1
|
Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
Collapse
Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| |
Collapse
|
2
|
Li S, Ji Y, Yang Q, Ying J, Haohao Z. Analysis of mental health literacy level and its influencing factors in low-income population of Wuxi, China. Asian J Psychiatr 2023; 90:103825. [PMID: 37922814 DOI: 10.1016/j.ajp.2023.103825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Shiming Li
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Yingying Ji
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Queping Yang
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Jiang Ying
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
| | - Zhu Haohao
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
| |
Collapse
|
3
|
Zeldman J, Varela EG, Gorin AA, Gans KM, Gurka MJ, Bernier AV, Mobley AR. Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study. Matern Child Health J 2023; 27:1905-1913. [PMID: 37273139 PMCID: PMC10241118 DOI: 10.1007/s10995-023-03731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.
Collapse
Affiliation(s)
- Jamie Zeldman
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Elder Garcia Varela
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Kim M Gans
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
- Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269, USA
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Angelina V Bernier
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA.
| |
Collapse
|
4
|
Sana S, Kollmann J, Magnée T, Merkelbach I, Denktaş S, Kocken PL. The role of socio-demographic and health factors during COVID-19 in remote access to GP care in low-income neighbourhoods: a cross-sectional survey of GP patients. BMC Prim Care 2022; 23:289. [PMID: 36402983 PMCID: PMC9675957 DOI: 10.1186/s12875-022-01887-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 10/25/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. DESIGN Cross-sectional survey study. SETTING General practice in low-income neighbourhoods in the Netherlands. PARTICIPANTS Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. MAIN OUTCOME MEASURES Need for GP contact, decision to contact a GP practice, and GP service utilisation. RESULTS Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). CONCLUSION Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.
Collapse
Affiliation(s)
- S. Sana
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - J. Kollmann
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - T. Magnée
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
- Senior researcher, Nivel, Utrecht, Netherlands
| | - I. Merkelbach
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - S. Denktaş
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - P. L. Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
5
|
Kuhn AG, Ganacias KG, Rethy JA. Strategies to improve enrollment in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): examining high coverage states and leveraging successful COVID-19 pandemic adjustments. Public Health Nutr 2022; 25:1-5. [PMID: 35866330 PMCID: PMC9304943 DOI: 10.1017/s1368980022001471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an essential program in the USA providing food benefits and nutritional and breast-feeding support to low-income pregnant or postpartum women, infants and children at nutritional risk. Despite similarities amongst federal regulations shared across WIC programs at the state level, important differences in the operations, policies and technologies between states exist. Nationally, nearly half of women, infants and children who were eligible to receive WIC benefits in 2018 were not participating in the program. In this paper, we evaluate common practices exhibited by states with the highest and lowest WIC coverage rates to identify strategies that may improve enrollment and retention rates in regions with low WIC coverage rates. We use WIC as a case study for identifying strategies that can be broadly applied to improve utilisation of similar food assistance programs globally, particularly those benefiting low-income women and children. The four strategies discussed here include utilising data to check adjunctive eligibility and reach eligible non-participants, increasing public awareness of WIC through outreach and referral efforts, implementing a centralised smartphone app and linking personal electronic benefits and streamlining the use of technologies for online applications, participant portals and remote communication. In most states, the COVID-19 pandemic and the federal waivers issued in response have offered the opportunity to promptly implement some of these strategies, particularly with regard to remote communication capabilities. With proper resources and implementation, these strategies can improve utilisation of WIC and similar programs globally.
Collapse
Affiliation(s)
- Amanda G Kuhn
- Georgetown University, School of Medicine, 3900 Reservoir Rd NW, Washington, DC20007, USA
| | - Karen G Ganacias
- Georgetown University, School of Medicine, 3900 Reservoir Rd NW, Washington, DC20007, USA
- MedStar Georgetown University Hospital/Georgetown University School of Medicine, Department of Pediatrics, 3800 Reservoir Rd NW, Washington, DC20007, USA
| | - Janine A Rethy
- Georgetown University, School of Medicine, 3900 Reservoir Rd NW, Washington, DC20007, USA
- MedStar Georgetown University Hospital/Georgetown University School of Medicine, Department of Pediatrics, 3800 Reservoir Rd NW, Washington, DC20007, USA
| |
Collapse
|
6
|
González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions. Radiologia (Engl Ed) 2022; 64:256-265. [PMID: 35676057 DOI: 10.1016/j.rxeng.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 10/18/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
Collapse
Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, IL, United States
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, CO, United States
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain; RAD-AID Internacional
| |
Collapse
|
7
|
Petruzzi LJ, Prezio E, Phillips F, Smith B, Currin-McCulloch J, Blevins C, Gaddis D, Eckhardt SG, Kvale E, Jones B. An exploration of financial toxicity among low-income patients with cancer in Central Texas: A mixed methods analysis. Palliat Support Care 2022;:1-11. [PMID: 35301963 DOI: 10.1017/S1478951522000256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment. METHOD This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants. RESULTS Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = -3.79, 95% CI = -7.42, -0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support. SIGNIFICANCE OF RESULTS Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.
Collapse
|
8
|
Aquilina SR, Shrubsole MJ, Butt J, Sanderson M, Schlundt DG, Cook MC, Epplein M. Adverse childhood experiences and adult diet quality. J Nutr Sci 2021; 10:e95. [PMID: 34804516 PMCID: PMC8596075 DOI: 10.1017/jns.2021.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022] Open
Abstract
Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40-79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race-sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.
Collapse
Affiliation(s)
| | - Martha J. Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Butt
- Infections and Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Mekeila C. Cook
- Division of Public Health Practice, Meharry Medical College, Nashville, TN, USA
| | - Meira Epplein
- Department of Population Health Sciences, Duke University and Cancer Risk, Detection, and Interception Program, Duke Cancer Institute, Durham, NC, USA
| |
Collapse
|
9
|
Garcia-Estrada E, Morales-Gómez JA, Romero-González M, Martínez-Ortíz RG, García-Hernández MA, Ramos-Delgado CA, López-Hernández PA, Palacios-Ortiz IJ, Martínez-Ponce de León AR. Decompressive Craniectomy for Hemispheric Infarction in a Low-Income Population. World Neurosurg 2021; 156:e152-e159. [PMID: 34517142 DOI: 10.1016/j.wneu.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC). METHODS A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome. RESULTS Forty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again. CONCLUSIONS Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient.
Collapse
Affiliation(s)
- Everardo Garcia-Estrada
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Jesús Alberto Morales-Gómez
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
| | - Mariana Romero-González
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ricardo Gerardo Martínez-Ortíz
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Marco Antonio García-Hernández
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Alessandro Ramos-Delgado
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Paúl André López-Hernández
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Isaac Jair Palacios-Ortiz
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Angel Raymundo Martínez-Ponce de León
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| |
Collapse
|
10
|
Shi J, Yang Y, Xie H, Wang X, Wu J, Long J, Courtney R, Shu XO, Zheng W, Blot WJ, Cai Q. Association of oral microbiota with lung cancer risk in a low-income population in the Southeastern USA. Cancer Causes Control 2021; 32:1423-32. [PMID: 34432217 DOI: 10.1007/s10552-021-01490-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Oral microbiome plays an important role in oral health and systemic diseases, including cancer. We aimed to prospectively investigate the association of oral microbiome with lung cancer risk. METHODS We analyzed 156 incident lung cancer cases (73 European Americans and 83 African Americans) and 156 individually matched controls nested within the Southern Community Cohort Study. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Paired t test and the permutational multivariate analysis of variance test were used to evaluate lung cancer risk association with alpha diversity or beta diversity, respectively. Conditional logistic regression models were used to evaluate the association of individual bacterial abundance or prevalence with lung cancer risk. RESULTS No significant differences were observed for alpha or beta diversity between lung cancer cases and controls. Abundance of families Lachnospiraceae_[XIV], Peptostreptococcaceae_[XI], and Erysipelotrichaceae and species Parvimonas micra was associated with decreased lung cancer risk, with odds ratios (ORs) and 95% confidence intervals (CIs) of 0.76 (0.59-0.98), 0.80 (0.66-0.97), 0.81 (0.67-0.99), and 0.83 (0.71-0.98), respectively (all p < 0.05). Prevalence of five pre-defined oral pathogens were not significantly associated with overall lung cancer risk. Prevalence of genus Bacteroidetes_[G-5] and species Alloprevotella sp._oral_taxon_912, Capnocytophaga sputigena, Lactococcus lactis, Peptoniphilaceae_[G-1] sp._oral_taxon_113, Leptotrichia sp._oral_taxon_225, and Fretibacterium fastidiosum was associated with decreased lung cancer risk, with ORs and 95% CIs of 0.55 (0.30-1.00), 0.36 (0.17-0.73), 0.53 (0.31-0.92), 0.43 (0.21-0.88), 0.43 (0.19-0.94), 0.57 (0.34-0.99), and 0.54 (0.31-0.94), respectively (all p < 0.05). Species L. sp._oral_taxon_225 was significantly associated with decreased lung cancer risk in African Americans (OR [95% CIs] 0.28 [0.12-0.66]; p = 0.00012). CONCLUSION Results from this study suggest that oral microbiota may play a role in the development of lung cancer.
Collapse
|
11
|
González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions. Radiologia (Engl Ed) 2021; 64:S0033-8338(21)00089-8. [PMID: 34083079 DOI: 10.1016/j.rx.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
Collapse
Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, Illinois, Estados Unidos
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, Colorado, Estados Unidos
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, Washington, Estados Unidos; Fred Hutchinson Cancer Research Center, Seattle, Washington, Estados Unidos
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España; RAD-AID Internacional
| |
Collapse
|
12
|
Homs C, Berruezo P, Según G, Estrada L, de Bont J, Riera-Romaní J, Carrillo-Álvarez E, Schröder H, Milà R, Gómez SF. Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: study protocol of the FIVALIN project. BMC Pediatr 2021; 21:246. [PMID: 34020614 PMCID: PMC8139065 DOI: 10.1186/s12887-021-02697-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 519years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal. Methods We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 812years and 600 parents will be recruited during 3 consecutive editions (1st 2019/2020; 2nd 2020/2021; 3rd 2021/2022) of 10months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups. Discussion There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status. Trial registration ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered. Protocol version: 30 April 2021, version 5. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02697-x.
Collapse
Affiliation(s)
- C Homs
- Gasol Foundation, Sant Boi de Llobregat, Spain.,Faculty of Psychology, PSITIC Research Group, Education and Sport Sciences Blanquerna - Universitat Ramon Llull, Císter, 34 08032, Barcelona, Spain
| | - P Berruezo
- Gasol Foundation, Sant Boi de Llobregat, Spain
| | - G Según
- Gasol Foundation, Sant Boi de Llobregat, Spain
| | - L Estrada
- Gasol Foundation, Los Angeles, CA, USA
| | - J de Bont
- ISGlobal, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - J Riera-Romaní
- Faculty of Psychology, PSITIC Research Group, Education and Sport Sciences Blanquerna - Universitat Ramon Llull, Císter, 34 08032, Barcelona, Spain
| | - E Carrillo-Álvarez
- Global Research on Wellbeing (GRoW) research group, Blanquerna School of Health Sciences - Universitat Ramon Llull, Padilla, 326-332 08025, Barcelona, Spain
| | - H Schröder
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain.,Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - R Milà
- Global Research on Wellbeing (GRoW) research group, Blanquerna School of Health Sciences - Universitat Ramon Llull, Padilla, 326-332 08025, Barcelona, Spain
| | - S F Gómez
- Gasol Foundation, Sant Boi de Llobregat, Spain. .,GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain.
| |
Collapse
|
13
|
Rodrigues ALM, do Nascimento DM, de Lima JM, Reis MLP, Leão LBC, Azevedo MC, Muccini SR, da Silva PC, Carneiro TX. Safety and Feasibility of Outpatient High Dose Cytarabine for Acute Myeloid Leukemia in the Brazilian Amazon. Int J Hematol Oncol Stem Cell Res 2020; 14:151-156. [PMID: 33024520 PMCID: PMC7521396 DOI: 10.18502/ijhoscr.v14i3.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high-dose cytarabine in the outpatient setting. Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with high-dose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff. Results: Twenty-seven patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference in relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Non-relapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03). Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years.
Collapse
Affiliation(s)
| | | | - Josy Marinho de Lima
- Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém - PA, Brazil
| | - Marcos Laércio Pontes Reis
- Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém - PA, Brazil
| | | | | | | | | | - Thiago Xavier Carneiro
- Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém - PA, Brazil
| |
Collapse
|
14
|
Abstract
The COVID-19 pandemic has caused high mortality rates among older people, and in order to avoid a healthcare system crisis, almost all countries worldwide have adopted social isolation measures to prevent the spread of the disease. However, in Brazil, a country demarcated by economic inequalities, in which approximately 25% of the population live below the poverty line, these measures will cost severe economic losses and accentuated starvation. For this reason, the underprivileged population should be immediately prioritized and well informed through good practice to avoid the virus. Since, government discrepancies in dealing with the COVID-19 outbreak leaves the population without congruent guidelines on how to react or what to believe, allowing the spread of fake news and political crises. Here, we discuss who will pay the price of the Brazilian government denying the impact of COVID-19 pandemic and suggest some measures to ensure that clear information and protection reach this population.
Collapse
Affiliation(s)
- Fabiana Ribeiro
- Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg. .,Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, São Bernardo do Campo, Brazil.
| | - Anja Leist
- Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
15
|
González-Duarte A, Zambrano-González E, Medina-Franco H, Alberú-Gómez J, Durand-Carbajal M, Hinojosa CA, Aguilar-Salinas CA, Kaufer-Horwitz M. II. THE RESEARCH ETHICS INVOLVING VULNERABLE GROUPS. Rev Invest Clin 2020; 71:217-225. [PMID: 31448777 DOI: 10.24875/ric.19002812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.
Collapse
Affiliation(s)
| | | | - Heriberto Medina-Franco
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josefina Alberú-Gómez
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Durand-Carbajal
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
16
|
Brakema EA, Tabyshova A, van der Kleij RMJJ, Sooronbaev T, Lionis C, Anastasaki M, An PL, Nguyen LT, Kirenga B, Walusimbi S, Postma MJ, Chavannes NH, van Boven JFM. The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study. Respir Res 2019; 20:291. [PMID: 31864411 PMCID: PMC6925865 DOI: 10.1186/s12931-019-1255-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/05/2019] [Indexed: 01/01/2023] Open
Abstract
Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.
Collapse
Affiliation(s)
- Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Aizhamal Tabyshova
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.,Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Pham Le An
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Job F M van Boven
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | | |
Collapse
|
17
|
Leung J, Chiu V, Connor JP, Peacock A, Kelly AB, Hall W, Chan GCK. Alcohol consumption and consequences in adolescents in 68 low and middle-income countries - a multi-country comparison of risks by sex. Drug Alcohol Depend 2019; 205:107520. [PMID: 31707267 DOI: 10.1016/j.drugalcdep.2019.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/26/2023]
Abstract
AIMS Alcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC). DESIGN Multi-staged cross-sectional international standardized self-report questionnaires administered in the classroom. SETTING The Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003-2014. PARTICIPANTS 271,156 students aged 13-17 years old. MEASUREMENTS Alcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific. FINDINGS Overall, males had higher odds of alcohol use (OR = 2.38 [1.91-2.96]), a history of intoxication (OR = 2.64 [2.11-3.31]), and alcohol-related problems (OR = 1.72 [1.41-2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females; five regions (excluding Europe) recorded greater odds of intoxication in males; and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences - in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand. CONCLUSIONS Among adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.
Collapse
Affiliation(s)
- Janni Leung
- School of Psychology, Brisbane, The University of Queensland, QLD 4067, Australia; National Drug and Alcohol Research Centre, Sydney, University of New South Wales, NSW 2031, Australia; Centre for Youth Substance Abuse Research, Brisbane, The University of Queensland, QLD 4067, Australia; Institute for Health Metrics and Evaluation, University of Washington, WA 98121, United States.
| | - Vivian Chiu
- School of Psychology, Brisbane, The University of Queensland, QLD 4067, Australia; National Drug and Alcohol Research Centre, Sydney, University of New South Wales, NSW 2031, Australia; Centre for Youth Substance Abuse Research, Brisbane, The University of Queensland, QLD 4067, Australia.
| | - Jason P Connor
- Centre for Youth Substance Abuse Research, Brisbane, The University of Queensland, QLD 4067, Australia.
| | - Amy Peacock
- National Drug and Alcohol Research Centre, Sydney, University of New South Wales, NSW 2031, Australia.
| | - Adrian B Kelly
- Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD 4059, Australia.
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, Brisbane, The University of Queensland, QLD 4067, Australia; King's College London, London, WC2R 2LS, United Kingdom.
| | - Gary C K Chan
- Centre for Youth Substance Abuse Research, Brisbane, The University of Queensland, QLD 4067, Australia.
| |
Collapse
|
18
|
Molitor F, Doerr C, Pugliese J, Whetstone L. Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program-Education) eligible households across California. Public Health Nutr 2020; 23:3-12. [PMID: 31744585 DOI: 10.1017/S1368980019003197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children. DESIGN Cross-sectional telephone surveys using a validated 24 h dietary assessment. SETTING Randomly sampled households with incomes ≤185 % of the US federal poverty level across California. PARTICIPANTS Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12-17 years) and 6043 children (5-11 years). Respondents were mostly Latino. RESULTS Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children. CONCLUSIONS The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.
Collapse
|
19
|
Han J, Zhang Y, No G, Urmie J. Medication adherence among chronic condition patients in the Medicaid coverage gap. Res Social Adm Pharm 2019; 16:982-986. [PMID: 31838055 DOI: 10.1016/j.sapharm.2019.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with incomes below the Federal Poverty Level (FPL) do not qualify for health insurance subsidies and may not be eligible for Medicaid. Patients in this Medicaid Coverage Gap may have difficulty paying for their medications. OBJECTIVE To estimate medication adherence and the prevalence of underinsurance among chronic condition patients in the Medicaid Coverage Gap. METHODS A retrospective cohort study was conducted using 2014-2016 data extracted from the Medical Expenditure Panel Survey. The sample included non-elderly patients with prescription fills (≥2) for at least one of five chronic conditions (hypertension, hyperlipidemia, diabetes, depression and anxiety disorder) and income below the FPL. Medication adherence was measured using Medication Possession Ratio (MPR), and adjusted using patient demographics, health conditions, and health care utilization. The prevalence of underinsurance also was examined. RESULTS Of the 316 patients, 60.4% were female, with an average age of 50, and an average of 3 health conditions. The weighted MPR was 72.0% and 44.6% had an adjusted MRP ≥80%. Nearly 80% of the patients were either continuously uninsured (21.6%) or underinsured (59.0%). CONCLUSIONS A significant proportion of chronic condition patients in Medicaid Coverage Gap were underinsured and less than half were adherent to their medications.
Collapse
Affiliation(s)
- Jayoung Han
- School of Pharmacy and Health Sciences, Fairleigh Dickinson University, USA.
| | - Yiran Zhang
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, USA
| | - Gina No
- School of Pharmacy and Health Sciences, Fairleigh Dickinson University, USA
| | - Julie Urmie
- Division of Health Services Research, Department of Pharmacy Practice and Science, University of Iowa, USA
| |
Collapse
|
20
|
Calloway EE, Seligman HK, Boyd LW, Stern KL, Rosenmoss S, Yaroch AL. Development and testing of the FRESH Foods Survey to assess food pantry clients' dietary behaviours and correlates. Public Health Nutr 2019; 22:2170-8. [PMID: 31111812 DOI: 10.1017/S1368980019000697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) - the FRESH Foods Survey. DESIGN New and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed. SETTING Three US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY. PARTICIPANTS Food pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years. RESULTS Measures of dietary correlates performed well psychometrically: Cronbach's α range 0·71-0·90, slope (α) parameter range 1·26-6·36, and threshold parameters (β) indicated variability in the 'difficulty' of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07-4·71), indicating unidimensionality. Average (median, Q1-Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87-4·58); junk foods (1·16, 0·58-2·16); fast foods and similar entrées (1·45, 0·58-2·03); whole-grain foods (0·87, 0·58-1·71); sugar-sweetened beverages (0·58, 0·29-1·29); milk and milk alternatives (0·71, 0·29-1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity. CONCLUSIONS The FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.
Collapse
|
21
|
Foster BA, Weinstein K, Shannon J. Growing Healthy Together: protocol for a randomized clinical trial using parent mentors for early childhood obesity intervention in a Latino community. Trials 2019; 20:235. [PMID: 31023345 PMCID: PMC6485154 DOI: 10.1186/s13063-019-3342-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latino children in the US experience high rates of obesity, increasing their risk of subsequent diabetes. There are few clinical trials among low-income, Latino families to test interventions that account for and address their unique situation. METHODS/DESIGN This trial, conducted in a Head Start (early childhood education) setting, randomly assigns children 2-5 years of age who have obesity by CDC (Centers for Disease Control and Prevention) guidelines (at least 95th percentile body mass index) and their parents to one of three conditions: (1) control, (2) parent mentor with an experimental curriculum, or (3) parent mentor with a standard curriculum (active control). We designed the experimental arm (2) using data from positive deviants: low-income, Latino families who had been successful in moving their child toward a healthy weight. Parent mentors are recruited and trained from the Head Start centers. Parent mentors then facilitate the teaching and coaching of parent-child dyads with weekly interactions over the course of a 6-month period. The primary outcome is change in adjusted body mass index z-score at the end of intervention and at 6 months post-intervention. Secondary outcomes include generalized self-efficacy, dietary intake, the home food environment, and reported physical activity. DISCUSSION This clinical trial contributes to the field by evaluating parent mentoring interventions that are potentially scalable for a population at high risk for continued obesity and subsequent morbidity and mortality. TRIAL REGISTRATION This trial was registered on October 31, 2017 (ClinicalTrials.gov identifier: NCT03330743 ).
Collapse
Affiliation(s)
- Byron A. Foster
- School of Medicine, Oregon Health and Science University, 3303 SW Bond Avenue CH16D, Portland, OR 97239 USA
| | - Kelsey Weinstein
- School of Medicine, Oregon Health and Science University, 3303 SW Bond Avenue CH16D, Portland, OR 97239 USA
| | - Jackilen Shannon
- School of Public Health, Oregon Health and Science University and Portland State University, 3181 SW Sam Jackson Park Road GH230, Portland, OR 97239 USA
| |
Collapse
|
22
|
Nackers F, Roederer T, Marquer C, Ashaba S, Maling S, Mwanga-Amumpaire J, Muny S, Sokeo C, Shom V, Palha M, Lefèbvre P, Kirubi BW, Kamidigo G, Falissard B, Moro MR, Grais RF. A screening tool for psychological difficulties in children aged 6 to 36 months: cross-cultural validation in Kenya, Cambodia and Uganda. BMC Pediatr 2019; 19:108. [PMID: 30979364 PMCID: PMC6460684 DOI: 10.1186/s12887-019-1461-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6-36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months. METHODS A primary validation of the PSYCa 6-36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6-36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6-36 and external validity was assessed by comparing the results of the PSYCa 6-36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant. RESULTS The PSYCa 6-36 showed satisfactory psychometric properties (Cronbach's alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia. CONCLUSIONS The PSYCa 6-36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children's psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6-36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties.
Collapse
Affiliation(s)
| | | | | | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Epicentre, Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda.,Mbarara University of Science and Technology, P.O. Box 1404, Mbarara, Uganda
| | - Sothara Muny
- Medicine Department, Preah Kossamak Hospital, Ministry of Health, Phnom Pen, Cambodia
| | - Chea Sokeo
- Médecins Sans Frontières, Phnom Pen, Cambodia
| | - Vireak Shom
- Médecins Sans Frontières, Phnom Pen, Cambodia
| | - Maria Palha
- Médecins Sans Frontières, Phnom Pen, Cambodia
| | | | | | | | - Bruno Falissard
- Centre de recherche en épidémiologie et santé des populations (CESP)/ Institut national de la santé et de la recherche médicale (INSERM) U1018, Maison de Solenn, Paris, France
| | - Marie-Rose Moro
- Centre de recherche en épidémiologie et santé des populations (CESP)/ Institut national de la santé et de la recherche médicale (INSERM) U1018, Maison de Solenn, Paris, France.,Médecins Sans Frontières, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
23
|
Rethy JA, Gallo S, Doig AC, Brady J, Goodfriend D. Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. Public Health Nutr 2019; 22:1667-74. [PMID: 30803466 DOI: 10.1017/S1368980019000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. DESIGN Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ 2 tests and logistic regression were used describe the sample and explore relationships between variables. SETTING Loudoun County, VA, USA. SUBJECTS A sample of 190 predominantly Hispanic women attending local WIC clinics. RESULTS Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months. CONCLUSIONS A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.
Collapse
|
24
|
Foster BA, Winkler P, Weinstein K, Parra-Medina D. Developing a patient-centered outcome for targeting early childhood obesity across multiple stakeholders. BMC Obes 2018; 5:39. [PMID: 30524744 PMCID: PMC6276184 DOI: 10.1186/s40608-018-0216-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022]
Abstract
Background Patient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common. Methods We used growth chart data to identify low-income, Latino children 2-5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity. Results We identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful. Conclusions The development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.
Collapse
Affiliation(s)
- Byron A Foster
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
| | - Paula Winkler
- 2Center for Research to Advance Community Health, University of Texas Health San Antonio, San Antonio, TX USA
| | - Kelsey Weinstein
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
| | | |
Collapse
|
25
|
Tabak RG, Dsouza N, Schwarz CD, Quinn K, Kristen P, Haire-Joshu D. A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study. BMC Public Health 2018; 18:586. [PMID: 29720138 PMCID: PMC5932800 DOI: 10.1186/s12889-018-5466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. Methods Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. Results From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. Conclusions RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.
Collapse
Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Nishita Dsouza
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Karyn Quinn
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Patricia Kristen
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| |
Collapse
|
26
|
Sheikhattari P, Apata J, Kamangar F, Schutzman C, O'Keefe A, Buccheri J, Wagner FA. Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research. J Community Health 2016; 41:1146-52. [PMID: 27688221 DOI: 10.1007/s10900-016-0264-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. The intervention consisted of three Phases. Phase I (n = 404) was a clinic-based trial comparing two types of counseling. Phase II (n = 398) and Phase III (n = 163) interventions were conducted in community venues by trained Peer Motivators. Quit rates at 12-week follow-up increased from 9.4 % in Phase I (clinic-based) to an average of 23.7 % in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR 2.6, 95 % CI 1.7-4.2) while controlling for possible confounders. A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.
Collapse
|
27
|
Milambo JPM, Cho K, Okwundu C, Olowoyeye A, Ndayisaba L, Chand S, Corden MH. Newborn follow-up after discharge from a tertiary care hospital in the Western Cape region of South Africa: a prospective observational cohort study. Glob Health Res Policy 2018; 3:2. [PMID: 29372186 PMCID: PMC5765667 DOI: 10.1186/s41256-017-0057-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section. Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment. We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up. Methods Mother-newborn dyads at Tygerberg Hospital in Cape Town, South Africa were enrolled from November 2014 to April 2015. Demographic data were obtained via questionnaire and medical records. Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit, and if not, the barriers to follow-up. Factors associated with follow-up were analyzed using logistic regression. Results Of 972 newborns, 794 (82%) were seen at a clinic for a follow-up visit within one week of discharge. Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up. The follow-up rate did not differ based on hospital length of stay. Main reported barriers to follow-up included maternal illness, lack of money for transportation, and mother felt follow-up was unnecessary because newborn was healthy. Conclusions Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge, in keeping with local practice guidelines. Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.
Collapse
Affiliation(s)
| | - KaWing Cho
- 2Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA USA
| | - Charles Okwundu
- 3Centre for Evidence Based Healthcare, Stellenbosch University, Cape Town, South Africa
| | - Abiola Olowoyeye
- 2Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA USA
| | - Leonidas Ndayisaba
- 4Department of Respiratory Intensive Care, Groote Schuur Hospital, Cape Town, South Africa
| | - Sanjay Chand
- 5Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 94, Los Angeles, CA 90027 USA
| | - Mark H Corden
- 5Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 94, Los Angeles, CA 90027 USA.,6Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
28
|
Tasevska N, DeLia D, Lorts C, Yedidia M, Ohri-Vachaspati P. Determinants of Sugar-Sweetened Beverage Consumption among Low-Income Children: Are There Differences by Race/Ethnicity, Age, and Sex? J Acad Nutr Diet 2017; 117:1900-1920. [PMID: 28495478 DOI: 10.1016/j.jand.2017.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/13/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Understanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions. OBJECTIVE Our aim was to identify child and parent lifestyle and household demographic factors predictive of high SSB consumption frequency in children from low-income, ethnically diverse communities that may help inform public health interventions. DESIGN We used a cross-sectional telephone household survey. PARTICIPANTS/SETTING Participants were 717 boys and 686 girls aged 3 to 18 years old from the New Jersey Childhood Obesity Study living in five low-income cities (Camden, New Brunswick, Newark, Trenton, and Vineland). The adult most knowledgeable about household food shopping completed a questionnaire over the telephone inquiring about their and their child's dietary and physical activity habits, and household-, parent-, and child-level demographics. MAIN OUTCOME MEASURES Child's SSB consumption frequency was measured. STATISTICAL ANALYSIS PERFORMED Multivariate ordered logit models were designed to investigate a variety of variables hypothesized to affect the frequency of SSB consumption. Exploratory stratified analyses by race, sex, and age were also conducted. RESULTS Eight percent of our study participants never consumed SSBs, 45% consumed SSBs at least once per day, and 23% consumed twice or more per day. SSB consumption was higher among children 12 to 18 years vs 3 to 5 years (P<0.0001), of non-Hispanic black vs non-Hispanic white race/ethnicity (P=0.010), who were moderate fast food consumers vs never consumers (P=0.003), and those whose parents were high vs low SSB consumers (P<0.0001). Living in a non-English-speaking household (P=0.030), having a parent with a college or higher education vs less than high school (P=0.003), and having breakfast 6 to 7 days/wk vs never to 2 days/wk or less were associated with lower SSB consumption (P=0.001). CONCLUSIONS We identified a number of household-, parent-, and child-level predictors of SSB consumption, which varied by race, sex, and age, useful for building customized interventions targeting certain behaviors in ethnically diverse, low-income children.
Collapse
|
29
|
Cotter EW, Teixeira C, Bontrager A, Horton K, Soriano D. Low-income adults' perceptions of farmers' markets and community-supported agriculture programmes. Public Health Nutr 2017; 20:1452-60. [PMID: 28202100 DOI: 10.1017/S1368980017000088] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To better understand low-income adults' attitudes towards participating in farmers' markets, community-supported agriculture (CSA) and nutrition education programming. DESIGN Focus groups were held with a diverse sample of adults. Interviews were transcribed verbatim and analysed using thematic analysis. SETTING Three affordable housing communities in Washington, DC, USA. SUBJECTS Participants included twenty-eight residents of the three affordable housing communities. RESULTS Four major themes emerged across groups, along with several sub-themes within each theme. These included: (i) perceptions of farmers' markets (benefits, barriers, current participation and knowledge); (ii) perceptions of CSA (benefits, barriers and questions/concerns); (iii) need/interest in additional programming (nutrition education, non-nutrition education, qualities of programming and perceived barriers); and (iv) current health knowledge and behaviours (dietary behaviours, health recommendations and health concerns). CONCLUSION Adults living in urban, affordable housing communities desire access to healthy foods, but are limited by cost. Programmes could have a higher likelihood of success if they accept benefits like SNAP (the Supplemental Nutrition Assistance Program), are heavily marketed and incorporate culturally relevant nutrition education components.
Collapse
|
30
|
Abstract
Low-income women and women of color are disproportionately affected by unintended pregnancy. Lack of knowledge of abortion laws and services is one of several factors likely to hinder access to services, though little research has documented knowledge in this population. Survey with convenience sample of 1,262 women attending primary care or full-scope Ob/Gyn clinics serving low-income populations in three large cities and multivariable analyses with four knowledge outcomes. Among all participants, 53% were first-generation immigrants, 25% identified the correct gestational age limit, 41% identified state parental consent laws, 67% knew partner consent is not required, and 55% knew where to obtain abortion services. In multivariable analysis, first-generation immigrants and primarily Spanish speakers were significantly less likely than higher-generation or primarily English speakers to display correct knowledge. Design and evaluation of strategies to improve knowledge about abortion, particularly among migrant women and non-primary English speakers, is needed.
Collapse
Affiliation(s)
- Diana Lara
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California Street, Suite 265, San Francisco, CA, USA.
| | - Kelsey Holt
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | | | - Daniel Grossman
- Ibis Reproductive Health, Oakland, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
31
|
Messinger CJ, Mahmud I, Kanan S, Jahangir YT, Sarker M, Rashid SF. Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis. Reprod Health 2017; 14:7. [PMID: 28088232 PMCID: PMC5237487 DOI: 10.1186/s12978-016-0274-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022] Open
Abstract
Background As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women’s access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. Conclusions We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR – and increasing publicity of these services in low-income communities – may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
Collapse
Affiliation(s)
- Chelsea Jordan Messinger
- Yale College, Yale University, New Haven, CT, USA.,James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.,Present Address: Harvard Medical School, Boston, MA, 02115, USA
| | - Ilias Mahmud
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sushama Kanan
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Yamin Tauseef Jahangir
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| |
Collapse
|
32
|
Kreuter MW, McQueen A, Boyum S, Fu Q. Unmet basic needs and health intervention effectiveness in low-income populations. Prev Med 2016; 91:70-75. [PMID: 27496395 PMCID: PMC5050133 DOI: 10.1016/j.ypmed.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/20/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022]
Abstract
In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010-2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral+tailored print reminder (N=372), or verbal referral+navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services.
Collapse
Affiliation(s)
- Matthew W Kreuter
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Amy McQueen
- Washington University, School of Medicine, Campus Box 8005, 4523 Clayton Ave., St. Louis, MO 63110, United States.
| | - Sonia Boyum
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Qiang Fu
- Saint Louis University, College for Public Health and Social Justice, Salus Center Room 480, 3545 Lafayette Ave., St. Louis, MO 63104, United States.
| |
Collapse
|
33
|
Lòpez-De Fede A, Stewart JE, Hardin JW, Mayfield-Smith K. Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population. Int J Equity Health 2016; 15:89. [PMID: 27282199 PMCID: PMC4901405 DOI: 10.1186/s12939-016-0378-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. Methods To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. Results Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. Conclusions A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.
Collapse
Affiliation(s)
- Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, 29208, SC, USA.
| | - John E Stewart
- Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, 29208, SC, USA
| | - James W Hardin
- Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, 29208, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 445, Columbia, SC, USA
| | - Kathy Mayfield-Smith
- Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, 29208, SC, USA
| |
Collapse
|
34
|
Abstract
PURPOSE The purpose of this study was to evaluate the nutritional status of low-income urban elders by diversified ways, and to analyze the risk factors for malnutrition. METHODS The participants in this study were 183 low-income elders registered at a visiting healthcare facility in a public health center. Data were collected using anthropometric measurements, and a questionnaire survey. For data analysis, descriptive statistics, χ²-test, t-test, Fisher's exact test, multiple logistic regression analysis were performed using SPSS 20.0. RESULTS Regarding the nutritional status of low-income elders as measured by the Mini Nutritional Assessment (MNA), 10.4% of the elders were classified as malnourished; 57.4% as at high risk for malnutrition; and 32.2% as having normal nutrition levels. The main factors affecting malnutrition for low-income elders were loss of appetite (OR=3.34, 95% CI: 1.16~9.56) and difficulties in meal preparation (OR=2.35, 95% CI: 1.13~4.88). CONCLUSION In order to effectively improve nutrition in low-income urban elders, it is necessary to develop individual intervention strategies to manage factors that increase the risk of malnutrition and to use systematic approach strategies in local communities in terms of a nutrition support system.
Collapse
Affiliation(s)
- Hye Sun Hyun
- Department of Nursing, Sangmyung University, Cheonan, Korea
| | - Insook Lee
- College of Nursing, Seoul National University, Seoul, Korea.
| |
Collapse
|
35
|
Bielderman A, Schout G, de Greef M, van der Schans C. Understanding how older adults living in deprived neighbourhoods address ageing issues. Br J Community Nurs 2015; 20:394-9. [PMID: 26252237 DOI: 10.12968/bjcn.2015.20.8.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Older adults living in deprived areas are at risk of developing frailty and becoming care dependent. The aim of this qualitative study is to explore how community-dwelling, older adults living in deprived neighbourhoods address ageing issues. In-depth interviews were conducted with 20 participants who were community-dwelling (independently living), aged 65 years and older, not dependent on care, and living in a socioeconomically deprived urban neighbourhood in the northern part of the Netherlands. Data were analysed using the constant comparative method. Our findings emphasise the resourcefulness of these older adults when coping with apparent adversities. Simultaneously, the findings convey deficits concerning knowledge about ageing and health. Despite this, it appeared that these older adults possess an optimistic view of life, accept their situation, and are content with the capacities they still possess. Perspectives on how older adults address ageing issues are important for developing leads for nursing practice. Nurses will be challenged to recognise the coping strategies of older adults, particularly considering their deficits in health knowledge. The results of this study may serve as a basis for community nurses to manage care for older adults in deprived neighbourhoods.
Collapse
Affiliation(s)
- Annemiek Bielderman
- Researcher, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Gert Schout
- Senior Researcher, Department of Metamedica, VU Medical Center, Amsterdam, the Netherlands
| | - Mathieu de Greef
- Professor of Allied Health Care and Ageing, Institute of Human Movement Sciences, University Medical Center Groningen, the Netherlands, and Professor, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences
| | - Cees van der Schans
- Professor of Health Care and Nursing, Department of Rehabilitation Medicine, University Medical Center Groningen, and Professor, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences
| |
Collapse
|
36
|
Nicholson LM, Schwirian PM, Groner JA. Recruitment and retention strategies in clinical studies with low-income and minority populations: Progress from 2004-2014. Contemp Clin Trials 2015; 45:34-40. [PMID: 26188163 DOI: 10.1016/j.cct.2015.07.008] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
More than 20years have passed since the NIH 1993 Act was initiated, and while progress has been made toward better representation of minorities and women in clinical research studies, as this review will show, there is still tremendous room for improvement. The purpose of this review was to identify the current state of literature on recruitment and retention strategies in clinical studies of low-income and minority populations. We identified 165 studies published in English between 2004 and 2014. Data extracted included information on the study type (descriptive or analytical), study design, study focus (recruitment, retention, both recruitment and retention), health outcome, specific minority group, special population or age group, if specific recruitment/retention techniques were tested, and key research findings. Particular attention was given to articles that statistically analyzed the effectiveness of recruitment and retention strategies on enrollment/retention rates. Effective recruitment and retention strategies for low-income and minority groups, differential effectiveness across groups, and implications for future research are discussed.
Collapse
Affiliation(s)
- Lisa M Nicholson
- The Institute for Health Research and Policy, The University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
| | - Patricia M Schwirian
- The Ohio State University, College of Nursing and Department of Family Medicine, Columbus, OH United States
| | - Judith A Groner
- Section of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, OH United States
| |
Collapse
|
37
|
Bynum SA, Staras SAS, Malo TL, Giuliano AR, Shenkman E, Vadaparampil ST. Factors associated With Medicaid providers' recommendation of the HPV vaccine to low-income adolescent girls. J Adolesc Health 2014; 54:190-6. [PMID: 24064282 PMCID: PMC3946969 DOI: 10.1016/j.jadohealth.2013.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination in the United States remains a public health challenge with vaccine rates of 50%. Although health care providers can facilitate HPV vaccination, several factors may impede their ability to universally recommend the vaccine. To maximize the potential of HPV vaccines, it is important to understand challenges providers face in the clinical environment. The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early (9-10), target (11-12), early adolescent catch-up (13-14), and late adolescent catch-up (15-17) vaccination groups. METHODS Surveys were mailed between October 2009 and April 2010 to a random sample of Florida-based physicians serving Medicaid-enrolled adolescents. Data were analyzed in 2013. RESULTS Among early adolescents, discomfort discussing sexually transmitted infections (STIs) with teens (odds ratio [OR] = 1.75), difficulty ensuring vaccine completion (OR = .73), and discomfort discussing STIs with parents (OR = .44) were associated with recommendation. For target adolescents, discomfort discussing STIs with teens (OR = 2.45), time constraints (OR = .70), vaccine efficacy concerns (OR = .65), discomfort discussing STIs with parents (OR = .33), obstetrics/gynecology (OR = .25) and family medicine (OR = .24) specialty, and non-Hispanic black patient (OR = .15) were associated with recommendation. In early catch-up adolescents, concerns that teens will practice riskier behaviors (OR = .57), discomfort discussing STIs with parents (OR = .47), and family medicine specialty (OR = .20) were associated with recommendation. For late catch-up adolescents, family medicine specialty (OR = .13) was associated with recommendation. CONCLUSIONS Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention. Overall, findings suggest that efforts should focus on sexuality communication and family medicine specialty.
Collapse
Affiliation(s)
- Shalanda A. Bynum
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Stephanie A. S. Staras
- Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, FL
| | - Teri L. Malo
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL
| | - Anna R. Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL,Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa
| | - Elizabeth Shenkman
- Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, FL
| | - Susan T. Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL,Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa
| |
Collapse
|
38
|
Gilles I, Bejaoui B, Courvoisier N, Clémence A. Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis. Rev Epidemiol Sante Publique 2014; 62:5-14. [PMID: 24434247 DOI: 10.1016/j.respe.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 07/22/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. METHOD In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. RESULTS We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. DISCUSSION The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.
Collapse
Affiliation(s)
- I Gilles
- Social science institute, university of Lausanne, bâtiment Geopolis, quartier Mouline, CH-1015 Lausanne, Switzerland.
| | - B Bejaoui
- Community center for social action/Centre communal d'action sociale, 6, rue des Prés-Riants, 73100 Aix-les-Bains, France
| | - N Courvoisier
- Social science institute, university of Lausanne, bâtiment Geopolis, quartier Mouline, CH-1015 Lausanne, Switzerland
| | - A Clémence
- Social science institute, university of Lausanne, bâtiment Geopolis, quartier Mouline, CH-1015 Lausanne, Switzerland
| |
Collapse
|