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Preston MA, Amoli MM, Chukmaitov AS, Krist AH, Dahman B. The impact of the affordable care act and Medicaid expansion on colorectal cancer screening: Evidence from the 5th year of Medicaid expansion. Cancer Med 2024; 13:e7054. [PMID: 38591114 PMCID: PMC11002632 DOI: 10.1002/cam4.7054] [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] [Received: 08/19/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Colorectal cancer screening rates remain suboptimal, particularly among low-income populations. Our objective was to evaluate the long-term effects of Medicaid expansion on colorectal cancer screening. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from 354,384 individuals aged 50-64 with an income below 400% of the federal poverty level (FPL), who participated in the Behavioral Risk Factors Surveillance System from 2010 to 2018. A difference-in-difference analysis was employed to estimate the effect of Medicaid expansion on colorectal cancer screening. Subgroup analyses were conducted for individuals with income up to 138% of the FPL and those with income between 139% and 400% of the FPL. The effect of Medicaid expansion on colorectal cancer screening was examined during the early, mid, and late expansion periods. MAIN OUTCOMES AND MEASURES The primary outcome was the likelihood of receiving colorectal cancer screening for low-income adults aged 50-64. RESULTS Medicaid expansion was associated with a significant 1.7 percentage point increase in colorectal cancer screening rates among adults aged 50-64 with income below 400% of the FPL (p < 0.05). A significant 2.9 percentage point increase in colorectal cancer screening was observed for those with income up to 138% the FPL (p < 0.05), while a 1.5 percentage point increase occurred for individuals with income between 139% and 400% of the FPL. The impact of Medicaid expansion on colorectal cancer screening varied based on income levels and displayed a time lag for newly eligible beneficiaries. CONCLUSIONS Medicaid expansion was found to be associated with increased colorectal cancer screening rates among low-income individuals aged 50-64. The observed variations in impact based on income levels and the time lag for newly eligible beneficiaries receiving colorectal cancer screening highlight the need for further research and precision public health strategies to maximize the benefits of Medicaid expansion on colorectal cancer screening rates.
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Affiliation(s)
- Michael A. Preston
- School of Population Health, Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Massey Cancer Center, Health Equity and Disparities ResearchVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Pharmacy PracticePurdue UniversityWest LafayetteIndianaUSA
| | - Mahmoud Manouchehri Amoli
- School of Population Health, Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Askar S. Chukmaitov
- School of Population Health, Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Alex H. Krist
- Department of Family Medicine and Population HealthVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Bassam Dahman
- School of Population Health, Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
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Zemlak JL, Alexander KA, Wilson D, Singer R, Williams JS, Sherman SG. Sex Workers' Experiences of Screening for Intimate Partner Violence. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00034-0. [PMID: 38490264 DOI: 10.1016/j.jogn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To examine experiences of intimate partner violence (IPV) screening among women who sell sex. DESIGN A qualitative descriptive study. SETTING Telephone interviews during the COVID-19 pandemic (June 2020 to October 2020). PARTICIPANTS Women aged 18 to 49 years who sold or traded sex for food, drugs, money, or shelter at least three times during the past 3 months before recruitment (N = 22). METHODS We used individual, semistructured telephone interviews to collect data about participants' experiences with IPV and IPV screening during health care encounters. We used reflexive thematic analysis to examine these data. RESULTS We identified two overarching themes related to IPV screening experiences: Preferences for IPV Screening and Barriers to Disclosure of IPV Experiences. Participants described a preference for IPV screening done face-to-face with providers who show a genuine interest in their responses. Stigma was a barrier of IPV disclosure. CONCLUSION Health care providers are a trusted safety net for disclosure of IPV experiences. Providing screening in a trauma-informed, nonstigmatizing manner may facilitate disclosure of IPV by women who sell sex. Future research among marginalized populations is needed to examine ways to address IPV in clinical settings with a harm reduction empowerment lens.
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Grudziąż-Sękowska J, Sękowski K, Pinkas J, Jankowski M. Public Expectations and Needs Related to Type 2 Diabetes Prevention: A Population-Based Cross-Sectional Study in Poland. Int J Public Health 2024; 69:1606790. [PMID: 38322305 PMCID: PMC10844515 DOI: 10.3389/ijph.2024.1606790] [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: 10/31/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
Objective: This study aimed to understand the public's expectations regarding type 2 diabetes prevention and to identify factors associated with willingness to participate in preventive activities among adults in Poland. Methods: A cross-sectional survey was carried out using a computer-assisted web interview (CAWI) on a representative sample of 1,046 adults in Poland. A non-probability quota sampling method was used. A study tool was a self-prepared questionnaire. Results: Most respondents (77.3%) declared willingness to participate in preventive activities. Consultation with a diabetologist (75.1%) or family doctor consultation (74.9%) were the most often selected. Lifestyle interventions in the form of dietary and culinary workshops (58.1%) were the least chosen. Having higher education (OR = 3.83, 1.64-8.94, p = 0.002), chronic diseases (OR = 1.36, 1.01-1.85, p = 0.04), and a history of diabetes in the family (OR = 1.67, 1.21-2.30, p = 0.002) were significantly associated with a higher interest in type 2 diabetes prevention. Conclusion: The adults in Poland are keen on participating in diabetes prevention programs, mostly those based on medical counselling rather than lifestyle-oriented interventions. Educational level was the most important factor associated with willingness to participate in type 2 diabetes prevention.
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Park Y, King J, Eggleston MM, Elias TI. Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants. Am J Health Promot 2024; 38:90-100. [PMID: 37670568 DOI: 10.1177/08901171231200779] [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] [Indexed: 09/07/2023]
Abstract
PURPOSE To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. APPROACH Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. SETTING Women from across Pennsylvania, primarily from rural communities. PARTICIPANTS Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). METHODS – DATA COLLECTION AND ANALYSIS Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. RESULTS Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. CONCLUSION The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.
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Affiliation(s)
- Yuae Park
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jennifer King
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Molly M Eggleston
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Eliason EL, Agostino J, Vivier P. Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic. Acad Pediatr 2024; 24:105-110. [PMID: 37487800 DOI: 10.1016/j.acap.2023.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type. METHODS This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance. RESULTS Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries. CONCLUSIONS Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
| | - Jasmine Agostino
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI
| | - Patrick Vivier
- Department of Public Health and Community Medicine (P Vivier), Tufts University School of Medicine, Boston, Mass
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Spallek S, Birrell L, Kershaw S, Devine EK, Thornton L. Can we use ChatGPT for Mental Health and Substance Use Education? Examining Its Quality and Potential Harms. JMIR Med Educ 2023; 9:e51243. [PMID: 38032714 PMCID: PMC10722374 DOI: 10.2196/51243] [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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The use of generative artificial intelligence, more specifically large language models (LLMs), is proliferating, and as such, it is vital to consider both the value and potential harms of its use in medical education. Their efficiency in a variety of writing styles makes LLMs, such as ChatGPT, attractive for tailoring educational materials. However, this technology can feature biases and misinformation, which can be particularly harmful in medical education settings, such as mental health and substance use education. This viewpoint investigates if ChatGPT is sufficient for 2 common health education functions in the field of mental health and substance use: (1) answering users' direct queries and (2) aiding in the development of quality consumer educational health materials. OBJECTIVE This viewpoint includes a case study to provide insight into the accessibility, biases, and quality of ChatGPT's query responses and educational health materials. We aim to provide guidance for the general public and health educators wishing to utilize LLMs. METHODS We collected real world queries from 2 large-scale mental health and substance use portals and engineered a variety of prompts to use on GPT-4 Pro with the Bing BETA internet browsing plug-in. The outputs were evaluated with tools from the Sydney Health Literacy Lab to determine the accessibility, the adherence to Mindframe communication guidelines to identify biases, and author assessments on quality, including tailoring to audiences, duty of care disclaimers, and evidence-based internet references. RESULTS GPT-4's outputs had good face validity, but upon detailed analysis were substandard in comparison to expert-developed materials. Without engineered prompting, the reading level, adherence to communication guidelines, and use of evidence-based websites were poor. Therefore, all outputs still required cautious human editing and oversight. CONCLUSIONS GPT-4 is currently not reliable enough for direct-consumer queries, but educators and researchers can use it for creating educational materials with caution. Materials created with LLMs should disclose the use of generative artificial intelligence and be evaluated on their efficacy with the target audience.
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Affiliation(s)
- Sophia Spallek
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Birrell
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Stephanie Kershaw
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Emma Krogh Devine
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Grudziąż-Sękowska J, Sękowski KB, Pinkas J, Jankowski M. Blood glucose level testing in Poland - do socio-economic factors influence its frequency? A nationwide cross-sectional survey. Ann Agric Environ Med 2023; 30:483-489. [PMID: 37772524 DOI: 10.26444/aaem/162964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
INTRODUCTION AND OBJECTIVE The number of patients diagnosed with diabetes is constantly increasing. Opportunistic screening for diabetes, based on blood glucose tests, can result in early diagnosis and mitigation of its complications. The aim of the study was to assess the frequency of blood-glucose tests in adults in Poland, and factors associated with the frequency of blood-glucose tests, including respondents' knowledge about diabetes. MATERIAL AND METHODS In June 2022, a nationwide cross-sectional survey was carried out among adults in Poland.` The survey used a computer-assisted web interview technique and a self-developed questionnaire that included questions on respondents' self-reported knowledge of diabetes, time since last blood glucose test and socio-demographic characteristics of participants. RESULTS The study population comprised 1,051 individuals aged 18-85 years, among whom 53.3% were females. Over a third of respondents (36.3%) declared a bad or rather bad knowledge about diabetes. Almost half of the respondents (48.7%) had a blood glucose test in the last 12 months, and 12.4% declared that they had never had a blood glucose test. Among respondents without diagnosed diabetes, female gender (OR=1.30, 0.96-1.76; p=0.009), age over 50 years (p<0.05), history of diabetes in the respondent's family (OR=1.83, 1.33-2.51; p<0.001), and good or at least moderate level of knowledge of diabetes were significantly associated (p<0.05) on blood glucose test frequency. CONCLUSIONS The presented data manifest the need to intensify screening for diabetes combined with implementing a comprehensive education strategy regarding diabetes in Poland.
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Affiliation(s)
| | | | - Jarosław Pinkas
- Centre of Postgraduate Medical Education, School of Public Health, Warsaw, Poland
| | - Mateusz Jankowski
- Centre of Postgraduate Medical Education, School of Public Health, Warsaw, Poland
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Gagnon KW, Coulter RWS, Egan JE, Ho K, Hawk M. Patient and Clinician Sociodemographics and Sexual History Screening at a Multisite Federally Qualified Health Center: A Mixed Methods Study. Ann Fam Med 2023; 21:395-402. [PMID: 37748900 PMCID: PMC10519747 DOI: 10.1370/afm.3012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE In 2018, there were 68 million sexually transmitted infections in the United States. Sexual history screening is an evidence-based practice endorsed by guidelines to identify risk of these infections and adverse sexual health outcomes. In this mixed methods study, we investigated patient- and clinician-level characteristics associated with receipt of sexual history screening, and contextualized these differences in more depth. METHODS We collected sociodemographics of patients from the electronic health record and sociodemographics of their primary care clinicians via a census survey. Semistructured interviews were conducted with key practice staff. We conducted multilevel crossed random effects logistic regression analysis and thematic analysis on quantitative and qualitative data, respectively. RESULTS A total of 53,246 patients and 56 clinicians from 13 clinical sites participated. Less than one-half (42.4%) of the patients had any sexual history screening documented in their health record. Patients had significantly higher odds of documented screening if they were gay or lesbian (OR = 1.23), were cisgender women (OR = 1.10), or had clinicians who were cisgender women (OR = 1.80). Conversely, patients' odds of documented screening fell significantly with age (OR per year = 0.99) and with the number of patients their clinicians had on their panels (OR per patient = 0.99), and their odds were significantly lower if their primary language was not English (OR = 0.91). In interviews, key staff expressed discomfort discussing sexual health and noted assumptions about patients who are older, in long-term relationships, or from other cultures. Discordance of patient-clinician gender and patients' sexual orientation were also noted as barriers. CONCLUSIONS Interventions are needed to address the interplay between the social and contextual factors identified in this study, especially those that elicited discomfort, and the implementation of sexual history screening.
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Affiliation(s)
- Kelly W Gagnon
- Division of Infectious Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert W S Coulter
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James E Egan
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken Ho
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Hawk
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Fong J, Venables M, D'Souza D, Maskerine C. Patient Communication Preferences for Prostate Cancer Screening Discussions: A Scoping Review. Ann Fam Med 2023; 21:448-455. [PMID: 37748915 PMCID: PMC10519764 DOI: 10.1370/afm.3011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Prostate cancer screening guidelines have changed as new evidence showing an equivocal mortality benefit led many organizations to relax recommendations for this screening and instead suggest shared decision making. Presently, it is unknown how successfully these conversations happen. Our objective was to understand men's communication preferences when they discuss prostate cancer screening. METHODS In this scoping review, we searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) and the gray literature. Additional studies were obtained from reference lists of included studies and relevant review articles. We included qualitative studies reporting patient perspectives relevant to the research question and published in English. Two independent researchers screened titles and abstracts based on these criteria, conducted a full-text review for final inclusion, evaluated the remaining articles for validity, extracted data, and used thematic analysis to build a thematic framework. A subgroup analysis was performed for Black men as many studies elicited their perspectives. RESULTS Analyses were based on 29 studies. We identified 4 main themes that men described as critical for successful prostate cancer screening risk discussions with their primary care clinician: using everyday language, receiving a sufficient quantity of information, spending enough time, and having a trusting and respectful relationship. Three additional themes emerged that prohibited men from having any discussions at all: having already decided to pursue prostate cancer screening, being passive in medical encounters, and perceiving threat to one's well-being. Black men faced racism, which impacted medical interactions. CONCLUSIONS Our findings point to strategies to support men's communication preferences and address preconceptions surrounding prostate cancer screening. More studies are needed in certain underrepresented populations given the propensity for disparity in health outcomes.
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Affiliation(s)
- Justin Fong
- University of Ottawa, Faculty of Medicine, Department of Family Medicine, Ottawa, Ontario, Canada
| | - Maddie Venables
- University of Ottawa, Faculty of Medicine, Department of Family Medicine, Ottawa, Ontario, Canada
| | - Deion D'Souza
- University of Ottawa, Faculty of Medicine, Department of Family Medicine, Ottawa, Ontario, Canada
| | - Courtney Maskerine
- University of Ottawa, Faculty of Medicine, Department of Family Medicine, Ottawa, Ontario, Canada
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Usher K, Jackson D, Peng W, Amarasena S, McCowan D, Miller J, Cashman B, Sibbritt D. Mental health and use of Medicare Benefits Schedule follow-up mental health services by Indigenous people in Australia during the COVID-19 pandemic. Front Public Health 2023; 11:1190484. [PMID: 37670830 PMCID: PMC10475934 DOI: 10.3389/fpubh.2023.1190484] [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: 03/21/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
Background Mental health care has declined during the COVID-19 pandemic as has attendance for preventive mental health health services. This study aimed to investigate trends in all types of mental health service claims identified in an Indigenous-specific health assessment for Indigenous people before and during COVID-19. Methods We conducted an analysis of Medicare Benefits Scheme (MBS) mental health service items (Items 81,325 and 81,355), to investigate the trends in all types of mental health service claims specifically intended for Indigenous people of Australia. Data were analysed using descriptive statistics, including the total annual numbers of Indigenous peoples' mental health service claims cross-tabulated by age groups and gender, between the calendar years 2017-2021. Multivariable Poisson regression modelling was used to determine associations that were statistically significant. Results Our results indicate an overall rise in MBS claims for mental health follow-up services during 2019-2020 followed by a decline in 2020-2021. In addition, there was an overall decline in claims for follow-up psychology services across the time period 2019-2021. Conclusion We found a significant decline in MBS items specific to follow-up mental health services (MBS Items 81,325 and 81,355) for Indigenous people in Australia suggesting a decline in attendance for mental health service follow-up which in turn may indicate a deficit in mental health care during the COVID-19 pandemic, an issue that may lead to poorer mental health outcomes in the future. Further research is needed to understand whether these changes were due to the impact of the COVID-19 pandemic or other factors.
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Affiliation(s)
- Kim Usher
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Debra Jackson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Wenbo Peng
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Debbie McCowan
- Armajun Health Service Aboriginal Corporation, Inverell, NSW, Australia
| | - Joe Miller
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Belinda Cashman
- Aboriginal Maternal & Infant Health Service, Western Sydney Local Health District, Mount Druitt, NSW, Australia
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Fox JM, Lee MJ, Fairhead CL, Ledwaba-Chapman LM, Nori AV, McQuillan O, Wang Y, Clarke A, Menon-Johansson A. Self-start HIV postexposure prophylaxis (PEPSE), to reduce time to first dose and increase efficacy. Sex Transm Infect 2023; 99:367-372. [PMID: 36564186 DOI: 10.1136/sextrans-2022-055622] [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: 09/22/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effectiveness of HIV postexposure prophylaxis (PEPSE) correlates with speed of uptake following HIV exposure. Time to first dose has not improved in the UK for over 10 years. On-demand pre-exposure prophylaxis (PrEP) has shown that people can self-start medication for HIV prevention.We hypothesised that advanced provision of PEPSE (HOME PEPSE) for men who have sex with men (MSM) to self- initiate would reduce time to first dose following HIV exposure. METHODS Phase IV, randomised, prospective, 48-week, open-label study was carried out. MSM at medium risk of acquiring HIV were randomised (1:1) to immediate or deferred standard of care (SOC) HOME PEPSE. Every 12 weeks, participants self-completed mental health/risk behaviour surveys and had HIV/sexually transmitted infection (STI) testing.HOME PEPSE comprised a 5-day pack of emtricitabine/tenofovir disoproxil fumarate/maraviroc 600 mg once daily initiated following potential exposure to HIV. If taken, participants completed a risk survey; PEPSE continuation was physician directed. Primary outcome was time from potential exposure to HIV to first PEPSE dose. FINDINGS 139 participants randomised 1:1; 69 to immediate HOME PEPSE and 70 to deferred HOME PEPSE. Median age 30 years (IQR 26-39), 75% white, 55% UK born and 72% university educated. 31 in HOME PEPSE and 15 in SOC arm initiated PEPSE. Uptake of HOME PEPSE was appropriate in 27/31 cases (87%, 95% CI: 71% to 95%). Median time from exposure to first dose was 7.3 hours (3.0, 20.9) for HOME PEPSE and 28.5 hours (17.3, 34.0) for SOC (p<0.01). HOME PEPSE was well tolerated with no discontinuations.No significant differences in missed opportunities for PEPSE uptake, sexual behaviour or bacterial STI infections between treatment arms. INTERPRETATION HOME PEPSE reduced the time from exposure to first-dose PEPSE by 21+ hours, with no impact on safety. This significantly improves the efficacy of PEPSE and provides an option for people declining PrEP.
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Affiliation(s)
- Julie M Fox
- Department of GUM and HIV, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Infectious Diseases, King's College London, London, UK
| | - Ming Jie Lee
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - Achyuta V Nori
- Department of GUM and HIV, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Orla McQuillan
- The Northern Contraception Sexual Health Service & HIV Service, Manchester University NHS Foundation Trust, Manchester, UK
| | - Yanzhong Wang
- Department of Infectious Diseases, King's College London, London, UK
| | - Amanda Clarke
- Department of GUM and HIV, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Ju HH, Momin R, Cron S, Jularbal J, Alford J, Johnson C. A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study. JMIR Nurs 2023; 6:e40000. [PMID: 37279046 DOI: 10.2196/40000] [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: 09/19/2022] [Revised: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. OBJECTIVE The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. METHODS The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. RESULTS Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). CONCLUSIONS This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.
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Affiliation(s)
- Hsiao-Hui Ju
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Rashmi Momin
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Stanley Cron
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Jed Jularbal
- Affiliates of Family Medicine, Spring, TX, United States
| | - Jeffery Alford
- Sweetwater Medical Associates, Sugar Land, TX, United States
| | - Constance Johnson
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
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13
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Salvador Costa MJ, Melo P, Azeiteiro U, Carvalho S, Ryan R. Nursing Interventions to Reduce Health Risks from Climate Change Impact in Urban Areas: A Scoping Review Protocol. Nurs Rep 2023; 13:496-505. [PMID: 36976697 PMCID: PMC10051177 DOI: 10.3390/nursrep13010045] [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: 01/26/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Considering that the public health sector has been considered as a key stakeholder in climate action, it seems important to understand what interventions are carried out globally by trusted professionals such as nurses engaged in health promotion and environmental health in optimizing the health of individuals, families, and communities toward the dissemination of lifestyle decarbonization and guidance on healthier climate-related choices. The objective of this review was to understand the extent and type of evidence related to the community-based interventions of nurses that are being led or have been implemented thus far with the aim of reducing the health risks from climate change impact in urban areas. The present protocol follows the JBI methodological framework. Databases to be searched include PubMed, MEDLINE complete, CINAHL, Scopus, Embase, Web of Science, SciELO (Scientific Electronic Library Online), and BASE (Bielefeld Academic Search Engine). Hand searched references were also considered for inclusion. This review will include quantitative, qualitative, and mixed methods studies from 2008 onwards. Systematic reviews, text, opinion papers, and the gray literature in English and Portuguese were also considered. Mapping the nurse led interventions or those that have been implemented thus far in urban areas may lead to further reviews that may help identify the best practices and gaps within the field. The results are presented in tabular format alongside a narrative summary.
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Affiliation(s)
- Maria João Salvador Costa
- Centre for Interdisciplinary Research in Health (Lisboa), Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Pedro Melo
- Centre for Interdisciplinary Research in Health (Porto), Institute of Health Sciences, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Ulisses Azeiteiro
- CESAM-Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Sara Carvalho
- CESAM-Centre for Environmental and Marine Studies & Department of Biology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Robert Ryan
- Department of Landscape Architecture and Regional Planning, University of Massachusetts, 109 Hills North, Amherst, MA 01003, USA
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14
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Clifford S, Smith-Vaughan H, Brown L, Walters N, Hoosan W, Boyd N. Incorporating local health education priorities in HealthLAB: Learnings from very remote Australia. Health Promot J Austr 2023; 34:13-16. [PMID: 35879266 DOI: 10.1002/hpja.645] [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: 11/15/2021] [Revised: 04/14/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED It is well-established that health education and promotion programs work best when they have been tailored to meet local contextual needs. In this brief report we describe a health education program and how it identified and incorporated local priorities into its delivery in two remote Aboriginal communities in the "Top End" of the Northern Territory. METHODS During the first visit to each community team members met with local stakeholders and ran an inaugural HealthLAB session. Fieldnotes were taken during or directly after each interaction. At the end of each day team members debriefed regarding their fieldnotes. After both trips had been completed, priority areas were extracted from fieldnotes and synthesised. RESULTS Although some health priorities were congruent across all groups, Community Members and Childcare staff tended to identify practical solutions while School and Clinic staff were focused on the clinical outcome. Community Members were particularly focused on the wider social and systemic factors impacting health. CONCLUSION In response to the need for practical support, HealthLAB modified their health education packages to upskill mothers and sports coaches to provide brief health education sessions to local children and young people. SO WHAT?: It is recognised that many health promotion programs focus on individual behaviours without creating supportive environments. While it was out of scope for HealthLAB to address physical environmental factors, by building local capacity and knowledge to deliver health education, the program can contribute to a healthier and supportive social environment.
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Affiliation(s)
- Sarah Clifford
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Northern Territory Department of Health, Darwin, Australia
| | - Niamah Walters
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Whitney Hoosan
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nicole Boyd
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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15
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Schrimpf A, Bleckwenn M, Braesigk A. COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11. [PMID: 36766895 DOI: 10.3390/healthcare11030320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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16
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Froidevaux L, Fiorini-Bernasconi C, Campiche V, Gehri M, Jacto-Guillarmod M, Crisinel PA. School-based HPV Vaccination: Variation in Inter-school Vaccine Uptake not Influenced by the Introduction of a New Information Brochure. Asian Pac J Cancer Prev 2023; 24:249-255. [PMID: 36708574 PMCID: PMC10152852 DOI: 10.31557/apjcp.2023.24.1.249] [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: 08/10/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Switzerland, with an adolescent HPV vaccination coverage at 59%, remains far from reaching the crucial swiss national goal of 80% coverage. Our objective was to implement a new information brochure in schools to increase HPV vaccination uptake. METHODS We designed a public health quality project. A new information brochure was produced and was distributed to a test group of 9th grade students from the Canton of Vaud, in Switzerland during the 2019-2020 school year. Vaccine uptake of the test group was compared to those of all other students in 2019-2020 and of students in the same schools in 2017-2018. RESULTS 12,143 electronic records were analyzed. 713 students were enrolled in 6 schools where the new brochure was distributed. Median age was 13 years (IQR 12-13), and 6,031 (49.7%) were female. Vaccine uptake was 52% (6,299/12,143). The new brochure did not result in increased uptake. Age ≥ 13 years (aOR 1.39, 95% CI 1.22-1.58) was significantly associated with uptake. Uptake increased between 2017-2018 (51%, 3,216/6,307) and 2019-2020 (52.8%, 3,083/5,836, p=0.04) due to increased acceptance among boys. The only determinant of uptake in 2019-2020 was uptake in the same schools in 2017-2018. CONCLUSION The introduction of a new information brochure was insufficient to increase HPV vaccination coverage. More innovative strategies are needed.
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Affiliation(s)
| | - Cristina Fiorini-Bernasconi
- Specialized Education and Training Support Service, Health Promotion and prevention in Schools, Community Health Department of the Canton of Vaud, Lausanne, Vaud, Switzerland
| | - Valérie Campiche
- Specialized Education and Training Support Service, Health Promotion and prevention in Schools, Community Health Department of the Canton of Vaud, Lausanne, Vaud, Switzerland
| | - Mario Gehri
- Service of Pediatrics, Department Woman Mother Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women Mother Child, Lausanne University, Hospital and University of Lausanne, Lausanne, Switzerland
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17
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Ebner D, Kisiel J, Barnieh L, Sharma R, Smith NJ, Estes C, Vahdat V, Ozbay AB, Limburg P, Fendrick AM. The cost-effectiveness of non-invasive stool-based colorectal cancer screening offerings from age 45 for a commercial and medicare population. J Med Econ 2023; 26:1219-1226. [PMID: 37752872 DOI: 10.1080/13696998.2023.2260681] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
AIM The United States Preventive Services Taskforce (USPSTF) recently recommended lowering the age for average-risk colorectal cancer (CRC) screening from 50 to 45 years. While initiating screening at age 45 versus 50 provides a greater opportunity for CRC early detection and prevention, the full profile of benefits, risks, and cost-effectiveness of expanding the screen-eligible population requires further evaluation. MATERIALS AND METHODS The costs and clinical outcomes for screening at age 45 for triennial multi-target stool DNA [mt-sDNA], and other non-invasive stool-based modalities (annual fecal immunochemical test [FIT] and annual fecal-occult blood test [FOBT]), were estimated using the validated CRC-AIM microsimulation model over a lifetime horizon. Test sensitivity and specificity inputs were based on 2021 USPSTF modeling analyses; adherence rates were based on published real-world data and the costs of the screening test, follow-up colonoscopies, complications, and CRC care were included. Outcomes are reported from the perspective of a United States payer as clinical, life-years gained (LYG), and incremental cost-effectiveness ratio (ICER); stool-based and follow-up colonoscopy adherence ranges were explored in one-way, probabilistic and threshold analyses. RESULTS When compared to initiation of CRC screening at age 45 versus 50, all modalities reduced both the incidence of and mortality from CRC and increased LYG. Initiating CRC screening at age 45 was cost-effective with an ICER of $59,816 and $35,857 per quality-adjusted life year (QALY) for mt-sDNA versus FIT and FOBT, respectively. In the threshold analyses, at equivalent rates to stool-based screening, mt-sDNA was always cost-effective at a willingness-to-pay threshold of $100,000 per QALY versus FIT and FOBT. CONCLUSIONS Initiating average-risk CRC screening at age 45 instead of age 50 increases the estimated clinical benefit by reducing disease burden while remaining cost-effective. Among stool-based screening modalities, mt-sDNA provides the most clinical benefit in a Commercial and Medicare population.
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Affiliation(s)
- Derek Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - John Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - A Mark Fendrick
- Center for Value Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
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18
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Glenn LE, Thurlow CB, Enriquez M. The "Ups and Downs" of Living With Type 2 Diabetes Among Working Adults in the Rural South. J Prim Care Community Health 2022; 13:21501319221143715. [PMID: 36564892 PMCID: PMC9793025 DOI: 10.1177/21501319221143715] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.
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Affiliation(s)
- Lynn E. Glenn
- Augusta University, Augusta, GA,
USA,Lynn E. Glenn, College of Nursing, Augusta
University, 1120 15th Street EC 4338, Augusta, GA 30912, USA.
| | | | - Maithe Enriquez
- Research College of Nursing, Kansas
City, MO, USA,University of Missouri, Columbia, MO,
USA
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19
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Bhatta DN, Hecht J, Facente SN. Factors associated with stigma related to HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM). Sex Transm Infect 2022; 98:592-594. [PMID: 35121674 DOI: 10.1136/sextrans-2021-055296] [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: 09/18/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a noteworthy scientific development that increases the opportunities for men who have sex with men (MSM) to prevent HIV infection, but stigma is a major barrier to its uptake. This study aims to determine the associations between PrEP-related stigma and individual characteristics among MSM. METHODS Self-reported cross-sectional data were collected from routine-collected electronic healthcare record data from 4084 MSM receiving PrEP in San Francisco, California, between July 2018 and June 2020. Multivariable logistic regression was performed to determine the associations between individual characteristics and PrEP-related stigma, adjusting for age, race, gender identity, injection history, housing status and mental health status. RESULTS PrEP-related stigma was experienced by 9.0% of the participants in our study. PrEP-related stigma was significantly associated with being transgender or gender non-conforming (adjusted OR (AOR): 1.81, 95% CI 1.21 to 2.72), having a history of injection drug use (AOR: 2.02, 95% CI 1.18 to 3.46), being unstably housed (AOR: 1.58, 95% CI 1.11 to 2.26) and having mental health concerns (AOR: 1.99, 95% CI 1.35 to 2.92), after controlling for age, race, gender, injection history, housing status and mental health status. CONCLUSION Participants who reported being transgender or gender non-conforming, having a history of injection drug use, or having mental health concerns were more likely to report experiencing PrEP-related stigma. It is crucial to develop culturally appropriate interventions to reduce PrEP-related stigma among populations who are at high risk of HIV infection and may benefit strongly from improved PrEP uptake.
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Affiliation(s)
- Dharma N Bhatta
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Jennifer Hecht
- San Francisco AIDS Foundation, San Francisco, California, USA.,Springboard HealthLab, Berkeley, California, USA
| | - Shelley N Facente
- School of Public Health, University of California Berkeley, Berkeley, California, USA .,Facente Consulting, Richmond, California, USA
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20
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Abstract
All Medicaid programs pay for fluoride varnish applications during medical visits for infants and toddlers, but receipt of care varies considerably across states. Using 2006-2014 Medicaid data from 22 states, this study examined the association between Medicaid payment and receipt of fluoride varnish during pediatric medical visits. Among 3,393,638 medical visits, fewer than one in 10 visits included fluoride varnish. Higher Medicaid payment was positively associated with receipt of fluoride varnish during pediatric medical visits. As policymakers consider strategies for increasing young children's access to preventive oral health services, as well as consider strategies for balancing budgets, attention should be paid to the effects of provider payment on access to pediatric oral health services.
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21
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Dieckelmann M, Schütze D, Gerber M, Siebenhofer A, Engler J. Preventive and health-promoting activities in general practices in Germany: A scoping review. Health Soc Care Community 2022; 30:2025-2036. [PMID: 35373409 DOI: 10.1111/hsc.13801] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
General practices are rooted in the local community and considered to be particularly well-positioned for engaging in preventive and health-promoting activities. The overall aim of the scoping review is to identify priorities and gaps in research published in the past 20 years on preventive and health-promoting activities provided by general practitioners or their teams in general practices in Germany. MEDLINE and Embase databases were systematically searched in November 2020. Papers were selected in dual-review mode and extracted in single-review mode. Data analysis was finished by May 2021. In total, 530 papers were included in the synthesis. Little research has been carried out into collaboration opportunities both within the general practice team and in communities as a whole, with specialists (18%), hospitals (9%), and health insurance companies (6%) being the most frequent cooperation partners of GPs. 15%-20% of papers each dealt with 'early detection', 'information provision' and 'cardiovascular prevention'. Secondary (53%) and tertiary prevention (43%) was more often the subject of research than primary (39%) and quaternary prevention (15%). Healthy subjects (26%) were less often studied than people with pre-existing conditions (42%) and risk factors (48%). Little information was available on preventive activities in terms of gender, young people, migration background, housing conditions or educational background. Personal counselling (15%) was the most frequently described approach to health promotion in general practices, along with printed information materials (10%). This scoping review provides information on which to base targeted interventions and future research that can contribute towards transforming general practices into promoters of health within the community.
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Affiliation(s)
- Mirjam Dieckelmann
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Dania Schütze
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Meike Gerber
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute of General Practice and Evidence-based Health Services Research, Medical University Graz, Graz, Austria
| | - Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
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22
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Jentzsch A, Geier AK, Bleckwenn M, Schrimpf A. Differences in Demographics of Vaccinees, Access to, and Satisfaction with SARS-CoV-2 Vaccination Procedures between German General Practices and Mass Vaccination Centers. Vaccines (Basel) 2022; 10:1823. [PMID: 36366332 PMCID: PMC9696883 DOI: 10.3390/vaccines10111823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 10/29/2023] Open
Abstract
In the European Union, SARS-CoV-2 vaccines became available in December 2020. The vaccination campaign in Germany was initially implemented through mass vaccination centers and later joined by general practitioners (GPs) in spring 2021. This study compared population characteristics, perceived access barriers, and satisfaction with the vaccination procedure between vaccination centers and GP practices. A paper-based survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Participants in vaccine centers were younger compared to participants in GP practices. GP preference was higher in older participants and those with pre-existing illnesses. Wait time at vaccination site was longer in GP practices, whereas travel distance to site was longer for participants in vaccine centers. However, satisfaction with patient education and recommendation of site were more likely with increasing comprehensibility of the vaccination procedure and physicians' information as well as perceived sufficiency of patient education duration, factors that can be easily modified by all vaccination sites. Our results demonstrate that both types of vaccination sites complement each other in terms of accessibility and target population and that satisfaction with the vaccination procedure can be promoted at all sites by an easy-to-understand process.
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Affiliation(s)
- Anne Jentzsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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23
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Takahashi K, Nakamura S, Watanabe K, Sakaguchi M, Narimatsu H. Availability of Financial and Medical Resources for Screening Providers and Its Impact on Cancer Screening Uptake and Intervention Programs. Int J Environ Res Public Health 2022; 19:11477. [PMID: 36141750 PMCID: PMC9517448 DOI: 10.3390/ijerph191811477] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Interventions for residents and medical/financial resources available to screening providers can improve cancer screening rates. Yet the mechanisms by which the interactions of these factors affect the screening rates remain unknown. This study employed structural equation modeling to analyze the mechanisms underlying these factors. Data for Japanese municipalities' medical/financial status, their implementation of screening interventions, and the number of municipality-based cancer screening appointments from April 2016 to March 2017 were obtained from an open database. Five cancer screenings were included: gastric, lung, colorectal, breast, and cervical cancer screening; all are nationally recommended for population screening in Japan. We defined two latent variables, namely, intervention for residents and medical/financial resources, and then analyzed the relationships between these variables and screening rates using structural equation modeling. Models were constructed for gastric, lung, and breast cancer screening, and similar relationships were observed. With these cancer types, medical/financial resources affected the intervention for residents, directly affecting screening rates. One limitation of this study is that it only included screening by municipalities, which may cause selection bias. In conclusion, financial pressures and lack of medical resources may cause a reduction in screening intervention programs, leading to stagnant screening rates. Ensuring consistent implementation of interventions for residents may improve local and regional cancer screening rates.
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Affiliation(s)
- Koshi Takahashi
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
- Kaneyama Town Clinic, 324-1 Kaneyama, Kaneyama Town, Mogami-gun 999-5402, Japan
| | - Sho Nakamura
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
- Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki 210-0821, Japan
| | - Kaname Watanabe
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
- Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
| | - Masahiko Sakaguchi
- Department of Engineering Informatics, Faculty of Information and Communication Engineering, Osaka Electro-Communication University, 18-8 Hatsucho, Neyagawa-shi 572-8530, Japan
| | - Hiroto Narimatsu
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
- Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki 210-0821, Japan
- Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
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Chang F, O'Connell MB, Mills ME, Hwang JM, Khreizat HS, Garwood CL, Houser A. Preventive health therapy and behavior outcomes from a brown bag medication review for older adults. J Am Geriatr Soc 2022; 70:3202-3209. [PMID: 35906965 DOI: 10.1111/jgs.17982] [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: 02/23/2022] [Revised: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Morbidity and mortality associated with preventable diseases can be reduced with the use of preventive health services. We evaluated the uptake and retention of preventive health behaviors and management of accidental medication poisonings in older adults after a health prevention educational component was combined with a brown bag medication review. METHODS This study used a cohort design and was conducted in six urban senior centers and three independent senior living communities in Detroit, Michigan. Participants included 85 older adults (>60 years old) taking five or more medications with 63 participants returning follow up materials. Pharmacy personnel conducted brown bag medication reviews that were combined with a preventive health education component. Information was collected on medications, vaccinations, supplement use, and accidental medication poisoning management. Participants were given written recommendations on prescription medications and preventive health therapies to improve health and medication use. An investigator developed program satisfaction survey was administered immediately after the review. An investigator-developed follow-up preventive health implementation survey was conducted at least 3 months later to assess recommendation implementation. RESULTS Participants' mean age was 75.9 ± 8.5 years. Fifty-six older adults had 124 recommendations in preventive health in total (1-5/participant). Eleven participants had no recommendations. Sixty-three participants (74%) returned follow-up preventive health surveys. Twenty-three percent of recommendations were already implemented with 34% planned to be done in the future. Poisoning management knowledge increased for 13 participants, reporting they would call the poison control center. The program was well received, with participants reporting high satisfaction scores (4.8 ± 0.7 out of 5). CONCLUSIONS Brown bag medication reviews can be an effective method to promote the uptake of preventive health behaviors among older adults, but additional accidental medication poisoning management education is still needed.
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Affiliation(s)
- Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Beth O'Connell
- Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
| | - Megan E Mills
- Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, Michigan, USA
| | - Jamie M Hwang
- Henry Ford Health Systems and Health Alliance Plan Pierson Clinic, Grosse Pointe Farms, Michigan, USA
| | - Hanan S Khreizat
- Henry Ford Fairlane Internal Medicine and Health Alliance Plan, Dearborn, Michigan, USA
| | - Candice L Garwood
- Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA.,Detroit Medical Center, Rosa Parks Geriatric Center of Excellence and Harper University Hospital, Detroit, Michigan, USA
| | - Ashley Houser
- Monroe Carell Jr. Children's Hospital, Vanderbilt, Nashville, Tennessee, USA
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25
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Begum S, Povey R, Ellis N, Gidlow C, Chadwick P. Influences of decisions to attend a national diabetes prevention programme from people living in a socioeconomically deprived area. Diabet Med 2022; 39:e14804. [PMID: 35122316 PMCID: PMC9315040 DOI: 10.1111/dme.14804] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
AIMS To explore key influences of decisions in participants from a socioeconomically deprived area to attend the Healthier You: NHS Diabetes Prevention Programme (NHSDPP). The NHSDPP is a lifestyle behaviour change programme for adults with prediabetes living in England. METHODS Semi-structured interviews were conducted with 35 participants who had attended the initial assessment, but not yet started the NHSDPP; 23 were classified as "attenders," 12 as "non-attenders" after they were interviewed based on whether they had attended the first NHSDPP session or not. Transcribed interviews were analysed using inductive thematic analysis. RESULTS Seven themes were derived from the data. The results demonstrate how understanding type 2 diabetes, making lifestyle changes, comparing themselves with others, having support and certain self-perceptions can all affect individuals' motivation to attend a diabetes prevention programme. Accessibility and practicalities also influenced both motivation and attendance. CONCLUSIONS This study identified a range of different influences on decisions to attend a diabetes prevention programme, which programme organisers and healthcare professionals should consider to maximise attendance. Initial communication from general practitioners (GPs) and initial assessments are key points where people's beliefs and understanding could be explored.
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Affiliation(s)
- Sonia Begum
- School of Health, Science and WellbeingStaffordshire UniversityStoke‐on‐TrentUK
| | - Rachel Povey
- School of Health, Science and WellbeingStaffordshire UniversityStoke‐on‐TrentUK
| | - Naomi Ellis
- School of Health, Science and WellbeingStaffordshire UniversityStoke‐on‐TrentUK
| | - Christopher Gidlow
- School of Health, Science and WellbeingStaffordshire UniversityStoke‐on‐TrentUK
| | - Paul Chadwick
- Centre for Behaviour ChangeUniversity College LondonLondonUK
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Heuckendorff S, Johansen MN, Overgaard C, Johnsen SP, Thomsen JL, Fonager K. Six-year-old children had greater risks of functional gastrointestinal disorders if their parents had mental health conditions. Acta Paediatr 2022; 111:2029-2037. [PMID: 35726689 PMCID: PMC9546162 DOI: 10.1111/apa.16459] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 05/25/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
Aim This study examined any associations between parents' mental health conditions and hospital diagnoses of functional gastrointestinal disorders (FGIDs) in offspring at the age of six. We also examined any associations between children who met these criteria and attended routine Danish preventive child health appointments. Methods Nationwide registers identified all children born in Denmark from 2000 to 2011 and parents' mental health conditions. Negative binomial regression analyses estimated the incidence rate ratios (IRRs) with 95% confidence intervals (CIs) of children receiving their first hospital diagnosis for an FGID at the age of six. Results We identified 750,379 children and 38% had at least one parent with a mental health condition: 24% were minor, 12% were moderate, and 2% were severe. These children faced a higher risk of an FGID diagnosis than children whose parents did not have mental health conditions. The IRRs were highest for maternal exposure: minor (1.35, 95% CI 1.29–1.42), moderate (1.58, 95% CI 1.48–1.67) and severe (1.58, 95% CI 1.38–1.81). Attending routine preventive child health examinations was associated with a higher risk of FGIDs associated with parents' mental health conditions. Conclusion Paediatric FGIDs were associated with parents' mental health conditions, especially mothers, and attending routine preventive child health examinations.
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Affiliation(s)
- Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Aalborg University, Denmark.,Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
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Tudor K, Brooks J, Howick J, Fox R, Aveyard P. Unblinded and Blinded N-of-1 Trials Versus Usual Care: A Randomized Controlled Trial to Increase Statin Uptake in Primary Care. Circ Cardiovasc Qual Outcomes 2022; 15:e007793. [PMID: 35698974 DOI: 10.1161/circoutcomes.120.007793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim was to assess whether an intervention incorporating a practicable open-label n-of-1 trial would lead to greater uptake of statin than usual care and comparable uptake to a closed-label gold-standard n-of-1 trial. METHODS We enrolled patients who had stopped or declined statins into a 3-arm trial (usual care, unblinded, and blinded n-of-1 intervention arms). Physicians advised participants randomized to usual care to take statin therapy to prevent cardiovascular disease. In both intervention arms, physicians delivered a theoretically informed informed intervention endorsing the value of experimenting with medication in n-of-1 trials to assess whether it caused side-effects. In these trials, participants alternated between 4 weeks of medication and no medication (unblinded arm) or randomly sorted active and placebo (blinded arm) and recorded symptoms and symptom attributions for 6 months. Thereafter, physicians discussed participants' symptom reports during active/inactive treatment periods and asked participants to resume statins if appropriate. RESULTS Seventy-three were randomized to the intervention arms and 20 to the control group. Fifty-six of 73 (77%) attempted the n-of-1 experiment; 28/36 (78%) in the unblinded arm; and 28/37 (76%) in the blinded arm. Forty-three of 56 (77%) completed the 6-month experiment and received feedback from the physician; 20/28 (71%) in the unblinded arm and 23/28 (82%) in the blinded arm. Thirty-three of 76 (45%) people restarted statins in the n-of-1 arms compared with 4/20 (20%) in the control arm, difference 24% (95% CI, 5%-43%; P=0.041). There was no evidence this differed between blinded and unblinded arms, difference 2% (95% CI, -20% to 24%; P=0.86). Adverse events occurred at a similar rate on and off statin. CONCLUSIONS In patients refusing or intolerant of statin, supporting experimentation with n-of-1 trials increases medication uptake compared with usual care. Alternating on-off medication in unblinded n-of-1 experiments appears as effective as a blinded experiment. REGISTRATION URL: https://doi.org/10.1186/ISRCTN11142694; Unique identifier: ISRCTN11142694.
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Affiliation(s)
- Kate Tudor
- Nuffield Department of Primary Care Health Sciences (K.T., J.B., P.A.), University of Oxford, Radcliffe Observatory Quarter, United Kingdom.,Department of Psychiatry, University of Oxford, Warneford Hospital, United Kingdom (K.T.)
| | - Jenny Brooks
- Nuffield Department of Primary Care Health Sciences (K.T., J.B., P.A.), University of Oxford, Radcliffe Observatory Quarter, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy (J.H.), University of Oxford, Radcliffe Observatory Quarter, United Kingdom
| | - Robin Fox
- Bicester Health Centre, Coker Close, Bicester, United Kingdom (R.F.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (K.T., J.B., P.A.), University of Oxford, Radcliffe Observatory Quarter, United Kingdom.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, United Kingdom (P.A.)
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İkiışık H, Sezerol MA, Taşçı Y, Maral I. COVID-19 vaccine hesitancy and related factors among primary healthcare workers in a district of Istanbul: a cross-sectional study from Turkey. Fam Med Community Health 2022; 10:e001430. [PMID: 35470223 PMCID: PMC9039154 DOI: 10.1136/fmch-2021-001430] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aimed to determine the COVID-19 risk perceptions, vaccination intentions and predictive factors of family physicians and family healthcare staff working in primary care in Üsküdar. DESIGN A cross-sectional study was performed using an online questionnaire to determine the demographic and general characteristics of the participants and their willingness to be vaccinated. SETTING An online questionnaire was applied to family physicians and family health workers working in primary care family health centres in Üsküdar between 25 and 29 December 2020. Multivariate analysis was performed to identify independent predictors of the willingness of individuals to be vaccinated. PARTICIPANTS Out of 323 health workers working in 44 family health centres in the district, a total of 276 health workers were reached, including 126 physicians (n=158, 79.7%) and 150 midwives/nurses (n=165, 90.9%) (response rate 85.4%). RESULTS 50.4% (n=139) of the healthcare workers were willing to have the COVID-19 vaccine, 29% (n=80) were undecided and 20.7% (n=57) refused the vaccine. The rate of acceptance to be vaccinated was higher in physicians, in men and in those who had not received a seasonal influenza vaccination regularly each year. CONCLUSIONS Half of the primary healthcare workers, one of the high-risk groups in the pandemic, were hesitant or refused to be vaccinated for COVID-19. Knowing the factors affecting the vaccine acceptance rates of healthcare professionals can be considered one of the most strategic moves in reaching the target of high community vaccination rates. For evidence-based planning in vaccination studies, there is a need to investigate the reasons for COVID-19 vaccine acceptance by healthcare workers at all levels.
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Affiliation(s)
- Hatice İkiışık
- Department of Public Health, Istanbul Medeniyet University Faculty of Medicine, Uskudar, Istanbul, Turkey, Üsküdar, Istanbul, Turkey
| | - Mehmet Akif Sezerol
- Public Health Department, Institute of Health Sciences, Istanbul University, Istanbul University, Fatih, Istanbul, Turkey
| | - Yusuf Taşçı
- Public Health Department, Institute of Health Sciences, Istanbul University, Istanbul University, Fatih, Istanbul, Turkey
| | - Işıl Maral
- Department of Public Health, Istanbul Medeniyet University Faculty of Medicine, Uskudar, Istanbul, Turkey, Üsküdar, Istanbul, Turkey
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Dutey-Magni P, Brown J, Holmes J, Sinclair J. Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT. Addiction 2022; 117:580-589. [PMID: 34374144 DOI: 10.1111/add.15662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. DESIGN Cross-sectional diagnostic study based on a nationally-representative survey. SETTINGS Community dwelling households in England. PARTICIPANTS A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. MEASUREMENTS Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. FINDINGS EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). CONCLUSIONS A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
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Affiliation(s)
- Peter Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jamie Brown
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
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30
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Recio-Vivas AM, Font-Jiménez I, Mansilla-Domínguez JM, Belzunegui-Eraso A, Díaz-Pérez D, Lorenzo-Allegue L, Peña-Otero D. Fear and Attitude towards SARS-CoV-2 (COVID-19) Infection in Spanish Population during the Period of Confinement. Int J Environ Res Public Health 2022; 19:ijerph19020834. [PMID: 35055656 PMCID: PMC8775959 DOI: 10.3390/ijerph19020834] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022]
Abstract
In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population’s fear of the new situation and increasing the perception of risk. This fear can cause behaviour that will determine the course of the pandemic and, therefore, the purpose of this study was to analyse the fear of infection from COVID-19 among the Spanish population during the state of emergency. A cross-sectional, descriptive observational study was conducted with 16,372 participants. Data on sociodemographic factors, health factors, risk perception and fear were collected through an online survey. Level of fear is associated with older age, a lower level of education, having a person infected with SARS-CoV-2 in the immediate surroundings and living with and belonging to the most socioeconomically vulnerable group of people. Risk perception is associated with increased preventive behaviour. This paper provides relevant information for the public health sector since it contributes first-hand knowledge of population data that is highly useful in terms of prevention. Understanding the experiences of people in this pandemic helps to create more effective future intervention strategies in terms of planning and management for crisis situations.
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Affiliation(s)
- Ana María Recio-Vivas
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - Isabel Font-Jiménez
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - José Miguel Mansilla-Domínguez
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
- Correspondence:
| | - Angel Belzunegui-Eraso
- Medical Anthropology Research Centre, Department of Quantitative Methods at the Faculty of Nursing, Rovira i Virgili University, 43002 Tarragona, Spain;
| | - David Díaz-Pérez
- Respiratory Nursing Department at SEPAR, Respiratory Nurse at the Pneumology and Thoracic Surgery Service of the Hospital Universitario Nuestra Señora de Candelaria (Tenerife), 38010 Santa Cruz, Spain;
| | - Laura Lorenzo-Allegue
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - David Peña-Otero
- Respiratory Nursing Department at SEPAR, Nurse Member of the IDIVAL and IiSGM Research Institutes, 28007 Madrid, Spain;
- Hospital de Sierrallana, Cantabrian Health Service, 39300 Torrelavega, Spain
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Abstract
BACKGROUND Mobile health (mHealth) prompts (e.g., text messaging, push notifications) are a commonly used technique within behaviour change interventions to prompt or cue a specific behaviour. Such prompts are being increasingly integrated into diabetes prevention programs (DPPs). While mHealth prompts provide a convenient and cost-effective way to reinforce behaviour change, no reviews to date have examined mHealth prompt use within DPPs. This scoping review aims to: (I) understand how mHealth prompts are being used within behaviour change interventions for individuals at risk for developing type 2 diabetes (T2D); and (II) provide recommendations for future mHealth prompt research, design, and application. METHODS The scoping review methodology outlined by Arksey and O'Malley were followed. Medline, CINAHL, PsycInfo, Web of Science, and SportDiscus were searched. The search strategy combined keywords relating to T2D risk and mHealth prompts in conjunction with database-controlled vocabulary when available (e.g., MeSH for Medline). RESULTS Of the 4,325 publications screened, 44 publications (based on 33 studies) met the inclusion criteria and were included for data extraction. Text messaging was the most widely used mHealth prompt (73%) followed by push notifications (21%). Only 30% of studies discussed the theoretical basis for prompt content and time of day messages were sent, and only 27% provided justification for prompt timing and frequency. Fourteen studies assessed participant satisfaction with mHealth prompts of which only two reported dissatisfaction due to either prompting frequency (hourly) or message content (solely focused on weight). Nine studies assessed behavioural outcomes including weight loss, physical activity, and diabetes incidence, and found mixed effects overall. CONCLUSIONS While mHealth prompts were well-received by participants, there are mixed effects on the influence of mHealth prompts on behavioural outcomes and diabetes incidence. More thorough reporting of prompt content development and delivery is needed, and more experimental research is needed to identify optimal content, delivery characteristics, and impact on behavioural and clinical outcomes.
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Affiliation(s)
- Megan M. MacPherson
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Kohle J. Merry
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Sean R. Locke
- Department of Kinesiology, Brock University, St. Catherines, Canada
| | - Mary E. Jung
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
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Divakar DD, Nimbeni SB, Al-Kheraif AA, Khan AA, Naik S, Khanagar SB, Jhugroo C, Nimbeni B. Knowledge and attitude of dental professionals toward COVID-19 in Riyadh, Saudi Arabia: a cross-sectional survey. ASIAN BIOMED 2021; 15:277-284. [PMID: 37551362 PMCID: PMC10321220 DOI: 10.2478/abm-2021-0034] [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] [Indexed: 11/20/2022]
Abstract
Background Coronavirus disease-2019 (COVID-19) is a life-threatening global pandemic. The dental profession is considered a high-risk group in the transmission of the responsible virus. Objective To assess the knowledge and attitude among dental professionals in response to the COVID-19 pandemic. Methods We conducted a cross-sectional study of dental graduates, interns, postgraduates, and dental faculty from May to July 2020. A standardized questionnaire was developed to assess knowledge and attitude of 650 participants. The questionnaire comprised 14 questions to assess general knowledge about COVID-19, 11 questions regarding knowledge about prevention of COVID-19 in dental practice, and 10 questions regarding the attitude toward preventing COVID-19. Results Among the study population, only 376 (57.8%) knew the causative virus for COVID-19. Only 425 (65.3%) knew about rinsing the mouth with an antimicrobial solution or 1% hydrogen peroxide before the dental procedure. Regarding the hand hygiene guidelines, 357 (54.9%) had knowledge of the Centers for Disease Control and Prevention (CDC) and 377 (58.0%) about World Health Organization (WHO) guidelines. At the time of our survey, 72% of the participants showed sufficient knowledge, while 28% had low or insufficient knowledge about COVID-19. Conclusion While there was a lack of knowledge among dental professionals in Riyadh, Saudi Arabia about COVID-19, there was an excellent positive attitude toward preventing disease. Greater awareness is needed to control the spread of this disease.
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Affiliation(s)
- Darshan Devang Divakar
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh11433, Saudi Arabia
| | - Shruti Basavaraj Nimbeni
- Department of Preventive Dentistry, Division of Pediatric Dentistry, College of Dental Sciences, Mustaqbal University, Buraydah, Al-Qassim Province51431, Saudi Arabia
| | - Abdulaziz A. Al-Kheraif
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh11433, Saudi Arabia
| | - Aftab Ahmed Khan
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh11433, Saudi Arabia
| | - Sachin Naik
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh11433, Saudi Arabia
| | - Sanjeev Balappa Khanagar
- Dental Public Health, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh11426, Saudi Arabia
| | - Chitra Jhugroo
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh11433, Saudi Arabia
| | - Basavaraj Nimbeni
- Agmal Ebtsama Dental and Derma Clinics Center, Buraydah, Al-Qassim Province51431, Saudi Arabia
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Fraiz Barbeito M, Rey Veiga S, González González Y, Da Cuña Carrera I, Alonso-Calvete A, Santamaría Solís MT. Epidemiology of spinal pain in a population of schoolchildren from Spain. ARCH ARGENT PEDIATR 2021; 119:364-369. [PMID: 34813228 DOI: 10.5546/aap.2021.eng.364] [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: 01/30/2021] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
Introduction Spinal pain is one of the main reasons for seeking care; it usually appears during school age, increases with age, and is related to certain risk factors. The objective of this study is to analyze the prevalence of spinal pain among schoolchildren and examine associated factors. Population and methods Cross-sectional study with a questionnaire administered to schoolchildren aged 9-11 years. The prevalence of pain, physical activity, spine self-care, backpack use, and electronic device use were analyzed. Results A total of 329 subjects were analyzed. The prevalence of spinal pain is 34.3%, with no differences observed between sexes. Pain severity is considered mild, with a mean severity of 1.99 ± 2.54 over 10 according to the Wong-Baker FACES® scale; in more than 50% of cases, pain had a short duration (less than 12 hours). Cervical pain was referred by 22.2% of schoolchildren, whereas dorsal and lumbar pain were reported by 14% and 11.9%, respectively. In addition, 47.9% referred pain in more than one region of the spine. Also, 73.3% of schoolchildren did physical activity outside school hours and 90.6% used electronic devices. An association was observed between the presence of pain and adequate postural hygiene habits. Conclusions Schoolchildren referred spinal pain that was mild and short in duration, often in the cervical region. The association with risk factors indicates that children who referred pain have better postural habits.
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Affiliation(s)
- Manuel Fraiz Barbeito
- Unidad de Desviaciones del Raquis, Complejo Hospitalario Universitario Pontevedra, Hospital Montecelo, Pontevedra. España
| | - Sara Rey Veiga
- Unidad de Desviaciones del Raquis, Complejo Hospitalario Universitario Pontevedra, Hospital Montecelo, Pontevedra. España
| | | | | | | | - María T Santamaría Solís
- Unidad de Desviaciones del Raquis, Complejo Hospitalario Universitario Pontevedra, Hospital Montecelo, Pontevedra. España
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Boyd RP, DeVolld TA, DiPietro Mager NA, Burke WJ. Healthy People and Interested Students: Medical and Pharmacy Students' Knowledge and Attitudes Regarding Public Health. Pharmacy (Basel) 2021; 9:176. [PMID: 34842820 DOI: 10.3390/pharmacy9040176] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/21/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
Little is known about health professions students’ awareness and attitudes regarding public health in the United States. Therefore, the purpose of this study was to assess medical and pharmacy students’ knowledge and interest in the Healthy People initiative as well as perceptions of public health content in their curricula. An electronic survey was distributed in March 2021 in seven schools across Ohio; participation was incentivized through a USD 5 donation to the Ohio Association of Foodbanks to aid in COVID-19 relief efforts (maximum USD 1000) for each completed survey. A total of 182 medical students and 233 pharmacy students participated (12% response rate). Less than one-third of respondents reported familiarity with Healthy People and correctly identified the latest edition. However, nearly all respondents agreed public health initiatives are valuable to the American healthcare system. Almost all students expressed a desire to practice interprofessionally to attain public health goals. Both medical and pharmacy students recognized core public health topics in their curricula, and nearly 90% wanted more information. These findings indicate that the majority of medical and pharmacy students in Ohio believe public health initiatives to be important, yet knowledge gaps exist regarding Healthy People. This information can guide curricular efforts and inform future studies of health professions students.
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Munck HNM, Qvist T, Helleberg M, Kaye PS, Pichon F, Cowan S. At-Risk Groups of Men Who Have Sex With Men Can Be Reached Through Community-Based HIV Testing in Denmark. AIDS Educ Prev 2021; 33:439-449. [PMID: 34369829 DOI: 10.1521/aeap.2021.33.5.1] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study evaluates whether the community-based HIV testing clinic Checkpoint could reach at-risk groups of men who have sex with men (MSM) and link patients to care. A prospective observational study of all Checkpoint visits during 2013-2016 and a retrospective registry study of all MSM diagnosed with HIV in Denmark during the same period were conducted. One percent of the 9,074 tests in Checkpoint were HIV-positive, accounting for 19% of all new HIV diagnoses among MSM in Denmark. Checkpoint testers reported frequent condomless anal sex. Two percent of migrant Checkpoint testers were HIV-positive compared to 1 % among Danish MSM. HIV-positive MSM identified through Checkpoint were significantly younger, more of them were migrant, and a smaller proportion were late testers compared to those testing through the conventional health care system. Checkpoint reaches at-risk populations of MSM and links patients successfully to care.
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Affiliation(s)
| | - Tavs Qvist
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Susan Cowan
- Department of Sexually Transmitted Infections and Blood-Borne Viruses, Statens Serum Institut, Copenhagen, Denmark
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Lum E, Tummalapalli SL, Khare M, Keyhani S. Receipt of preventive health services and current cannabis users. J Addict Dis 2021; 40:192-196. [PMID: 34433384 DOI: 10.1080/10550887.2021.1967688] [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] [Indexed: 10/20/2022]
Abstract
Substance use is associated with greater barriers and reduced access to care. Little research, however, has examined the relationship between cannabis use and receipt of preventive health services. Using data from the 2017 Behavioral Risk Factor Surveillance System, we examined the association between current cannabis use and receipt of 12 preventive health services, adjusting for sociodemographic characteristics and access to care. In analyses that adjusted for sociodemographic factors and access to care, participants with current cannabis use had lower odds of being vaccinated for influenza (AOR = 0.67, 95% CI = 0.54-0.83) and higher odds of ever receiving HPV vaccination (AOR = 1.77, 95% CI = 1.06-2.96) and HIV screening (AOR = 2.34, 95% CI = 1.88-2.92) compared with those without cannabis use. Among the 12 preventive services examined, we found three differences in receipt of preventive services by cannabis use status. Cannabis use does not appear to be associated with significant underuse of preventive services.
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Affiliation(s)
- Emily Lum
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Meena Khare
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco Veterans Administration, San Francisco, CA, USA
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Balogun T, Troisi C, Swartz MD, Beyda R. Juvenile Justice-Involved Youth: Preventive Health Services Received Prior to Detention. J Correct Health Care 2021; 27:232-237. [PMID: 34402679 DOI: 10.1089/jchc.20.01.0002] [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] [Indexed: 11/12/2022]
Abstract
Few studies on youth in the juvenile justice system describe preventive services received at community health visits. We determined preventive services received at their most recent visit to a health care provider through a cross-sectional survey of youth at a detention center. Data on their health outcomes were abstracted from medical records. Many did not receive comprehensive screenings for sexual health, mental health symptoms, or substance use at well-child visits in the past year. Health outcomes were not significantly different from those who did not attend a well visit in the past year. Limited preventive screenings could explain why well checks did not influence health outcomes; therefore, providers should incorporate recommended screenings into sick visits as well as preventive visits.
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Affiliation(s)
- Titilola Balogun
- Department of Graduate Programs in Public Health, College of Graduate & Professional Studies, University of New England, Portland, Maine, USA
| | - Catherine Troisi
- Department of Management, Policy and Community Health, and The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Rebecca Beyda
- Department of Pediatrics, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
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Cuzin L, Cabras O, Marquise A, Pierre-François S, Pircher M, Cabié A. Challenges of providing HIV pre-exposure prophylaxis in Martinique, French West Indies. Sex Transm Infect 2021; 98:387. [PMID: 34400577 DOI: 10.1136/sextrans-2021-055158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lise Cuzin
- Infectious and Tropical Diseases, CHU de Martinique, Fort-de-France, Martinique .,UPS, Toulouse, France
| | - Ornella Cabras
- Infectious and Tropical Diseases, CHU de Martinique, Fort-de-France, Martinique
| | - Athena Marquise
- Infectious and Tropical Diseases, CHU de Martinique, Fort-de-France, Martinique
| | | | - Mathilde Pircher
- Infectious and Tropical Diseases, CHU de Martinique, Fort-de-France, Martinique
| | - André Cabié
- Infectious and Tropical Diseases, CHU de Martinique, Fort-de-France, Martinique
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Tatari CR, Andersen B, Brogaard T, Badre-Esfahani S, Jaafar N, Kirkegaard P. The SWIM study: Ethnic minority women's ideas and preferences for a tailored intervention to promote national cancer screening programmes-A qualitative interview study. Health Expect 2021; 24:1692-1700. [PMID: 34232543 PMCID: PMC8483185 DOI: 10.1111/hex.13309] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ethnic minority women from non-Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group. OBJECTIVE To explore ethnic minority women's own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies. METHODS An interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty-seven women from 10 non-Western countries contributed to the study. The interviews were audio-recorded and transcribed verbatim followed by a thematic analysis. RESULTS According to the women, a tailored intervention should focus on knowledge in the form of face-to-face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network. CONCLUSION Ethnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation. PATIENT OR PUBLIC CONTRIBUTION Minority women were involved in the interview study.
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Affiliation(s)
- Camilla Rahr Tatari
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,University Research Clinic for Cancer Screening, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,University Research Clinic for Cancer Screening, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sara Badre-Esfahani
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,University Research Clinic for Cancer Screening, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Negin Jaafar
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,University Research Clinic for Cancer Screening, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Yaya I, Diallo F, Kouamé MJB, Agboyibor MK, Traoré I, Coulibaly A, Maiga K, Mora M, Palvadeau P, Dah ETT, Mensah E, Anoma C, Dembélé Keita B, Spire B, Laurent C. Decrease in incidence of sexually transmitted infections symptoms in men who have sex with men enrolled in a quarterly HIV prevention and care programme in West Africa (CohMSM ANRS 12324-Expertise France). Sex Transm Infect 2021; 98:85-94. [PMID: 33753460 DOI: 10.1136/sextrans-2020-054755] [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: 08/24/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although men who have sex with men (MSM) are at high risk of STI, their access to tailored healthcare services remains limited in West Africa. We assessed the change in STI symptoms incidence over time among MSM enrolled in a quarterly HIV prevention and care programme in four cities in Burkina Faso, Côte d'Ivoire, Mali and Togo. METHODS We performed a prospective cohort study in MSM followed up between 2015 and 2019. Men aged over 18 who reported anal sex with another man within the previous 3 months were offered quarterly syndromic diagnosis and treatment for STI, as well as HIV testing, peer-led counselling and support. Condoms and lubricants were also provided. The change in STI symptoms incidence during follow-up was investigated using a non-parametric trend test and mixed-effect Poisson regression models. RESULTS 816 participants were followed for a total duration of 1479 person-years. 198 participants (24.3%) had at least one STI symptom during follow-up. Overall, STI symptoms incidence was 20.4 per 100 person-years (95% CI 18.4 to 22.6), ranging from 15.3 in Abidjan to 33.1 in Ouagadougou (adjusted incidence rate ratio (aIRR) 2.39, 95% CI 1.55 to 3.69, p<0.001). STI symptoms incidence was 16.8 and 23.0 per 100 person-years in HIV-positive and HIV-negative participants, respectively (aIRR 0.77, 95% CI 0.57 to 1.04, p=0.087). STI symptoms incidence decreased significantly from 29.9 per 100 person-years in the first 6 months to 8.6 at 30-35 months of follow-up (aIRR per 6-month increase 0.84, 95% CI 0.77 to 0.92, p<0.001). CONCLUSION STI symptoms incidence decreased over time but the overall burden of STI appeared to be very high in MSM followed up in West Africa. STI services including counselling, diagnosis and treatment should be reinforced. Laboratory tests that allow accurate diagnosis of STI are required. Strengthening STI services will be critical for controlling the HIV and STI epidemics in this vulnerable population and in the general population. TRIAL REGISTRATION NUMBER NCT02626286.
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Affiliation(s)
- Issifou Yaya
- IRD, Inserm, Univ Montpellier, TransVIHMI, Montpellier, France
| | | | | | | | - Issa Traoré
- Association African Solidarité, Ouagadougou, Burkina Faso
| | | | | | - Marion Mora
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Marseille, France
| | | | - Elias Ter Tiero Dah
- IRD, Inserm, Univ Montpellier, TransVIHMI, Montpellier, France.,Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Marseille, France
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Mitričević S, Janković J, Stamenković Ž, Bjegović-Mikanović V, Savić M, Stanisavljević D, Mandić-Rajčević S. Factors Influencing Utilization of Preventive Health Services in Primary Health Care in the Republic of Serbia. Int J Environ Res Public Health 2021; 18:3042. [PMID: 33809546 PMCID: PMC7999125 DOI: 10.3390/ijerph18063042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
The use of preventive health services is a long-term health investment due to its potential to help individuals to take care of their health. This study aimed to explore the availability and performance of health services in primary health care (PHC) in the domain of general practice (GP), pediatrics, and gynecology, as well as to analyze the influence of sociodemographic and health determinants on the utilization of preventive health services. This descriptive study used data from the National Health Insurance Fund and the Statistical Office of the Republic of Serbia for 2015 and included 149 independent PHC units. The relationship between the utilization of preventive services and sociodemographic and health characteristics of the population was analyzed by bivariate and multivariate linear regression models. The higher health expenditure per capita and noncommunicable diseases mortality rate were, the more preventive health services were provided by a chosen GP. Children with a higher completion rate of primary school (p = 0.024), higher health expenditure (p = 0.017), and higher life expectancy at birth (p = 0.041) had more preventive health services. The fertility rate was positively associated with the number of preventive health services per 1000 women (p = 0.033). Our findings should serve as a starting point for where efforts should be made to achieve better health outcomes.
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Affiliation(s)
- Slavka Mitričević
- Cabinet of Minister without Portfolio in Charge of Demography and Population Policy, 11000 Belgrade, Serbia;
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (Ž.S.); (V.B.-M.)
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Željka Stamenković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (Ž.S.); (V.B.-M.)
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vesna Bjegović-Mikanović
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (Ž.S.); (V.B.-M.)
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Savić
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.S.); (D.S.)
| | - Dejana Stanisavljević
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.S.); (D.S.)
| | - Stefan Mandić-Rajčević
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (Ž.S.); (V.B.-M.)
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Rietkerk W, de Jonge-de Haan J, Slaets JPJ, Zuidema SU, Gerritsen DL. Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation. J Aging Health 2021; 33:482-492. [PMID: 33625262 PMCID: PMC8236665 DOI: 10.1177/0898264321993321] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.
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Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Joris P J Slaets
- Faculty of Medical Sciences, 3647University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,443696Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Sacoto F, Torres I, López-Cevallos DF. Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador. Rev Panam Salud Publica 2021; 45:e30. [PMID: 33643405 PMCID: PMC7901044 DOI: 10.26633/rpsp.2021.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program’s user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.
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Affiliation(s)
- Fernando Sacoto
- Ecuadorian Society of Public Health Quito Ecuador Ecuadorian Society of Public Health, Quito, Ecuador
| | - Irene Torres
- Octaedro Foundation Quito Ecuador Octaedro Foundation, Quito, Ecuador
| | - Daniel F López-Cevallos
- Oregon State University Oregon United States of America Oregon State University, Oregon, United States of America
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Annan E, Stockbridge EL, Katz D, Mun EY, Miller TL. A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States. Medicine (Baltimore) 2021; 100:e24838. [PMID: 33607853 PMCID: PMC7899900 DOI: 10.1097/md.0000000000024838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.
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Affiliation(s)
- Esther Annan
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, TX
| | - Erica L. Stockbridge
- Department of Advanced Health Analytics & Solutions, Magellan Healthcare, Magellan Health, Inc., Scottsdale, AZ
| | - Dolly Katz
- Division of Tuberculosis Elimination, National Center for HIV/AIDs, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, GA
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, TX
| | - Thaddeus L. Miller
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, TX
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Abstract
Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.
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Affiliation(s)
| | - Kaushal Shah
- Psychiatry, Griffin Memorial Hospital, Norman, USA
| | | | - Nkechi C Arinze
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Gaurav Chaudhari
- Psychiatry, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Chiu TY. Predictors of Use of Preventative Health Services for People with Disabilities in Taiwan. Int J Environ Res Public Health 2021; 18:ijerph18041661. [PMID: 33572360 PMCID: PMC7916133 DOI: 10.3390/ijerph18041661] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
People with disabilities display less use of preventive health services, such as health examinations, flu vaccinations, Pap smears and breast screening, but evidence has shown that preventive health services can detect or even prevent serious diseases and medical problems. Therefore, identifying the factors associated with the use of preventive health services is important for people with disabilities. This study examined the use of preventive health services by people with disabilities and identified other associated factors for people with disabilities. The research used social demographics and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12 items to measure activity and participation (AP) and other factors; there were 742 people with disabilities recruited with stratified proportional sampling. The data were collected through face-to-face interviews. The findings revealed that the common types of preventive services accessed by people with disabilities were health examinations and flu vaccinations; most of them had only used one preventive health service in the past year. The factors of having caregivers of spouses (OR = 1.74), perceived good health (OR = 1.26), and less limitation of AP (OR = 0.99) were significantly associated with the use of preventive services (p < 0.01). The study found a significant association between having children as caregivers and the non-use of Pap smears and breast screening services among women, providing valuable evidence for the distribution of the use of preventive health services for people with disabilities. Furthermore, the study highlighted the present status of disparities in the use of preventive services for people with disabilities and should encourage a boost in the adjustment of the medical environment and service resource allocation by the Taiwanese government for people with disabilities.
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Affiliation(s)
- Tzu-Ying Chiu
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei City 11153, Taiwan
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Berendes S, Gubijev A, McCarthy OL, Palmer MJ, Wilson E, Free C. Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect 2021; 97:190-200. [PMID: 33452130 DOI: 10.1136/sextrans-2020-054853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.
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Affiliation(s)
- Sima Berendes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Wilson
- Population, Policy & Practice Department, Faculty of Population Health Sciences, University College London GOS Institute of Child Health, London, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Cordioli M, Gios L, Huber JW, Sherriff N, Folch C, Alexiev I, Dias S, Nöstlinger C, Gama A, Naseva E, Valkovičová Staneková D, Marcus U, Schink SB, Rosinska M, Blondeel K, Toskin I, Mirandola M. Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities. Sex Transm Infect 2021; 97:534-540. [PMID: 33441447 DOI: 10.1136/sextrans-2020-054786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/09/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). METHODS The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. RESULTS 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01<CCC<0.62). CONCLUSION Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.
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Affiliation(s)
- Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jörg W Huber
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain - Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivailo Alexiev
- National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | | | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
| | | | - Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Magdalena Rosinska
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.,UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
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Msungama W, Menego G, Shaba F, Flowers N, Habel M, Bonongwe A, Banda M, Shire S, Maida A, Auld A, Phiri SJP, Dumbani K, Buono N, Luhanga M, Kapito M, Gibson H, Laube C, Toledo C, Kim E, Davis SM. Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services. Sex Transm Infect 2021; 97:345-350. [PMID: 33397801 PMCID: PMC8311083 DOI: 10.1136/sextrans-2020-054776] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Voluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More targeted interventions to reach older men and others at higher short-term HIV risk are needed. Methods We implemented a quality improvement project testing the effectiveness of an active referral-based VMMC recruitment approach, targeting men attending STI clinics and those escorting partners to antenatal care (ANC) clinics, at Bwaila Hospital in Lilongwe, Malawi. We compared the proportions aged older than 15 years among men who received VMMC following referral from STI and ANC clinics with those among men referred from standard community mobilisation. We also analysed referral cascades to VMMC. Results In total, 330 clients were circumcised after referral from STI (242) and ANC (88) clinics, as compared with 3839 other clients attributed to standard community mobilisation. All clients from ANC and STI clinics were aged over 15 years, as compared with 69% from standard community mobilisation. STI clinics had a higher conversion rate from counselling to VMMC than ANC (12% vs 9%) and a higher contribution to total circumcisions performed at the VMMC clinic (6% vs 2%). Conclusions Integrating VMMC recruitment and follow-up in STI and ANC clinics co-located with VMMC services can augment demand creation and targeting of men at risk of HIV, based on age and STI history. This approach can be replicated at least in similar health facilities with ANC and STI services in close proximity to VMMC service delivery.
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Affiliation(s)
- Wezi Msungama
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Frackson Shaba
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Nicole Flowers
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Habel
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Masford Banda
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Steven Shire
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Alice Maida
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew Auld
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Kayira Dumbani
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Nicole Buono
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Mishek Luhanga
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Martin Kapito
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Hannah Gibson
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Catey Laube
- HIV and Infectious Disease Unit, Jhpiego, Nairobi, Kenya
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Evelyn Kim
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Stephanie Marie Davis
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hwang AS, Dontchos BN, Dyer K, Murray J, Como JS, Horn DM. Targeted Inpatient Screening Mammogram Program to Reduce Disparities in Breast Cancer Screening Rates. Ann Fam Med 2021; 19:83. [PMID: 33431399 PMCID: PMC7800737 DOI: 10.1370/afm.2638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/27/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Andrew S. Hwang
- Corresponding author Andrew S. Hwang 100 Cambridge Street, 16 Floor Boston, MA 02114
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