

People living with different health conditions are generally less physically active compared with people living without a health condition. Both people living with and without self-reported health conditions share a number of key factors associated with physical activity levels. We also observed the expected protective association between physical activity and all-cause mortality.

Long-chain n -3 polyunsaturated fatty acids for the management of age- and disease-related declines in skeletal muscle mass, strength and physical function

PURPOSE OF REVIEW

This review uses the hierarchy of evidence as a framework to critically evaluate the effect of long chain n -3 polyunsaturated fatty acid (LC n -3 PUFA) ingestion alone, or as an adjunctive intervention to resistance training, on muscle health-related outcomes in healthy and clinical older adult populations.

RECENT FINDINGS

Systematic reviews and meta-analyses of randomized controlled trials consistently report small, but clinically-relevant, effects of LC n -3 PUFA ingestion on strength outcomes, whereas mixed findings have been reported regarding changes in muscle mass and physical function. Cohort studies indicate an association between higher dietary LC n -3 PUFA intake and reduced likelihood of a sarcopenia diagnosis. Acute metabolic studies provide limited evidence for an effect of LC n -3 PUFA ingestion alone, or in combination with resistance training, on free-living integrated rates of MPS, static markers of muscle protein breakdown, or satellite cell activation in healthy older adults.

SUMMARY

Recent data supports the efficacy of LCn-3 PUFA ingestion to facilitate small, but clinically relevant, improvements in muscle strength in healthy and clinical older adult populations. The mechanism(s) that underpin the action of LC n -3 PUFA in promoting strength outcomes remain unknown, but likely relate to neuromuscular function.

Predictive Criterion Validity of the Parsley Symptom Index Against the Patient-Reported Outcomes Measurement Information System-10 in a Chronic Disease Cohort: Retrospective Cohort Study

BACKGROUND

Approximately 60% of US adults live with chronic disease, imposing a significant burden on patients and the health care system. With the rise of telehealth, patient-reported outcomes measures (PROMs) have emerged as pivotal tools for managing chronic disease. While numerous PROMs exist, few have been designed explicitly for telehealth settings. The Parsley Symptom Index (PSI) is an electronic patient-reported outcome measure (ePROM) developed specifically for telehealth environments.

OBJECTIVE

Our aim is to determine whether the PSI predicts changes in the established Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) Global Health, a 10-question short form.

METHODS

We conducted a retrospective cohort study using data from 367 unique patients, amassing 1170 observations between August 30, 2017, and January 30, 2023. Patients completed the PSI and the PROMIS-10 multiple times throughout the study period. Using univariate regression models, we assess the predictive criterion validity of the PSI against PROMIS-10 scores.

RESULTS

This study revealed significant relationships between the PSI and PROMIS-10 physical and mental health scores through comprehensive univariate analyses, thus establishing support for the criterion validity of the PSI. These analyses highlighted the PSI's potential as an insightful tool for understanding and predicting both mental and physical health dimensions.

CONCLUSIONS

Our findings emphasize the importance of the PSI in capturing the nuanced interactions between symptomatology and health outcomes. These insights reinforce the value of the PSI in clinical contexts and support its potential as a versatile tool in both research and practice.

Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid)

Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.

CRUSE® -An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria

BACKGROUND

Chronic spontaneous urticaria (CSU) is unpredictable and can severely impair patients' quality of life. Patients with CSU need a convenient, user-friendly platform to complete patient-reported outcome measures (PROMs) on their mobile devices. CRUSE® , the Chronic Urticaria Self Evaluation app, aims to address this unmet need.

METHODS

CRUSE® was developed by an international steering committee of urticaria specialists. Priorities for the app based on recent findings in CSU were defined to allow patients to track and record their symptoms and medication use over time and send photographs. The CRUSE® app collects patient data such as age, sex, disease onset, triggers, medication, and CSU characteristics that can be sent securely to physicians, providing real-time insights. Additionally, CRUSE® contains PROMs to assess disease activity and control, which are individualised to patient profiles and clinical manifestations.

RESULTS

CRUSE® was launched in Germany in March 2022 and is now available for free in 17 countries. It is adapted to the local language and displays a country-specific list of available urticaria medications. English and Ukrainian versions are available worldwide. From July 2022 to June 2023, 25,710 observations were documented by 2540 users; 72.7% were females, with a mean age of 39.6 years. At baseline, 93.7% and 51.3% of users had wheals and angioedema, respectively. Second-generation antihistamines were used in 74.0% of days.

CONCLUSIONS

The initial data from CRUSE® show the wide use and utility of effectively tracking patients' disease activity and control, paving the way for personalised CSU management.

A Novel Curriculum for Internal Medicine Residents to Care for High-Need, High-Cost Patients

OBJECTIVES

High-need, high-cost (HNHC) patients represent a small proportion of patients in the US, but result in disproportionately higher healthcare utilization. Teaching Internal Medicine (IM) resident trainees to provide high value care for HNHC patients is critical. We sought to improve resident attitudes and increase clinical skills associated with treating HNHC patients by creating a curriculum that leveraged the UCLA Extensivist Program, a patient-centered medical home for HNHC patients.

METHODS

We developed a curriculum for PGY-2 and PGY-3 IM residents centered on caring for HNHC patients over the course of 6, 4h sessions during 1 academic year. Participants completed pre- and post-intervention surveys assessing self-rated attitudes and skills associated with caring for an HNHC patient population.

RESULTS

Twenty-one IM residents completed the curriculum and 41 were in the control group. There were no statistically significant differences in assessed attitudes and skills, but there were trends of improvement, including a decrease in participants who agreed or strongly agreed they felt overwhelmed when seeing patients for posthospital discharge follow up (45.0% pre- to 41.7% post-intervention) and an increase in participants who agreed or strongly agreed they have the skills to successfully transition HNHC patients between inpatient and ambulatory settings (20.0% pre- to 33.3% post-intervention). Participants reported better understanding of resources available to HNHC patients, effective coordination of transitions of care, and comprehensive assessment of social determinants of health.

CONCLUSION

A curriculum to improve resident attitudes and skills associated with caring for HNHC patients was successfully implemented in an IM program at a large academic medical center. The curriculum may be adapted for other training programs; long-term training woven throughout training may be important to significantly improve resident education on how to care for HNHC patients.

Undergraduate Nursing Student Reflections on Academic Service Learning Experiences - A Qualitative Study

The provision of nursing care has shifted toward integrated primary care (provision of community health services by an interprofessional team), requiring that nurse educators take steps to ensure students have opportunities to learn and practice the leadership and professional skills required to function as members and leaders of interdisciplinary teams. We developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for undergraduate nursing students to facilitate this learning. During clinical immersion, students participated in academic service learning (ASL) activities consisting of a minimum of 25 h of clinical agency service each semester. This descriptive qualitative design captures recurring themes in the ASL reflections of eight nursing students participating in the inaugural TRIP cohort. Three themes were identified (1) "Embracing the Nursing Profession" (2) "Utilizing the Professional Skills of Nursing" and (3) "I Am A Nurse". We urge our faculty colleagues to consider incorporating ASL experiences into their undergraduate activities. We believe the effort to initiate, develop and sustain these partnerships will pay handsome dividends in terms skill and confidence enhancements for our undergraduate nursing students.

Self-Management Analysis in Chronic Conditions (SMACC) checklist: an international consensus-based tool to develop, compare and evaluate self-management support programmes

OBJECTIVES

The Self-Management Analysis in Chronic Conditions (SMACC) checklist was developed as a guidance tool to support the development, comparison and evaluation of self-management support programmes for persons with a chronic condition. The checklist was based on a previously performed concept analysis of self-management. The aim of this study was to validate its content using an international Delphi study and to deliver a final version.

DESIGN

A two-round Delphi study was conducted between October 2022 and January 2023. Using the researchers' networks, professionals with research or clinical expertise in self-management support and chronic conditions were recruited via online purposive snowball sampling. Participants were asked to score each item of the checklist (16 items total) on 3 content validity indicators: (1) clarity and comprehensibility, (2) relevance and importance and (3) degree of alignment with the overall goal of the checklist to promote adequate and comprehensive self-management support programmes. A consensus threshold of 75% agreement was used. The participants were also asked general questions about the checklist as a whole and were asked to provide feedback considering its refinement.

RESULTS

Fifty-four professionals with an average 14.5 years of experience participated in round 1, 48 with an average 12.5 years of experience participated in round 2. The majority of professionals were from Western Europe. For the majority of items consensus was reached after round 1. In round 2, 3 of the 4 remaining items reached consensus, 1 last item was retained based on highly recurring feedback.

CONCLUSIONS

The SMACC checklist was considered a valid and comprehensive tool to aid the development, evaluation and comparison of self-management support programmes. It was acknowledged as a useful instrument to supplement existing frameworks and was seen as feasible to implement in both research and clinical settings. Further validation in the field, with input from patients and peer experts, will be valuable.

An Overview on the Hallucinogenic Peyote and Its Alkaloid Mescaline: The Importance of Context, Ceremony and Culture

Peyote (Lophophora williamsii) is a cactus that contains various biologically active alkaloids-such as pellotine, anhalonidine, hordenine and mescaline. Here, mescaline induces the psychoactive effects of peyote through the activation of the serotonin 5-HT2A receptor and the subsequent release of calcium (Ca2+) from the endoplasmic reticulum (ER). Moreover, an evaluation of the therapeutic benefits of mescaline is also currently the subject of research. It is important to consider that the outcome of taking a psychedelic drug strongly depends on the mindset of the recipient and the context (set and setting principle), including ceremonies and culture. This overview serves to summarise the current state of the knowledge of the metabolism, mechanism of action and clinical application studies of peyote and mescaline. Furthermore, the benefits of the potential of peyote and mescaline are presented in a new light, setting an example for combining a form of treatment embedded in nature and ritually enriched with our current highly innovative Western medicine.

Projecting the burden of dental caries and periodontal diseases among the adult population in the United Kingdom using a multi-state population model

Objectives

With the aging United Kingdom population, oral diseases are expected to increase. Exploring credible projections is fundamental to understanding the likely impact of emerging population-level interventions on oral disease burden. This study aims at providing a credible, evidence-based projection of the adult population in the United Kingdom with dental caries and periodontal diseases.

Methods

We developed a multi-state population model using system dynamics that disaggregates the adult population in the United Kingdom into different oral health states. The caries population was divided into three states: no caries, treated caries, and untreated caries. The periodontal disease population was disaggregated into no periodontal disease, pocketing between 4 and < 6 mm, 6 and < 9 mm, and 9 mm or more. Data from the 2009 dental health survey in the United Kingdom was used to estimate age and gender-specific prevalence rates as input to the multi-state population model.

Results

Of the population 16 years and older, the number with carious teeth is projected to decrease from 15.742 million in the year 2020 to 15.504 million by the year 2050, representing a decrease of 1.5%. For individuals with carious teeth, the older adult population is estimated to constitute 62.06% by 2050 and is projected to increase 89.4% from 5.079 million in 2020 to 9.623 million by 2050. The adult population with periodontal pocketing is estimated to increase from 25.751 million in 2020 to 27.980 million by 2050, while those with periodontal loss of attachment are projected to increase from 18.667 million in 2020 to 20.898 million by 2050. The burden of carious teeth and periodontal diseases is anticipated to shift from the adult population (16-59 years) to the older adult population. The older adult population with carious teeth is estimated to rise from 32.26% in 2020 to 62.06% by 2050, while that for periodontal disease is expected to increase from 42.44% in 2020 to 54.57% by 2050.

Conclusion

This model provides evidence-based plausible future demand for oral health conditions, allowing policymakers to plan for oral health capacity to address growing needs. Because of the significant delay involved in educating and training oral health personnel, such projections offer policymakers the opportunity to be proactive in planning for future capacity needs instead of being reactive.

Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals

Background

Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.

Methods

Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.

Findings

In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)).

Interpretation

This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks.

Funding

UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales.

Unveiling Spatial Associations between COVID-19 Severe Health Index, Racial/Ethnic Composition, and Community Factors in the United States

There are limited efforts to incorporate different predisposing factors into prediction models that account for population racial/ethnic composition in exploring the burden of high COVID-19 Severe Health Risk Index (COVID-19 SHRI) scores. This index quantifies the risk of severe COVID-19 symptoms among a county's population depending on the presence of some chronic conditions. These conditions, as identified by the Centers for Disease Control and Prevention (CDC), include Chronic Obstructive Pulmonary Disease (COPD), heart disease, high blood pressure, diabetes, and obesity. Therefore, the objectives of this study were (1) to investigate potential population risk factors preceding the COVID-19 pandemic that are associated with the COVID-19 SHRI utilizing non-spatial regression models and (2) to evaluate the performance of spatial regression models in comparison to non-spatial regression models. The study used county-level data for 3107 United States counties, utilizing publicly available datasets. Analyses were carried out by constructing spatial and non-spatial regression models. Majority White and majority Hispanic counties showed lower COVID-19 SHRI scores when compared to majority Black counties. Counties with an older population, low income, high smoking, high reported insufficient sleep, and a high percentage of preventable hospitalizations had higher COVID-19 SHRI scores. Counties with better health access and internet coverage had lower COVID-19 SHRI scores. This study helped to identify the county-level characteristics of risk populations to help guide resource allocation efforts. Also, the study showed that the spatial regression models outperformed the non-spatial regression models. Racial/ethnic inequalities were associated with disparities in the burden of high COVID-19 SHRI scores. Therefore, addressing these factors is essential to decrease inequalities in health outcomes. This work provides the baseline typology to further explore many social, health, economic, and political factors that contribute to different health outcomes.