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de Youngster S, Li SA. Use of Subsidized Health Services by Artists in Canada: An Exploratory Study. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241290666. [PMID: 39395018 DOI: 10.1177/2752535x241290666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2024]
Abstract
INTRODUCTION Creative and performing artists are often confronted with precarious employment and insufficient healthcare coverage. A clinic in Canada that provides specialized healthcare to artists offers eligible artists subsidized health services. We aim to compare the use of health services, demographics and health conditions between subsidy artist recipients (SAs) and non-subsidy artists (NSAs). METHODS We accessed existing data from 265 SAs and 711 NSAs and applied descriptive and inferential statistics to address our research questions. RESULTS Musculoskeletal issues, stress, anxiety disorders, and depressive disorders are the most common health problems faced by SAs. Compared to NSAs, SAs were more likely to seek treatment for stress, but less likely to seek treatment for anxiety disorders, depressive disorders, chronic problems, and upper extremity problems. DISCUSSION Future research may investigate the enduring effects of subsidized health services on SAs' health outcomes. Sustained positive outcomes are crucial for maintaining an artist's career and well-being.
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Affiliation(s)
- Sesinam de Youngster
- The Al & Malka Green Artists' Health Centre, University Health Network, Toronto, ON, Canada
| | - Shelly-Anne Li
- The Al & Malka Green Artists' Health Centre, University Health Network, Toronto, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Hasan F, Kim V, Silver EJ, Tomer G. Relationships of race and area deprivation indices to outcomes in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 79:877-884. [PMID: 39045750 DOI: 10.1002/jpn3.12329] [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: 02/01/2024] [Revised: 06/05/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Social determinants of health (SDOH) are nonmedical factors that influence health outcomes. Children with chronic illnesses living with socioeconomic risk factors have higher rates of unfavorable health outcomes. Our study aimed to assess the association between area deprivation indices (ADI), as a proxy for SDOH, and outcomes in pediatric patients with inflammatory bowel disease (IBD). METHODS A retrospective chart review was conducted on 134 pediatric patients with IBD, ages 0-21 years. Explanatory variables were the patient's ADI and demographics. Outcomes were assessed from time of diagnosis over a 1-year follow-up period. The primary outcome was the ratio of missed to completed appointments; secondary outcomes were the numbers of IBD-related emergency department (ED) visits and IBD-related hospitalizations. RESULTS Race/ethnicity was significantly associated with ADI (p < 0.001). In a multivariable regression model, no variables were associated with ratio of missed to completed appointments. Notably, ADI was not significantly associated with the ratio of missed to completed appointments. In a Poisson regression, Black (non-Hispanic) and Hispanic race/ethnicity, Medicaid insurance, female gender, and lower age were significantly associated with more IBD-related ED visits; ADI was not. In a similar model, Black (non-Hispanic) race, Medicaid insurance status, and lower age were significantly associated with more IBD-related hospitalizations; ADI was not. CONCLUSIONS In our cohort, ADI was not significantly associated with the ratio of missed to completed appointments, IBD-related ED visits, and IBD-related hospitalizations; however, race/ethnicity, age at diagnosis, insurance, and gender were associated with these outcomes.
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Affiliation(s)
- Faria Hasan
- Children's Hospital at Montefiore, Bronx, New York, USA
| | - Vivian Kim
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Gitit Tomer
- Children's Hospital at Montefiore, Bronx, New York, USA
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Sadreameli SC, Coates A, Sheares BJ. Advocacy and Health Equity: The Role of the Pediatric Pulmonologist. Clin Chest Med 2024; 45:771-783. [PMID: 39069337 DOI: 10.1016/j.ccm.2024.02.024] [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: 07/30/2024]
Abstract
Pediatric pulmonologists have the expertise to be advocates in many areas that affect the respiratory health of children. This article provides an overview of selected advocacy topics related to health equity and provides key examples that can improve child respiratory health in the clinical encounter and beyond.
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Affiliation(s)
- Sara Christy Sadreameli
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3015, Baltimore, MD 21287, USA.
| | - Anne Coates
- Department of Pediatrics, Tufts University School of Medicine, 887 Congress Street, Suite 320, Portland, ME, USA
| | - Beverley J Sheares
- Department of Pediatrics, Yale School of Medicine, 1 Park Street, New Haven, CT 06504, USA
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Johansson N, Warner G, Avogadri N, Sarkadi A. Screening for economic hardship at Child Health Care Centres: A qualitative study of stakeholders' perceptions and experiences of the Healthier Wealthier Families model in Sweden. Scand J Public Health 2024:14034948241252227. [PMID: 38813674 DOI: 10.1177/14034948241252227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
AIMS The Healthier Wealthier Families model uses the child healthcare services as an access point to screen and connect parents experiencing economic hardship to municipal Budget and Debt Counselling services. This study aimed to explore the perceptions and experiences of the Healthier Wealthier Families model in a Swedish context. METHODS Semi-structured interviews were conducted with three stakeholder groups: eligible parents who declined (n=10) and received (n=9) financial counselling; nurses (n=7); and financial counsellors (n=5). The data were analysed using thematic analysis. RESULTS The analysis resulted in three main themes conveying the stigma of talking about finance, the connection between economic situation and family wellbeing, and the nuts and bolts of providing preventive financial counselling. CONCLUSIONS A working model aiming to ameliorate child poverty in a societal service context needs to address the preconceptions and perceived mandate and role of the professionals, the prevalence of financial stigma in society, especially in relation to being a 'good' parent, and the current preoccupations and perceived financial needs and hopes of the families served.
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Affiliation(s)
- Nina Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Georgina Warner
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Nils Avogadri
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Rogerson C, Owora A, Tu W, Mendonca E. The influence of social and environmental determinants of health on hospitalizations for pediatric asthma. J Asthma 2024; 61:453-462. [PMID: 38010826 DOI: 10.1080/02770903.2023.2288323] [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: 06/22/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma. METHODS This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions. RESULTS The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate. CONCLUSION High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.
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Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eneida Mendonca
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
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Charlot-Swilley D, Thomas K, Mondi CF, Willis DW, Condon MC. A Holistic Approach to Early Relational Health: Cultivating Culture, Diversity, and Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:563. [PMID: 38791778 PMCID: PMC11121716 DOI: 10.3390/ijerph21050563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
Early Relational Health (ERH) is the foundation for infant and child emotional and social wellbeing. ERH is a quality of relationships co-created by infants, caregivers, and other members of their families and communities from pregnancy through childhood. Relationships themselves are not ERH; rather, ERH can be a feature of relationships. Those that are characterized by positive, shared emotionality become contexts within which members co-develop mutual capacities that enable them to prevail and flourish. This essay offers a synthesis of current knowledge about ERH in the US and begins to integrate Indigenous and non-Indigenous research and knowledge about ERH in the hope that readers will embrace "Etuaptmumk"-"Two-Eyed Seeing". The authors maintain that systems of care for infants, families, and their communities must first and foremost attend to revitalization, cultural context, diversity, equity, and inclusion. Authors discuss key concepts in ERH; Indigenous and non-Indigenous research that inform ERH; structural and systemic factors in the US that affect ERH ecosystems; the critical intersections of culture, diversity, equity; the broader concept of village support for fostering ERH; and efforts to revitalize ERH discourse, practices, and policies. The authors advocate for a holistic approach to ERH and suggest future directions for research and advocacy.
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Affiliation(s)
| | | | - Christina F. Mondi
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - David W. Willis
- Center for the Study of Social Policy, Washington, DC 20005, USA;
| | - Marie-Celeste Condon
- Independent Consultant and Researcher, University of Washington, Seattle, WA 98105, USA
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Miller J, Doucas A, Karra H, Thareja SK, Bowie O, Dong X, Terrell J, Hernandez S, Corujo-Ramirez AM, Xia N, Qi S, Huang CC, Lundh R, Young SA. Social determinants of health correlations and resource usefulness at a Milwaukee free clinic for uninsured individuals: A cross-sectional study. J Clin Transl Sci 2024; 8:e71. [PMID: 38690226 PMCID: PMC11058579 DOI: 10.1017/cts.2024.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Addressing social determinants of health (SDOH) is fundamental to improving health outcomes. At a student-run free clinic, we developed a screening process to understand the SDOH needs and resource utilization of Milwaukee's uninsured population. Methods In this cross-sectional study, we screened adult patients without health insurance (N = 238) for nine traditional SDOH needs as well as their access to dental and mental health care between October 2021 and October 2022. Patients were surveyed at intervals greater than or equal to 30 days. We assessed correlations between SDOH needs and trends in patient-reported resource usefulness. Results Access to dental care (64.7%) and health insurance (51.3%) were the most frequently endorsed needs. We found significant correlations (P ≤ 0.05) between various SDOH needs. Notably, mental health access needs significantly correlated with dental (r = 0.41; 95% CI = 0.19, 0.63), medications (r = 0.51; 95% CI = 0.30, 0.72), utilities (r = 0.39; 95% CI = 0.17, 0.61), and food insecurity (r = 0.42; 95% CI = 0.19, 0.64). Food-housing (r = 0.55; 95% CI = 0.32, 0.78), housing-medications (r = 0.58; 95% CI = 0.35, 0.81), and medications-food (r = 0.53; 95% CI = 0.32, 0.74) were significantly correlated with each other. Longitudinal assessment of patient-reported usefulness informed changes in the resources offered. Conclusions Understanding prominent SDOH needs can inform resource offerings and interventions, addressing root causes that burden under-resourced patients. In this study, patient-reported data about resource usefulness prompted the curation of new resources and volunteer roles. This proof-of-concept study shows how longitudinally tracking SDOH needs at low-resource clinics can inform psychosocial resources.
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Affiliation(s)
- Jessica Miller
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adrianna Doucas
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hamsitha Karra
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Suma K. Thareja
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Owen Bowie
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xiaowei Dong
- Medical College of Wisconsin, Milwaukee, WI, USA
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jennifer Terrell
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samuel Hernandez
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ana Mia Corujo-Ramirez
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicole Xia
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sabrina Qi
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Medical College of Wisconsin, Milwaukee, WI, USA
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rebecca Lundh
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Staci A. Young
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
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Williams V, Franco-Rowe C, Lopez C, Allison MA, Olds DL, Tung GJ. Coordination of family's care in an evidence-based nurse home visiting program. J Interprof Care 2024; 38:234-244. [PMID: 37855719 DOI: 10.1080/13561820.2023.2266452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2023] [Indexed: 10/20/2023]
Abstract
Interprofessional care coordination within evidence-based prevention programs like Nurse-Family Partnership® (NFP) is necessary to meet family needs and maximize program impact. This study aimed to describe the coordination of families' care in the NFP home visiting context. We used an adapted grounded theory approach and purposively sampled seven NFP sites. We conducted telephone interviews with 95 participants: 51 NFP staff (54%), 39 healthcare providers (41%), and 5 social service providers (5%). All interviews were recorded, transcribed, validated, and analyzed in NVivo11. Many community providers in all sites described their knowledge of the characteristics of the NFP intervention, including the strength of its evidence to achieve outcomes. Care coordination was dynamic and changed over time based on client needs and staff willingness to work together. Effective care coordination in the NFP context from the provider perspective is driven by shared knowledge, integrated systems, mission alignment, and individual champions who value the program.
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Affiliation(s)
- Venice Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carol Franco-Rowe
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Connie Lopez
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mandy A Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Jackson Tung
- Colorado School of Public Health, Department of Health Systems, Management & Policy, Aurora, CO, USA
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Cheung AT, Ho LLK, Li WHC, Chan GCF, Choi KC, Chung JOK, Chan CYWH. Group-based instrumental musical training to enhance resilience among school-aged children from low-income families: A pilot randomised waitlist controlled trial. Nurs Open 2024; 11:e2134. [PMID: 38481006 PMCID: PMC10937816 DOI: 10.1002/nop2.2134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
AIM To evaluate the acceptability, feasibility and potential effectiveness of a group-based instrumental musical training programme in improving resilience, depressive symptoms, self-esteem and quality of life among school-aged children from low-income families. DESIGN Assessor-blinded pilot randomised waitlist controlled trial with process evaluation. METHODS This study was conducted in the community from January 2022 to July 2023. Sixty-four children from low-income families (aged 8-12 years) were randomised (1:1) to intervention and waitlist control groups. The intervention group (n = 32) received weekly 1-hour instrumental musical training for 6 months in groups of four to five from professionally qualified musicians at a music centre. The participants in the waitlist control group (n = 32) received the same intervention as the participants in the intervention group after the completion of all outcome assessments. The primary outcome was the children's levels of resilience, measured using the Resilience Scale for Children - 10. The secondary outcomes were depressive symptoms, self-esteem and quality of life. Assessments were conducted at baseline (T0) and immediately post-intervention (T1). An intention-to-treat analysis was performed. RESULTS The 64 participants had a mean (SD) age of 9.5 (1.44) years, and 37 (57.8%) were boys. Compared with the waitlist control group, participants in the intervention group showed significantly greater improvements in resilience levels from baseline to T0 (group-by-time interaction coefficient β = 4.41; 95% CI, 1.82-6.99; p = 0.001), depressive symptoms (β = -6.42; 95% CI, -11.12 to -1.71; p = 0.008), self-esteem (β = -2.60; 95% CI, 0.28-4.92; p = 0.028) and quality of life (β = 6.69; 95% CI, 0.18-13.2; p = 0.044). CONCLUSION The group-based instrumental musical training programme was feasible and acceptable for school-aged underprivileged children and showed the potential to improve the resilience and quality of life of this vulnerable population.
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Affiliation(s)
- Ankie Tan Cheung
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Laurie Long Kwan Ho
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - William Ho Cheung Li
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Godfrey Chi Fung Chan
- Department of Paediatrics and Adolescent Medicine, School of Clinical MedicineThe University of Hong KongHong KongChina
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | | | - Carmen Yip Wing Han Chan
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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11
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Patel SR, Uriegas NA, Armstrong TA, Stover RM, Games KE, Winkelmann ZK. Digital Health Literacy and Social Determinants of Health Affecting Telehealth Use by Athletic Trainers. J Sport Rehabil 2024:1-10. [PMID: 38266633 DOI: 10.1123/jsr.2023-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/18/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
CONTEXT While increasing telehealth use throughout sports medicine has improved patients' access to health care, some communities may not have the same opportunities to connect with a provider. Barriers to telehealth implementation can be influenced by internal (eg, provider's digital health literacy and resources) and external (eg, community's social determinants of health or "SDOH") factors. This study aimed to assess the impact of internal and external factors on telehealth use by athletic trainers (ATs). DESIGN Cross-sectional survey. METHODS In total, 767 ATs participated in the study. Participants (age = 39 [13] y) completed a survey containing the electronic health literacy scale and digital health literacy instrument, reported professional use of telehealth as a provider (yes/no), provided resources at their clinical site, and provided the zip code for the community they served. After data collection, the researchers extracted SDOH information using the zip code data from 2 US databases, including population density, median household income, poverty index, education level, and technology access. Chi-square or independent samples t tests were conducted to compare telehealth use by each SDOH factor. RESULTS In total, 62.3% (n = 478/767) of ATs reported using telehealth, and 81.6% of ATs (n = 626) had a dedicated facility to offer health care services. We identified a significant difference in digital health literacy scores between users and nonusers of telehealth (P = .013). We did not identify any significant differences between telehealth users by community type (P = .957), population density (P = .053), income (P = .462), poverty index (P = .073), and computer (P = .211) or broadband internet access (P = .295). CONCLUSIONS Our data suggest that internal factors such as digital health literacy and clinical site resources may have contributed to an AT's previous telehealth use in clinical practice. However, the SDOH data extracted from the community zip code where the AT provided clinical services were similar for those with and without previous telehealth use.
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Affiliation(s)
- Sujal R Patel
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Nancy A Uriegas
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | | | - Ryan M Stover
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Kenneth E Games
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
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Moheize S, Hsu M, Matiz LA, Peretz P, Medina K, Esteves A, Meyer D, Maletz B, Pineda L, Berger-Jenkins E. The Role of an Early Childhood Community Health Worker in Addressing Psycho-Social Needs in the Perinatal and Early Childhood Period. J Prim Care Community Health 2024; 15:21501319241234478. [PMID: 38444152 PMCID: PMC10916458 DOI: 10.1177/21501319241234478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Addressing family psychosocial and mental health needs in the perinatal and early childhood period has a significant impact on long-term maternal and child health and is key to achieving health equity. We aimed to (1) describe and evaluate the role of an Early Childhood Community Health Worker (EC-CHW) to address psychosocial needs and improve psychosocial well-being for families in the perinatal period, and (2) examine factors associated with completion of goals. METHODS An EC-CHW program was modeled after an existing hospital CHW program for children with special healthcare needs and chronic disease. An evaluation was conducted using repeated measures to assess improvements in psychosocial outcomes such as family stress and protective factors after participating in the EC-CHW program. Linear regression was also used to assess factors associated with completion of goals. RESULTS Over a 21-month period (January 2019-September 2020), 161 families were referred to the EC-CHW. The most common reasons for referral included social needs and navigating systems for child developmental and behavioral concerns. There were high rates of family engagement in services (87%). After 6 months, families demonstrated statistically significant improvements in protective factors including positive parenting knowledge and social support. Only 1 key predictor variable, maternal depression, showed significant associations with completion of goals in the multivariable analysis. CONCLUSIONS This study demonstrated the need for, and potential impact of an EC-CHW in addressing psychosocial and mental health needs in the perinatal period, and in a primary care setting. Impacts on protective factors are promising.
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Affiliation(s)
- Sahar Moheize
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mandy Hsu
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luz Adriana Matiz
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | | | - Amanda Esteves
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Dodi Meyer
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Beth Maletz
- NewYork-Presbyterian Hospital, New York, NY, USA
- Columbia University School of Nursing, New York, NY, USA
| | - Lucie Pineda
- Greater Harlem Healthy Start at the Northern Manhattan Perinatal Partnership, New York, NY, USA
| | - Evelyn Berger-Jenkins
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Birkenmaier J, Maynard B, Shanks H, Blumhagen H. PROTOCOL: Medical-financial partnerships for improving financial and health outcomes for lower-income Americans: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1364. [PMID: 37818253 PMCID: PMC10561025 DOI: 10.1002/cl2.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
This is the protocol for a Campbell systematic review. The primary objectives of this review is to answer the following research questions using formal research studies: What is the extent and quality of MFP intervention research? What are the effects on financial outcomes of financial services embedded within healthcare settings? What are the effects on health-related outcomes of financial services embedded within healthcare settings?
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Affiliation(s)
| | - Brandy Maynard
- Saint Louis University School of Social WorkSt LouisMissouriUSA
| | - Hannah Shanks
- Saint Louis University School of Social WorkSt LouisMissouriUSA
| | - Harly Blumhagen
- Saint Louis University School of Social WorkSt LouisMissouriUSA
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Ng FYC, Tan PL, Sundar G. Improving visual outcomes in patients with rare paediatric eye diseases. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:625-634. [PMID: 38920150 DOI: 10.47102/annals-acadmedsg.202323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Rare paediatric eye diseases (RPEDs) threaten both vision and life. Recently, rare diseases were recognised as a global public health agenda, with children specified as a priority in the World Health Organization's VISION 2020 against avoidable visual loss. Method We conducted a review through a query of online databases (PubMed, Embase and Cochrane Library). Articles related to RPEDs were selected based on relevance by 2 authors, with any disagreements adjudicated by the third author. Results We synthesise the current state of knowledge regarding RPEDs, barriers to their care, and recommendations for the future. RPEDs often result in significant visual loss, profoundly impacting the way children comprehend and participate in the world. These diseases may also reduce life expectancy and even be life-threatening. Barriers to the care of RPEDs include an unclear definition of "rare diseases", missed or delayed diagnosis, inadequate knowledge and expertise in management, and challenging research environments. Conclusion Our findings provide an update on the diagnosis and management of RPEDs, which is of relevance to ophthalmologists, paediatricians, healthcare policymakers and social workers. We propose supportive policies and adequate resource allocation to these diseases, comprehensive and patient-centred care, alongside improved education and training, enhanced research capabilities and continued collaboration across institutions.
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Affiliation(s)
- Faye Yu Ci Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poh Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery Service, Department of Ophthalmology, National University Hospital, Singapore
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Jamal O, Mallipatna A, Hwang SW, Dimaras H. Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance. Transl Vis Sci Technol 2023; 12:36. [PMID: 38019501 PMCID: PMC10691384 DOI: 10.1167/tvst.12.11.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To characterize the availability of social determinants of health data in the electronic health record of pediatric ophthalmology patients and to examine the association of social determinants of health with attendance at scheduled operating room and clinic visits. Methods This was a retrospective cohort study of pediatric ophthalmology patients seen at The Hospital for Sick Children between June 1, 2018, and May 23, 2022. Data were collected on demographics, diagnosis, and management-plan. The χ2 tests and multivariable regression were used to examine associations between social determinants of health and attendance at scheduled operating room and clinic visits. Results The cohort consisted of 26,102 study subjects with 31,288 unique eye-related diagnoses representing 57 unique ICD-10 codes. Availability of data in the electronic health record ranged from 100% for sex, age and postal code to 0.1% for ethnic group. Female sex (P = 0.004) and urbanicity (P = 0.05) were associated with higher operating room visit cancellations. Female sex (P = 0.002), age group 0-13 (P ≤ 0.001), low-medium neighborhood income quintile (P ≤ 0.001), residence of Northern Ontario (P ≤ 0.001), and urbanicity (P ≤ 0.001) were associated with higher clinic visit cancellations and no-shows. Conclusions At a major tertiary-care hospital in Canada, key social determinant data such as ethnicity are not consistently available in the electronic health record of pediatric ophthalmology patients. Female sex, younger age, and living in a rural area or neighborhood with low-medium income quintile may be predictors of missed visits and require further study. Translational Relevance This study highlights a need for improved documentation of social determinants of health variables in electronic health records.
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Affiliation(s)
- Omer Jamal
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
| | - Ashwin Mallipatna
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Homs C, Berruezo P, Arcarons A, Wärnberg J, Osés M, González-Gross M, Gusi N, Aznar S, Marín-Cascales E, González-Valeiro MÁ, Serra-Majem L, Terrados N, Tur JA, Segú M, Fitó M, Benavente-Marín JC, Labayen I, Zapico AG, Sánchez-Gómez J, Jiménez-Zazo F, Alcaraz PE, Sevilla-Sanchez M, Herrera-Ramos E, Pulgar-Muñoz S, Bouzas C, Milà R, Schröder H, Gómez SF. Independent and Joined Association between Socioeconomic Indicators and Pediatric Obesity in Spain: The PASOS Study. Nutrients 2023; 15:nu15081987. [PMID: 37111206 PMCID: PMC10143028 DOI: 10.3390/nu15081987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16-0.48), severe obesity (OR = 0.20; 95% CI: 0.05-0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23-0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.
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Affiliation(s)
- Clara Homs
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
- Global Research on Wellbeing (GroW), Faculty of Health Sciences, Blanquerna Ramon Llull University, 08025 Barcelona, Spain
| | - Paula Berruezo
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
| | - Albert Arcarons
- Office of the High Commissioner against Child Poverty, 28079 Madrid, Spain
- Department of Sociology, National Distance Education University (UNED), 28012 Madrid, Spain
| | - Julia Wärnberg
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Maddi Osés
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Marcela González-Gross
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Susana Aznar
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Elena Marín-Cascales
- UCAM Research Center for High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Strength & Conditioning Society, 30008 Murcia, Spain
| | | | - Lluis Serra-Majem
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Preventive Medicine Service, Canarian Health Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), 35016 Las Palmas de Gran Canaria, Spain
| | - Nicolás Terrados
- Regional Unit of Sports Medicine-Municipal Sports Foundation of Avilés, 33402 Avilés, Spain
| | - Josep A Tur
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | - Marta Segú
- Barça Foundation, 08028 Barcelona, Spain
| | - Montserrat Fitó
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Juan Carlos Benavente-Marín
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Idoia Labayen
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Augusto G Zapico
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
- Department of Language, Arts and Physical Education, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jesús Sánchez-Gómez
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Fabio Jiménez-Zazo
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Strength & Conditioning Society, 30008 Murcia, Spain
| | - Marta Sevilla-Sanchez
- Faculty of Sports Sciences and Physical Education, Universida de da Coruña, 15001 A Coruña, Spain
| | - Estefanía Herrera-Ramos
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Susana Pulgar-Muñoz
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Cristina Bouzas
- Physiopathology of Obesity and Nutrition Networking Biomedial Research Center (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | - Raimon Milà
- Global Research on Wellbeing (GroW), Faculty of Health Sciences, Blanquerna Ramon Llull University, 08025 Barcelona, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
| | - Santiago F Gómez
- Gasol Foundation Europe, 08830 Sant Boi de Llobregat, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- Nursing and Physiotherapy Department, University of Lleida, 25198 Lleida, Spain
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Yeramilli V, Cheddadi R, Shah J, Brawner K, Martin C. A Review of the Impact of Maternal Prenatal Stress on Offspring Microbiota and Metabolites. Metabolites 2023; 13:metabo13040535. [PMID: 37110193 PMCID: PMC10142778 DOI: 10.3390/metabo13040535] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Maternal prenatal stress exposure affects the development of offspring. We searched for articles in the PubMed database and reviewed the evidence for how prenatal stress alters the composition of the microbiome, the production of microbial-derived metabolites, and regulates microbiome-induced behavioral changes in the offspring. The gut-brain signaling axis has gained considerable attention in recent years and provides insights into the microbial dysfunction in several metabolic disorders. Here, we reviewed evidence from human studies and animal models to discuss how maternal stress can modulate the offspring microbiome. We will discuss how probiotic supplementation has a profound effect on the stress response, the production of short chain fatty acids (SCFAs), and how psychobiotics are emerging as novel therapeutic targets. Finally, we highlight the potential molecular mechanisms by which the effects of stress are transmitted to the offspring and discuss how the mitigation of early-life stress as a risk factor can improve the birth outcomes.
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Affiliation(s)
- Venkata Yeramilli
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Riadh Cheddadi
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Juhi Shah
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
| | - Kyle Brawner
- Department of Biology, Lipscomb University, Nashville, TN 37204, USA
| | - Colin Martin
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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18
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Ochs JH. Addressing health disparities by addressing structural racism and implicit bias in nursing education. NURSE EDUCATION TODAY 2023; 121:105670. [PMID: 36502660 DOI: 10.1016/j.nedt.2022.105670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Jessica H Ochs
- Endicott College School of Nursing, 376 Hale Street, Beverly, MA 01915, United States of America.
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Ghani F, Wang H, Manning SE, Sambamoorthi U. Interactive association of chronic illness and food insecurity with emergency department utilization among school-age children in the United States: A cross-sectional study. Health Sci Rep 2023; 6:e1123. [PMID: 36814967 PMCID: PMC9940462 DOI: 10.1002/hsr2.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/23/2023] Open
Abstract
Background and Aims Food insecurity combined with chronic disease conditions is a risk factor for Emergency Department (ED) utilization, an indicator of poor quality of care. However, such an association is not certain among school-age children with chronic conditions. Therefore, we aim to determine the association of food insecurity, chronic conditions, and ED utilization among school-age children in the United States. Methods We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years (N = 5518). MEPS data was released electronically by the Agency for Healthcare Research and Quality (AHRQ). We identified four groups of school-age children based on the presence of food security and chronic conditions: 1) with food insecurity and chronic conditions; 2) no food insecurity and chronic conditions; 3) with food insecurity and no chronic conditions; and 4) no food insecurity and no chronic conditions. We compared ED utilization among these four groups using incidence rate ratios (IRR) after adjusting children's age, sex, race and ethnicity, household income, insurance coverage, obesity, and geographic region using count data model, specifically multivariable Poison regression. We used SAS 9.4 and STATA 14.2 for all the data analyses. Results There were unweighted 5518 school-age children who represented weighted 50,479,419 school-age children in the final analysis. Overall, 6.0% had food insecurity with chronic conditions. These children had higher ED utilization (19.7%) than the other three groups (13.3%, 8.8%, and 7.2%, p < 0.001). The adjusted IRR of ED utilization among school-age children with food insecurity and chronic conditions was 1.90 (95% confidence interval 1.20-3.01, p = 0.007) compared with those with food security and chronic conditions. Conclusion One in 16 school-age children has both food insecurity and chronic conditions. Food insecurity was positively associated with frequent ED visits in the presence of chronic conditions. Therefore, addressing food insecurity may reduce the risk of ED visits.
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Affiliation(s)
- Farheen Ghani
- Department of Pharmacotherapy, College of PharmacyUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Hao Wang
- Department of Emergency MedicineJPS Health NetworkFort WorthTexasUSA
| | | | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of PharmacyUniversity of North Texas Health Science CenterFort WorthTexasUSA
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Buczkowski A, Craig W, Holmes R, Allen D, Longnecker L, Kondrad M, Carr A, Turchi R, Gage S, Osorio SN, Cooperberg D, Mallory L. Factors Correlated With Successful Pediatric Post-Discharge Phone Call Attempt and Connection. Hosp Pediatr 2023; 13:47-54. [PMID: 36514893 DOI: 10.1542/hpeds.2022-006675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Postdischarge phone calls can identify discharge errors and gather information following hospital-to-home transitions. This study used the multisite Project IMPACT (Improving Pediatric Patient Centered Care Transitions) dataset to identify factors associated with postdischarge phone call attempt and connectivity. METHODS This study included 0- to 18-year-old patients discharged from 4 sites between January 2014 and December 2017. We compared demographic and clinical factors between postdischarge call attempt and no-attempt and connectivity and no-connectivity subgroups and used mixed model logistic regression to identify significant independent predictors of call attempt and connectivity. RESULTS Postdischarge calls were attempted for 5528 of 7725 (71.6%) discharges with successful connection for 3801 of 5528 (68.8%) calls. Connection rates varied significantly among sites (52% to 79%, P < .001). Age less than 30 days (P = .03; P = .01) and age 1 to 6 years (P = .04; P = .04) were independent positive predictors for both call attempt and connectivity, whereas English as preferred language (P < .001) and the chronic noncomplex clinical risk group (P = .02) were independent positive predictors for call attempt and connectivity, respectively. In contrast, readmission within 3 days (P = .004) and federal or state payor (P = .02) were negative independent predictors for call attempt and call connectivity, respectively. CONCLUSIONS This study suggests that targeted interventions may improve postdischarge call attempt rates, such as investment in a reliable call model or improvement in interpreter use, and connectivity, such as enhanced population-based communication.
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Affiliation(s)
- Amy Buczkowski
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Wendy Craig
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Rebekah Holmes
- Midwestern University - Chicago College of Osteopathic Medicine, Downers Grove, Illinois
| | - Dannielle Allen
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Lee Longnecker
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Monica Kondrad
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ann Carr
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Sandra Gage
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, Arizona
| | - Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medicine, Komansky Children's Hospital, New York Presbyterian Hospital, New York, New York
| | - David Cooperberg
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Leah Mallory
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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Francis TB, Sullaway GH, Feist BE, Shelton AO, Chui E, Daley C, Frick KE, Tolimieri N, Williams GD, Samhouri JF. Equivocal associations between small-scale shoreline restoration and subtidal fishes in an urban estuary. Restor Ecol 2022; 30:e13652. [PMID: 36589387 PMCID: PMC9790757 DOI: 10.1111/rec.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 01/04/2023]
Abstract
Restoration of degraded coastal and estuarine habitats owing to human activities is a major global concern. In Puget Sound, Washington, U.S.A., removal of hard armor from beaches and intertidal zones has become a priority for state and local agencies. However, the effectiveness of these shoreline restoration programs for subtidal habitats and fish is unknown. We surveyed six restoration sites in Puget Sound over 2 years to evaluate associations between shoreline restoration and subtidal fish abundance. We measured the abundance of juvenile salmonids and forage fishes along armored, restored, and reference shorelines. Bayesian generalized linear models showed limited support for associations between shoreline restoration and these fishes in the 3-7 years since armor removal. Pacific herring were more abundant at reference shorelines; the shoreline effect for surf smelt varied by survey site. Shoreline restoration was not an important predictor of salmonid abundance; the best models for Chinook and chum salmon included predictors for survey site and eelgrass, respectively. The retention of survey site in several species' top models reveals the influence of the broader landscape context. We also found seasonal variation in abundance for chum salmon and surf smelt. Our results suggest that juvenile forage fish and salmonids in estuaries likely have unique responses to shoreline features, and that the positive effects of armor removal either do not extend into subtidal areas or are not detectable at local scales. To be most effective, coastal restoration programs should consider broader landscape patterns as well as species-specific habitat needs when prioritizing investments.
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Affiliation(s)
- Tessa B. Francis
- Puget Sound InstituteUniversity of Washington TacomaTacomaWA98421U.S.A.
| | - Genoa H. Sullaway
- University of Alaska Fairbanks, College of Fisheries and Ocean SciencesJuneauAK99801U.S.A.
| | - Blake E. Feist
- Conservation Biology DivisionNorthwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
| | - Andrew O. Shelton
- Conservation Biology DivisionNorthwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
| | - Emily Chui
- Department of Marine ScienceCalifornia State University Monterey BaySeasideCA93955U.S.A.
| | - Caroline Daley
- Department of BiologyMiddlebury CollegeMiddleburyVT05753U.S.A.
| | - Kinsey E. Frick
- Fish Ecology DivisionNorthwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
| | - Nick Tolimieri
- Conservation Biology DivisionNorthwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
| | - Gregory D. Williams
- Pacific States Marine Fisheries Commission, Under contract to Northwest Fisheries Science CenterNational Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
| | - Jameal F. Samhouri
- Conservation Biology DivisionNorthwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric AdministrationSeattleWA98112U.S.A.
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22
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Singer C, Porta C. Improving patient well-being in the United States through care coordination interventions informed by social determinants of health. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2270-2281. [PMID: 35301764 DOI: 10.1111/hsc.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Health and well-being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim-driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well-being. To address the gap of risk-informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non-randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t-tests were incorporated to evaluate statistical significance of the intervention group. Impact on well-being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well-being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well-being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well-being.
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Affiliation(s)
- Chris Singer
- West Side Community Health Services d/b/a Minnesota Community Care, St. Paul, Minnesota, USA
| | - Carolyn Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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23
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Anis L, Letourneau N, Ross KM, Hart M, Graham I, Lalonde S, Varro S, Baldwin A, Soulsby A, Majnemer A, Donnelly C, Piotrowski C, Collier C, Lindeman C, Goldowitz D, Isaac D, Thomson D, Serré D, Citro E, Zimmermann G, Pliszka H, Mann J, Baumann J, Piekarski J, Dalton JA, Johnson-Green J, Wood K, Bruce M, Santana M, Mayer M, Gould M, Kobor M, Flowers M, Haywood M, Koerner M, Parker N, Muhajarine N, Fairie P, Chrishti R, Perry R, Merrill S, Pociuk S, StephanieTaylor, Cole S, Murphy T, Marchment T, Xavier V, Shajani Z, West Z. Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children’s health at scale. BMC Pediatr 2022; 22:491. [PMID: 35986306 PMCID: PMC9388995 DOI: 10.1186/s12887-022-03439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Children’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. Methods The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. Discussion The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. Trial registration Name of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03439-3.
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24
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Deoni SC, Beauchemin J, Volpe A, Dâ Sa V. The COVID-19 Pandemic and Early Child Cognitive Development: A Comparison of Development in Children Born During the Pandemic and Historical References. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.08.10.21261846. [PMID: 34401887 PMCID: PMC8366807 DOI: 10.1101/2021.08.10.21261846] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To characterize cognitive function in young children under 3 years of age over the past decade, and test whether children exhibit different cognitive development profiles through the COVID-19 pandemic. Study Design Neurocognitive data (Mullen Scales of Early Learning, MSEL) were drawn from 700 healthy and neurotypically developing children between 2011 to 2021 without reported positive tests or clinical diagnosis of SARS-CoV-2 infection. We compared MSEL composite measures (general cognition, verbal, and non-verbal development) to test if those measured during 2020 and 2021 differed significantly from historical 2011-2019 values. We also compared MSEL values in a sub-cohort comprising infants 0-16 months of age born during the pandemic vs. infants born prior. In all analyses, we also included measures of socioeconomic status, birth outcome history, and maternal stress. Results A significant decrease in mean population MSEL measures was observed in 2021 compared to historical references. Infants born during the pandemic exhibited significantly reduced verbal, non-verbal, and overall cognitive performance compared to children born pre-pandemic. Maternal stress was not found to be associated with observed declines but a higher socioeconomic status was found to be protective. Conclusions Results reveal a striking decline in cognitive performance since the onset of the COVID-19 pandemic with infants born since mid-2020 showing an average decrease of 27-37 points. Further work is merited to understand the underlying causative factors.
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Stiles-Shields C, Batts KR, Reyes KM, Archer J, Crosby S, Draxler JM, Lennan N, Held P. Digital Screening and Automated Resource Identification System to Address COVID-19-Related Behavioral Health Disparities: Feasibility Study. JMIR Form Res 2022; 6:e38162. [PMID: 35696607 PMCID: PMC9221976 DOI: 10.2196/38162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. OBJECTIVE This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant's responses. METHODS Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant's responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. RESULTS A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). CONCLUSIONS This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Kathryn R Batts
- Community Health Research Division, RTI International, Research Triangle Park, NC, United States
| | - Karen M Reyes
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Joseph Archer
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sharad Crosby
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Institute for Translational Medicine, University of Chicago, Chicago, IL, United States
| | - Janel M Draxler
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Nia Lennan
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Philip Held
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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26
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Halvaiepour Z, Nosratabadi M. Investigating the Relationship between Adverse Childhood Experiences and Cigarette Smoking in University Students in Isfahan, Iran. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:319-325. [PMID: 35600533 PMCID: PMC9120293 DOI: 10.1007/s40653-021-00383-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 06/03/2023]
Abstract
Adverse childhood experiences include various types of physical, psychological, and sexual abuse as well as household dysfunction. These experiences are associated with health-damaging behaviors such as smoking and other adverse health consequences. The aim of the present study was to explain the current use of cigarettes based on exposure to adverse childhood experiences in university students in Isfahan, Iran. This cross-sectional study was performed on a sample of 450 university students selected on a randomized basis in Isfahan in 2020. Checklist of adverse childhood experiences, checklist of demographic information, and smoking-related variables were employed to collect data. Multivariate logistic regression was used to investigate the effect of exposure to adverse childhood experiences on the current status of cigarette smoking. The results showed that 20.2% of the total sample students were current smokers. 46.5% of students stated that they had at least one unfavorable experience and 25.1% of all students reported six or more unfavorable experiences. By controlling demographic variables, respondents with one to five (R = 3.5) as well as six or more adverse experiences (OR = 6.8) were more likely to be current smokers than respondents who had no adverse experiences. This was more likely in female students than male university students. The results suggest that exposure to adverse experiences may increase the risk of behaviors such as smoking in adulthood. Since smoking is known as a mechanism to deal with negative events, it is necessary to develop interventions and programs to effectively deal with adverse experiences at various community levels and policy to reduce risky behaviors such as smoking in adolescents and young people.
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Affiliation(s)
- Zohreh Halvaiepour
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nosratabadi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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27
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Kiessling KA, Iott BE, Pater JA, Toscos TR, Wagner SR, Gottlieb LM, Veinot TC. Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want. JAMIA Open 2022; 5:ooac007. [PMID: 35274083 PMCID: PMC8903137 DOI: 10.1093/jamiaopen/ooac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/13/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
Objective To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development. Materials and Methods We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes. Results Providers lacked access to information about: patients’ ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information’s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges. Discussion These findings can inform the next generation of informatics tools for minimizing patients’ out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources. Conclusion Results identified opportunities to fill multidisciplinary providers’ information gaps and ways in which new tools could better support medication affordability for patients. Almost a quarter of Americans taking prescription medications have difficulty affording them. We asked 38 healthcare providers what they do to help patients get affordable medications. They try to reduce the number of medications that patients take, choose more affordable medication options, and connect them to free medications or financial help. But it is hard for providers to do these things because they don’t always know which patients have financial challenges, and they may not know how much medications cost patients. Healthcare providers use digital tools like ordering systems to pick medications for patients, but they do not always have clear price information and they do not help outside of healthcare visits with prescribers. It is also hard for healthcare providers to get information about what patients have difficulty affording medications, and about resources to help them. Healthcare providers want new and improved digital tools to help them choose medications, and to be able to compare exact medication price differences. They also want a visual sign for patients with financial challenges, and centralized information about cost reduction resources. Finally, they desire tools to help them talk to patients about mediation prices, and medication price reports for patients themselves.
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Affiliation(s)
| | - Bradley E Iott
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica A Pater
- Parkview Mirro Center for Research & Innovation, Parkview Health, Fort Wayne, Indiana, USA
| | - Tammy R Toscos
- Parkview Mirro Center for Research & Innovation, Parkview Health, Fort Wayne, Indiana, USA
| | - Shauna R Wagner
- Parkview Mirro Center for Research & Innovation, Parkview Health, Fort Wayne, Indiana, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California San Francisco, San Francisco, California, USA
| | - Tiffany C Veinot
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
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Pei C, Wu W, Zhou X, Zhou X, Qin Z. Application of nursing based on the authorization theory in asthmatic children aged 7 to 14 years. Am J Transl Res 2021; 13:9505-9513. [PMID: 34540072 PMCID: PMC8430092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of a nursing model based on the authorization theory of asthma in children aged 7 to 14 years. METHODS In total, 200 children who were 7 to 14 years with asthma in remission were recruited in this study. These children were admitted to our hospital and were randomly divided into the control group (n=100) and the experimental group (n=100). Patients in the control group received routine nursing, while those in the experimental group received routine nursing and nursing based on the authorization theory. Treatment compliance, the time of disappearance of symptoms (like sputum, cough, wheeze, and wet rales), the length of hospitalization, lung function, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC, general self-efficacy scale (GSES) score, MOS 36-item short form health survey (SF-36) score, and parents' satisfaction with nursing were compared between the two groups. RESULTS FEV1, FVC, FEV1/FVC, GSES score, and SF-36 scores in all aspects in the two groups after intervention were increased when compared with before intervention; in addition, FEV1, FVC, FEV1/FVC, GSES score, and SF-36 scores in all aspects in the experimental group after intervention were significantly higher than those in the control group (all P<0.05). The time of disappearance of symptoms (like sputum, cough, wheeze, and wet rales) and length of hospitalization in the experimental group were shorter than those in the control group (all P<0.05). Compared with the control group, treatment compliance and satisfaction in nursing in the experimental group were increased (both P<0.05). CONCLUSION Nursing based on the authorization theory can effectively improve treatment compliance, lung function, SF-36 scores, and satisfaction in nursing, and shorten the length of hospitalization.
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Affiliation(s)
- Chuanfeng Pei
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai First People’s Hospital)Shanghai, China
| | - Weiyu Wu
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai First People’s Hospital)Shanghai, China
| | - Xingmei Zhou
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai First People’s Hospital)Shanghai, China
| | - Xiaojian Zhou
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai First People’s Hospital)Shanghai, China
| | - Zhen Qin
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai First People’s Hospital)Shanghai, China
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29
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Shahriar AA, Prasad K, Casty K, Rahman ZI, Westerhaus M, Satin DJ. Race and Gender Differences in Medical Student Perspectives on Social Determinants of Health Education: A Single-Institution Survey Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:587-595. [PMID: 34104037 PMCID: PMC8179748 DOI: 10.2147/amep.s300447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The field of medicine is becoming increasingly aware of the role that social determinants of health (SDH) play in shaping health and health outcomes. Organized medicine - including prominent physician groups and accreditation bodies - has endorsed SDH education as an integral component of medical school curricula. This study sought to describe medical student perspectives on the current state of SDH in preclinical curricula. METHODS The authors developed a 9-item survey to assess time being spent on SDH and attitudes toward the current level of SDH content in preclinical curricula. All medical students at both campuses of a large public medical school were invited to participate between December 2019 and February 2020. RESULTS Of 1010 medical students invited to participate, 515 (51.0%) responded. Of the 515 respondents, 480 (93.2%) reported spending at least 40 hours per week on medical school, and of those, 405 (84.4%) said they spend 0-2 hours on SDH. The majority of all respondents (62.1%; 320/515) felt the current level of focus on SDH is "not enough", while only eleven students (2.1%; 11/515) felt it is "too much". In a multiple logistic model, Black students were over four times as likely as white students (aOR 4.19; 95% CI 1.37-18.38) to feel the current level of focus on SDH is "not enough". Likewise, women were 2.3-times (aOR 2.30; 95% CI 1.52-3.49) as likely as men to feel the level of focus on SDH is "not enough". CONCLUSION In practice, medical students are spending considerably less time learning SDH than is advised by consensus of expert educators and administrators. Over sixty percent of medical students do not feel the current level of focus on SDH is sufficient. Further study is needed to determine why women and racial minority students are significantly more likely to feel this way.
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Affiliation(s)
| | - Kriti Prasad
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Katherine Casty
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Zarin I Rahman
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Westerhaus
- University of Minnesota, Global Medicine, Minneapolis, MN, USA
- Center for International Health, St. Paul, MN, USA
| | - David J Satin
- University of Minnesota Medical School, Minneapolis, MN, USA
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30
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Rattermann MJ, Angelov A, Reddicks T, Monk J. Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes. PLoS One 2021; 16:e0247909. [PMID: 33730057 PMCID: PMC7968680 DOI: 10.1371/journal.pone.0247909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Data from two social determinants of health-access to health care and access to a quality education-are combined to examine the impact of health on student achievement. Data from a high poverty, high performing K-8 school revealed a significant negative correlation between the number of visits to a school-based nurse and standardized academic assessments. Fixed effect regression confirmed the effect of total number of visits to the school-based nurse on performance on standardized assessments, and also revealed that two types of visits, neurological and gastrointestinal, were predictive of student performance. Taken together, these results suggest that when students are suffering from ill health their academic performance is negatively impacted. Implications for improving health equity through data-driven educational interventions are discussed.
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Affiliation(s)
- Mary Jo Rattermann
- Paramount Health Data Project, Indianapolis, Indiana, United States of America
| | - Azure Angelov
- Paramount Health Data Project, Indianapolis, Indiana, United States of America
| | - Tommy Reddicks
- Paramount Schools of Excellence, Indianapolis, Indiana, United States of America
| | - Jess Monk
- Paramount Schools of Excellence, Indianapolis, Indiana, United States of America
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31
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Schroeder K, Day S, Konty K, Dumenci L, Lipman T. The impact of change in neighborhood poverty on BMI trajectory of 37,544 New York City youth: a longitudinal study. BMC Public Health 2020; 20:1676. [PMID: 33167949 PMCID: PMC7653753 DOI: 10.1186/s12889-020-09772-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity. METHODS Methods entailed secondary analysis of existing longitudinal data. The sample included youth attending New York City public schools in grades kindergarten through twelfth from school years 2006/2007 through 2016/2017. Eligibility criteria included moving to a higher or lower poverty neighborhood during the data midpoint [school years 2010/2011 through 2013/2014] of the 12-year data-period; New York City-specific metrics were used to define both neighborhood (Neighborhood Tabulation Area) and relevant neighborhood poverty levels (< 5, 5 to < 10%, 10 to < 20%, 20 to < 30%, 30 to < 40% and ≥ 40% of individuals below Federal Poverty Level). Two-piece latent growth curve models were used to describe BMI z-score trajectories of youth who moved to higher versus lower poverty neighborhoods, with propensity score weighting to account for preexisting differences between the two groups. Primary analyses were stratified by sex and exploratory subgroup analyses were stratified by sex and developmental stage (early childhood, middle childhood, and adolescence) to explore sensitive periods for neighborhood poverty exposure. RESULTS Of 532,513 youth with home address data, 18,370 youth moved to a higher poverty neighborhood and 19,174 moved to a lower poverty neighborhood (n = 37,544). Females and males who moved to a higher poverty neighborhood experienced less favorable BMI z-score trajectories for obesity risk, though effects were small. Exploratory subgroup analyses demonstrated that negative effects of neighborhood poverty were most pronounced among young and adolescent females and young males, whereas effects were mixed for other subgroups. CONCLUSIONS Youth who moved to higher poverty neighborhoods experienced less favorable BMI z-score trajectories for obesity risk, though effects were small and most consistent for females and younger youth. Additional research is needed to illuminate neighborhood poverty's impact on obesity, in order to inform policy, intervention, clinical, and research efforts to reduce obesity and improve child well-being.
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Affiliation(s)
- Krista Schroeder
- Temple University College of Public Health, 1101 West Montgomery Avenue, Philadelphia, PA 19122 USA
| | - Sophia Day
- New York City Department of Health and Mental Hygiene, Office of School Health, 42-09 28th Street, 14th floor, Long Island City, NY 11101 USA
| | - Kevin Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, 42-09 28th Street, 14th floor, Long Island City, NY 11101 USA
| | - Levent Dumenci
- Temple University College of Public Health, 1101 West Montgomery Avenue, Philadelphia, PA 19122 USA
| | - Terri Lipman
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19140 USA
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