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Wilkinson R, Byrne T, Cowden RG, Long KNG, Kuhn JH, Koh HK, Tsai J. First Decade of Supportive Services for Veteran Families Program and Homelessness, 2012-2022. Am J Public Health 2024; 114:610-618. [PMID: 38718339 PMCID: PMC11079843 DOI: 10.2105/ajph.2024.307625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
As homelessness remains an urgent public health crisis in the United States, specific programs in the US Department of Veterans Affairs (VA) system may serve as a roadmap for addressing it. We examine lessons learned from the first decade (2012-2022) of the Supportive Services for Veteran Families (SSVF) program, a cornerstone in the VA continuum of homeless services aimed at both preventing homelessness among those at risk and providing rapid rehousing for veterans and their families who are currently experiencing homelessness. Drawing on information from annual reports and other relevant literature, we have identified 3 themes of SSVF that emerged as features to comprehensively deliver support for homeless veterans and their families: (1) responsiveness and flexibility, (2) coordination and integration, and (3) social resource engagement. Using these strategies, SSVF reached nearly three quarters of a million veterans and their families in its first decade, thereby becoming one of the VA's most substantial programmatic efforts designed to address homelessness. We discuss how each feature might apply to addressing homelessness in the general population as well as future research directions. (Am J Public Health. 2024;114(6):610-618. https://doi.org/10.2105/AJPH.2024.307625).
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Affiliation(s)
- Renae Wilkinson
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Thomas Byrne
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Richard G Cowden
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Katelyn N G Long
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - John H Kuhn
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Howard K Koh
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Jack Tsai
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
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Nelson RE, Montgomery AE, Suo Y, Effiong A, Pettey W, Gelberg L, Kertesz SG, Tsai J, Byrne T. Temporary Financial Assistance for Housing Expenditures and Mortality and Suicide Outcomes Among US Veterans. J Gen Intern Med 2024; 39:587-595. [PMID: 37884831 PMCID: PMC10973310 DOI: 10.1007/s11606-023-08337-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/11/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION It is unclear whether interventions designed to increase housing stability can also lead to improved health outcomes such as reduced risk of death and suicide morbidity. The objective of this study was to estimate the potential impact of temporary financial assistance (TFA) for housing-related expenses from the US Department of Veterans Affairs (VA) on health outcomes including all-cause mortality, suicide attempt, and suicidal ideation. METHODS We conducted a retrospective national cohort study of Veterans who entered the VA Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the association between TFA and health outcomes using a multivariable Cox proportional hazards regression approach with inverse probability of treatment weighting. We conducted these analyses on our overall cohort as well as separately for those in the rapid re-housing (RRH) and homelessness prevention (HP) components of SSVF. Outcomes were all-cause mortality, suicide attempt, and suicidal ideation at 365 and 730 days following enrollment in SSVF. RESULTS Our analysis cohort consisted of 41,969 unique Veterans with a mean (SD) duration of 87.6 (57.4) days in the SSVF program. At 365 days following SSVF enrollment, TFA was associated with a decrease in the risk of all-cause mortality (HR: 0.696, p < 0.001) and suicidal ideation (HR: 0.788, p < 0.001). We found similar results at 730 days (HR: 0.811, p = 0.007 for all-cause mortality and HR: 0.881, p = 0.037 for suicidal ideation). These results were driven primarily by individuals enrolled in the RRH component of SSVF. We found no association between TFA and suicide attempts. CONCLUSION We find that providing housing-related financial assistance to individuals facing housing instability is associated with improvements in important health outcomes such as all-cause mortality and suicidal ideation. If causal, these results suggest that programs to provide housing assistance have positive spillover effects into other important aspects of individuals' lives.
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Affiliation(s)
- Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
- National Center On Homelessness among Veterans, Washington, DC, USA.
| | - Ann Elizabeth Montgomery
- National Center On Homelessness among Veterans, Washington, DC, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham VA Health Care System, Birmingham, AL, USA
| | - Ying Suo
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Atim Effiong
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Warren Pettey
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- National Center On Homelessness among Veterans, Washington, DC, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Stefan G Kertesz
- National Center On Homelessness among Veterans, Washington, DC, USA
- Birmingham VA Health Care System, Birmingham, AL, USA
- Heersink UAB School of Medicine, Birmingham, AL, USA
| | - Jack Tsai
- National Center On Homelessness among Veterans, Washington, DC, USA
- School of Public Health, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Thomas Byrne
- National Center On Homelessness among Veterans, Washington, DC, USA
- School of Social Work, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
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Chapman AB, Scharfstein DO, Montgomery AE, Byrne T, Suo Y, Effiong A, Velasquez T, Pettey W, Nelson RE. Using natural language processing to study homelessness longitudinally with electronic health record data subject to irregular observations. AMIA Annu Symp Proc 2024; 2023:894-903. [PMID: 38222404 PMCID: PMC10785905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
The Electronic Health Record (EHR) contains information about social determinants of health (SDoH) such as homelessness. Much of this information is contained in clinical notes and can be extracted using natural language processing (NLP). This data can provide valuable information for researchers and policymakers studying long-term housing outcomes for individuals with a history of homelessness. However, studying homelessness longitudinally in the EHR is challenging due to irregular observation times. In this work, we applied an NLP system to extract housing status for a cohort of patients in the US Department of Veterans Affairs (VA) over a three-year period. We then applied inverse intensity weighting to adjust for the irregularity of observations, which was used generalized estimating equations to estimate the probability of unstable housing each day after entering a VA housing assistance program. Our methods generate unique insights into the long-term outcomes of individuals with a history of homelessness and demonstrate the potential for using EHR data for research and policymaking.
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Affiliation(s)
- Alec B Chapman
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Daniel O Scharfstein
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Thomas Byrne
- National Center on Homelessness among Veterans
- School of Social Work, Boston University, Boston, MA
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA
| | - Ying Suo
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Atim Effiong
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Tania Velasquez
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Warren Pettey
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
- National Center on Homelessness among Veterans
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Richardson SAC, Anderson D, Burrell AJC, Byrne T, Coull J, Diehl A, Gantner D, Hoffman K, Hooper A, Hopkins S, Ihle J, Joyce P, Le Guen M, Mahony E, McGloughlin S, Nehme Z, Nickson CP, Nixon P, Orosz J, Riley B, Sheldrake J, Stub D, Thornton M, Udy A, Pellegrino V, Bernard S. Pre-hospital ECPR in an Australian metropolitan setting: a single-arm feasibility assessment-The CPR, pre-hospital ECPR and early reperfusion (CHEER3) study. Scand J Trauma Resusc Emerg Med 2023; 31:100. [PMID: 38093335 PMCID: PMC10717258 DOI: 10.1186/s13049-023-01163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia. METHODS This was a single jurisdiction, single-arm feasibility study. Physicians, with pre-existing ECMO expertise, responded to witnessed OHCA, age < 65 yrs, within 30 min driving-time, using an ECMO equipped rapid response vehicle. If pre-hospital ECPR was undertaken, patients were transported to hospital for investigations and therapies including emergent coronary catheterisation, and standard intensive care (ICU) therapy until either cardiac and neurological recovery or palliation occurred. Analyses were descriptive. RESULTS From February 2020 to May 2023, over 117 days, the team responded to 709 "potential cardiac arrest" emergency calls. 358 were confirmed OHCA. Time from emergency call to scene arrival was 27 min (15-37 min). 10 patients fulfilled the pre-defined inclusion criteria and all were successfully cannulated on scene. Time from emergency call to ECMO initiation was 50 min (35-62 min). Time from decision to ECMO support was 16 min (11-26 min). CPR duration was 46 min (32-62 min). All 10 patients were transferred to hospital for investigations and therapy. 4 patients (40%) survived to hospital discharge neurologically intact (CPC 1/2). CONCLUSION Pre-hospital ECPR was feasible, using an experienced ECMO team from a single-centre. Overall survival was promising in this highly selected group. Further prospective studies are now warranted.
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Affiliation(s)
- S A C Richardson
- The Alfred Hospital, Melbourne, Australia.
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - D Anderson
- The Alfred Hospital, Melbourne, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - A J C Burrell
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - T Byrne
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Coull
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Diehl
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D Gantner
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - K Hoffman
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Hooper
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Hopkins
- Ambulance Victoria, Melbourne, Australia
| | - J Ihle
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P Joyce
- The Alfred Hospital, Melbourne, Australia
| | - M Le Guen
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - E Mahony
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S McGloughlin
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C P Nickson
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P Nixon
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Orosz
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - B Riley
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - D Stub
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M Thornton
- Ambulance Victoria, Melbourne, Australia
| | - A Udy
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - V Pellegrino
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Bernard
- The Alfred Hospital, Melbourne, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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de Siqueira IC, de Almeida BL, Lage MLC, Serra L, Carvalho A, de Lima MM, Góes MDFN, Crispim MDSIN, da Costa Pereira MM, Costa BGG, Bailey H, Byrne T, Giaquinto C, Fernandes G, Ruiz-Burga E, Thorne C. Perinatal characteristics and longer-term outcomes in Brazilian children with confirmed or suspected congenital Zika infection: ZIKAction Paediatric Registry. Dialogues Health 2023; 2:100104. [PMID: 38515475 PMCID: PMC10953907 DOI: 10.1016/j.dialog.2023.100104] [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] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 03/23/2024]
Abstract
Background Despite growing scientific knowledge of Zika virus (ZIKV) infection, questions remain regarding ZIKV infection in pregnancy and congenital ZIKV syndrome (CZS). Methods The ZIKAction Paediatric Registry is an international registry of children with documented ZIKV exposure in utero and/or with confirmed or suspected CZS. Its aim is to characterize these children (i.e., clinical, radiological, neurodevelopmental features) and describe outcomes, longer-term sequelae and management through retrospective case note review. This analysis described the maternal and perinatal characteristics of children in the Registry's Bahia arm, assessed their neuroimaging, ophthalmic, hearing and electroencephalography abnormalities by microcephaly classification and reported on hospitalisations. Children born in 2015-2018 and enrolled 2020-2021 in three public health facilities in Salvador were included. Results Of 129 (57% female) children, 15 (11·6%) had laboratory-confirmed congenital ZIKV infection and 114 (88·4%) suspected CZS. At delivery, 15 (11·6%) were normocephalic, 30 (23·3%) moderately microcephalic, and 84 (65·1%) severely microcephalic. Median birth head circumference z-score was -3·51 [IQR, -4·69,-2·73]. During follow-up, all children had abnormal neuroimaging, 80·3% (94/117) abnormal electroencephalogram, 62·2% (77/120) ophthalmic abnormalities, and 27·4% (34/124) hearing impairment. Microcephaly classification was significantly associated with gestational age, and ophthalmological and electroencephalography abnormalities. Of 125 children with hospitalisation data, 52 (41·6%) had been hospitalised by most recent follow-up, at median age of 15·8 [4·0, 34·4] months; infections were the leading cause. Conclusion Congenital ZIKV infection is an emerging disease with a varied and incompletely understood spectrum. Continued long-term follow-up is essential to understand longer-term prognosis and to inform future health and educational needs.
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Affiliation(s)
| | - Breno Lima de Almeida
- Instituto Gonçalo Moniz-Fiocruz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil
| | - Maria Lucia Costa Lage
- Instituto Gonçalo Moniz-Fiocruz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil
| | - Leticia Serra
- Centro de Prevenção e Reabilitação da Pessoa com Deficiência – Cepred, Av. Antônio Carlos Magalhães, S/N, Parque Bela Vista, 40279-700 Salvador, BA, Brazil
| | - Alessandra Carvalho
- Rede SARAH de Hospitais de Reabilitação, Av. Tancredo Neves, 2782 - Caminho das Árvores, 41820-900 Salvador, BA, Brazil
| | - Maricélia Maia de Lima
- Universidade Estadual de Feira de Santana, Avenida Transnordestina, s/n - Novo Horizonte, 44036-900 Feira de Santana, BA, Brazil
| | | | | | | | | | - Heather Bailey
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Capper street, London WC1 6JB, UK
| | - Thomas Byrne
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Georgina Fernandes
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Elisa Ruiz-Burga
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Capper street, London WC1 6JB, UK
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
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Cusack M, Montgomery AE, Byrne T. Examining the Intersection of Housing Instability and Violence Among LGBTQ Adults. J Homosex 2023; 70:2943-2954. [PMID: 35700390 DOI: 10.1080/00918369.2022.2085936] [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: 06/15/2023]
Abstract
To assess the relationship between LGBTQ status and (1) current, recent, and lifetime experiences of housing instability, (2) risk of housing instability due to fears of interpersonal violence, and (3) perceived housing challenges, this study examined online survey data from individuals with a household income <$35,000 (N = 1,270). Analyses compared LGBTQ and cisgender heterosexual respondents using chi-square tests and logistic regression. Over their lifetime, LGBTQ respondents had increased odds of sleeping outdoors (adjusted odds ratios [AOR] = 1.580) or in a car (AOR = 1.465) because they had nowhere else to stay. They also had increased odds of reporting housing challenges related to violence from family/friends (AOR = 3.278), substance abuse (AOR = 3.063), and mental health (AOR = 2.048). Interventions serving LGBTQ adults should prioritize safety concerns and consider providing services to both individuals and families. In addition, providers should increase sensitivity toward issues of sexual orientation and gender identity and the unique needs of LGBTQ adults.
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Affiliation(s)
- Meagan Cusack
- U.S. Department of Veterans Affairs, Center for Health Equility Research & Promotion, Philadelphia, Pennsylvania, USA
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Thomas Byrne
- U.S. Department of Veterans Affairs, Center for Healthcare Outcomes & Implementation Research, Bedford, Massachusetts, USA
- School of Social Work, Boston University, Boston, Massachusetts, USA
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Byrne T, Kovar J, Beale S, Braithwaite I, Fragaszy E, Fong WLE, Geismar C, Hoskins S, Navaratnam AMD, Nguyen V, Patel P, Shrotri M, Yavlinsky A, Hardelid P, Wijlaars L, Nastouli E, Spyer M, Aryee A, Cox I, Lampos V, Mckendry RA, Cheng T, Johnson AM, Michie S, Gibbs J, Gilson R, Rodger A, Abubakar I, Hayward A, Aldridge RW. Cohort Profile: Virus Watch-understanding community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviour. Int J Epidemiol 2023; 52:e263-e272. [PMID: 37349899 PMCID: PMC10555858 DOI: 10.1093/ije/dyad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Ellen Fragaszy
- Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Pia Hardelid
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Linda Wijlaars
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eleni Nastouli
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Francis Crick Institute, London, UK
- University College London Hospital, London, UK
| | | | - Anna Aryee
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Ingemar Cox
- Department of Computer Science, University College London, London, UK
| | - Vasileios Lampos
- Department of Computer Science, University College London, London, UK
| | - Rachel A Mckendry
- London Centre for Nanotechnology and Division of Medicine, University College London, London, UK
| | - Tao Cheng
- SpaceTimeLab, Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
| | - Anne M Johnson
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
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8
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Hoskins S, Beale S, Nguyen V, Boukari Y, Yavlinsky A, Kovar J, Byrne T, Fong WLE, Geismar C, Patel P, Johnson AM, Aldridge RW, Hayward A. Deprivation, essential and non-essential activities and SARS-CoV-2 infection following the lifting of national public health restrictions in England and Wales. NIHR Open Res 2023; 3:46. [PMID: 37994319 PMCID: PMC10663878 DOI: 10.3310/nihropenres.13445.1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 11/24/2023]
Abstract
Background Individuals living in deprived areas in England and Wales undertook essential activities more frequently and experienced higher rates of SARS-CoV-2 infection than less deprived communities during periods of restrictions aimed at controlling the Alpha (B.1.1.7) variant. We aimed to understand whether these deprivation-related differences changed once restrictions were lifted. Methods Among 11,231 adult Virus Watch Community Cohort Study participants multivariable logistic regressions were used to estimate the relationships between deprivation and self-reported activities and deprivation and infection (self-reported lateral flow or PCR tests and linkage to National Testing data and Second Generation Surveillance System (SGSS)) between August - December 2021, following the lifting of national public health restrictions. Results Those living in areas of greatest deprivation were more likely to undertake essential activities (leaving home for work (aOR 1.56 (1.33 - 1.83)), using public transport (aOR 1.33 (1.13 - 1.57)) but less likely to undertake non-essential activities (indoor hospitality (aOR 0.82 (0.70 - 0.96)), outdoor hospitality (aOR 0.56 (0.48 - 0.66)), indoor leisure (aOR 0.63 (0.54 - 0.74)), outdoor leisure (aOR 0.64 (0.46 - 0.88)), or visit a hairdresser (aOR 0.72 (0.61 - 0.85))). No statistical association was observed between deprivation and infection (P=0.5745), with those living in areas of greatest deprivation no more likely to become infected with SARS-CoV-2 (aOR 1.25 (0.87 - 1.79). Conclusion The lack of association between deprivation and infection is likely due to the increased engagement in non-essential activities among the least deprived balancing the increased work-related exposure among the most deprived. The differences in activities highlight stark disparities in an individuals' ability to choose how to limit infection exposure.
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Affiliation(s)
- Susan Hoskins
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Sarah Beale
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, England, WC1N 1EH, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
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9
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DeRussy A, Byrne T, Nelson R, Richman J, Montgomery AE. Change in Homeless and Health Services Use Following Migration Among Veterans with Experience of Homelessness. J Gen Intern Med 2023; 38:2655-2661. [PMID: 37037985 PMCID: PMC10506970 DOI: 10.1007/s11606-023-08127-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Homelessness is associated with poor health outcomes, including lack of access to care. Homelessness experienced in rural areas is understudied but likely associated with difficulty accessing needed services. Prior studies have assessed the extent to which Veterans experiencing homelessness in rural areas "migrate" to urban areas, but have not focused on changes in services utilization following migration. OBJECTIVE To determine whether Veterans with a history of homelessness experience changes in the use of homeless and health services following a migration from a rural to urban residence, and vice versa, and to assess the magnitude of those changes. DESIGN Longitudinal retrospective analysis of services use among Veterans identified as experiencing homelessness and migrating at least 40 miles or from an urban to a rural area or vice versa. PARTICIPANTS A total of 81,620 Veterans with incident homelessness who experienced a migration and for whom we could establish 2 quarters of both pre-migration and post-migration service utilization. MAIN MEASURES In addition to sociodemographic and health-related factors, we assessed index location and destination using geographic descriptors both residential address and Veteran Affairs (VA) facility where Veterans were identified as experiencing homelessness. Outcomes included continuous measures of homeless services and outpatient care and dichotomous measures of emergency department use and inpatient admissions. KEY RESULTS Regardless of a Veteran's index location, migration to or within a rural area was associated with a significant decrease in the number of homeless and outpatient services and reduced risk of emergency department use or inpatient admission relative to migration to or within an urban area. CONCLUSION Controlling for sociodemographic and health-related factors, Veterans experiencing homelessness who had a residential migration to or within a rural area had a significant reduction in their use of VA health and homeless services compared to those who migrated to or within an urban area.
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Affiliation(s)
- Aerin DeRussy
- US Department of Veterans Affairs (VA), Birmingham VA Health Care System, Birmingham, AL, USA
| | - Thomas Byrne
- VA Bedford Health Care System, Bedford, MA, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Richard Nelson
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Joshua Richman
- US Department of Veterans Affairs (VA), Birmingham VA Health Care System, Birmingham, AL, USA
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- US Department of Veterans Affairs (VA), Birmingham VA Health Care System, Birmingham, AL, USA.
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
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10
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Condren J, Byrne T, Watts A. Seven years of SimWars - Reflecting on the educational value of competitive simulation training. Ir Med J 2023; 116:821. [PMID: 37606533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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11
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Byrne T, Miller DP, Thomas MMC. Impact of the monetary value of housing assistance on adult health outcomes. Health Serv Res 2023. [PMID: 37248792 DOI: 10.1111/1475-6773.14174] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To assess the impact of the dollar value of federal low-income housing assistance on adult health outcomes and whether this impact varies across housing assistance programs. DATA SOURCES We use the National Health Interview Survey (NHIS) from 1999 to 2016 linked with administrative records from the Department of Housing and Urban Development (HUD) tracking receipt of low-income housing assistance from 1999 to 2017. DESIGN We use two approaches to assess the impact of the value of housing assistance among HUD housing assistance recipients on outcomes capturing overall health and mental health, chronic and acute health conditions, health care hardship, and food insecurity. First, we use multivariable regression models that adjust for a wide array of possible confounders. Second, we use an instrumental variable approach in which the county-level supply of HUD housing serves as an instrument for the value of housing assistance. DATA COLLECTION/EXTRACTION METHODS Our sample includes all 12,031 adult HUD linkage-eligible NHIS respondents who were currently in HUD housing at the time of their NHIS interview. PRINCIPAL FINDINGS We find the most consistent associations between the value of housing assistance and measures of health care hardship, a relationship that is most robust for Housing Choice Voucher recipients, where we find a $100 increase in the value of housing assistance is associated with a 6.2 percentage point decrease in probability of needing but not being able to afford medical care. We find little evidence that the value of housing assistance impacts overall health or chronic health outcomes. CONCLUSIONS The relationship between the value of housing assistance and health likely operates via an income effect, wherein receipt of a more valuable benefit frees up resources to spend on needed care. Policy changes to increase the value of housing assistance may have tangible health benefits for tenants receiving housing assistance.
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Affiliation(s)
- Thomas Byrne
- Boston University School of Social Work, Boston, Massachusetts, USA
| | - Daniel P Miller
- Boston University School of Social Work, Boston, Massachusetts, USA
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12
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Byrne T, Cooke J, Bambrick P, McNeela E, Harrison M. Circulating inflammatory biomarker responses in intervention trials in frail and sarcopenic older adults: A systematic review and meta-analysis. Exp Gerontol 2023; 177:112199. [PMID: 37156445 DOI: 10.1016/j.exger.2023.112199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/15/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Consistent with the inflammaging concept, cross-sectional associations have been established between inflammatory biomarkers, frailty and sarcopenia. Less certain is the value of inflammatory markers in monitoring potential anti-inflammatory effects of therapeutic interventions targeted at frailty and sarcopenia. The aims of this systematic review and meta-analysis are to determine if there is a measurable change in inflammatory or immune biomarkers in interventions that improve frailty or sarcopenia and 2. To determine if there are specific inflammatory biomarkers with greater sensitivity to change. In total, 3051 articles were scanned with 16, primarily exercise and nutrition interventions, included in the systematic review and 11 in the meta-analysis. At least one of C reactive protein (CRP), interleukin-6 (IL-6) or tumour necrosis factor alpha (TNF-α) was reduced in 10 of the 16 review studies but only 3/13 studies reported reductions in multiple markers. CRP, IL-6 and TNF-α were individually sensitive to change in 5/11, 3/12 and 5/12 studies respectively. In meta-analyses, there was a positive effect favouring intervention conditions for CRP (SMD = -0.28, p = 0.05) and IL-6 (SMD = -0.28, p = 0.05) but not TNF- α (SMD = -0.12, p = 0.48). There were specific issues with the quality of these studies which were not designed with an inflammatory marker as the primary outcome. In conclusion, interventions that improve frailty and sarcopenia can also reduce CRP, IL-6 and TNF-α but the literature lacks consistency. We are unable to conclude any one marker as being superior to others.
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Affiliation(s)
- Thomas Byrne
- Department of Science, Pharmaceutical and Molecular Biotechnology Research Centre, South East Technological University, Waterford, Ireland
| | - John Cooke
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland; Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Padraig Bambrick
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | - Edel McNeela
- Department of Science, Pharmaceutical and Molecular Biotechnology Research Centre, South East Technological University, Waterford, Ireland
| | - Michael Harrison
- Department of Sport and Exercise Science, Pharmaceutical and Molecular Biotechnology Research Centre, South East Technological University, Waterford, Ireland.
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13
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Affiliation(s)
- Jack Tsai
- Both authors are with the US Department of Veterans Affairs National Center on Homelessness Among Veterans, Washington, DC. Jack Tsai is also with the School of Public Health, University of Texas Health Science Center at Houston. Tom Byrne is also with the School of Social Work, Boston University, Boston, MA
| | - Thomas Byrne
- Both authors are with the US Department of Veterans Affairs National Center on Homelessness Among Veterans, Washington, DC. Jack Tsai is also with the School of Public Health, University of Texas Health Science Center at Houston. Tom Byrne is also with the School of Social Work, Boston University, Boston, MA
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14
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Beale S, Yavlinsky A, Hoskins S, Nguyen V, Byrne T, Fong WLE, Kovar J, Van Tongeren M, Aldridge RW, Hayward A. Between-occupation differences in work-related COVID-19 mitigation strategies over time: Analysis of the Virus Watch Cohort in England and Wales. Scand J Work Environ Health 2023:4092. [PMID: 37066842 DOI: 10.5271/sjweh.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES COVID-19 mitigations have had a profound impact on workplaces, however, multisectoral comparisons of how work-related mitigations were applied are limited. This study aimed to investigate (i) occupational differences in the usage of key work-related mitigations over time and (ii) workers' perceptions of these mitigations. METHODS Employed/self-employed Virus Watch study participants (N=6279) responded to a mitigation-related online survey covering the periods of December 2020-February 2022. Logistic regression was used to investigate occupation- and time-related differences in the usage of work-related mitigation methods. Participants' perceptions of mitigation methods were investigated descriptively using proportions. RESULTS Usage of work-related mitigation methods differed between occupations and over time, likely reflecting variation in job roles, workplace environments, legislation and guidance. Healthcare workers had the highest predicted probabilities for several mitigations, including reporting frequent hand hygiene [predicted probability across all survey periods 0.61 (95% CI 0.56-0.66)] and always wearing face coverings [predicted probability range 0.71 (95% CI 0.66-0.75) - 0.80 (95% CI 0.76-0.84) across survey periods]. There were significant cross-occupational trends towards reduced mitigations during periods of less stringent national restrictions. The majority of participants across occupations (55-88%) agreed that most mitigations were reasonable and worthwhile even after the relaxation of national restrictions; agreement was lower for physical distancing (39-44%). CONCLUSIONS While usage of work-related mitigations appeared to vary alongside stringency of national restrictions, agreement that most mitigations were reasonable and worthwhile remained substantial. Further investigation into the factors underlying between-occupational differences could assist pandemic planning and prevention of workplace COVID-19 transmission.
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Affiliation(s)
- Sarah Beale
- Institute of Epidemiology and Health Care, University College London, London, UK, WC1E 7HB.
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15
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Beale S, Hoskins S, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam AMD, Nguyen V, Patel P, Yavlinsky A, Johnson AM, Van Tongeren M, Aldridge RW, Hayward A. Differential Risk of SARS-CoV-2 Infection by Occupation: Evidence from the Virus Watch prospective cohort study in England and Wales. J Occup Med Toxicol 2023; 18:5. [PMID: 37013634 PMCID: PMC10068189 DOI: 10.1186/s12995-023-00371-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Workers across different occupations vary in their risk of SARS-CoV-2 infection, but the direct contribution of occupation to this relationship is unclear. This study aimed to investigate how infection risk differed across occupational groups in England and Wales up to April 2022, after adjustment for potential confounding and stratification by pandemic phase. METHODS Data from 15,190 employed/self-employed participants in the Virus Watch prospective cohort study were used to generate risk ratios for virologically- or serologically-confirmed SARS-CoV-2 infection using robust Poisson regression, adjusting for socio-demographic and health-related factors and non-work public activities. We calculated attributable fractions (AF) amongst the exposed for belonging to each occupational group based on adjusted risk ratios (aRR). RESULTS Increased risk was seen in nurses (aRR = 1.44, 1.25-1.65; AF = 30%, 20-39%), doctors (aRR = 1.33, 1.08-1.65; AF = 25%, 7-39%), carers (1.45, 1.19-1.76; AF = 31%, 16-43%), primary school teachers (aRR = 1.67, 1.42- 1.96; AF = 40%, 30-49%), secondary school teachers (aRR = 1.48, 1.26-1.72; AF = 32%, 21-42%), and teaching support occupations (aRR = 1.42, 1.23-1.64; AF = 29%, 18-39%) compared to office-based professional occupations. Differential risk was apparent in the earlier phases (Feb 2020-May 2021) and attenuated later (June-October 2021) for most groups, although teachers and teaching support workers demonstrated persistently elevated risk across waves. CONCLUSIONS Occupational differences in SARS-CoV-2 infection risk vary over time and are robust to adjustment for socio-demographic, health-related, and non-workplace activity-related potential confounders. Direct investigation into workplace factors underlying elevated risk and how these change over time is needed to inform occupational health interventions.
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Affiliation(s)
- Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK.
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK.
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London, School of Hygiene and Tropical Medicine , Keppel Street, London, WC1E 7HT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Martie Van Tongeren
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
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16
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Byrne T, Montgomery AE, Chapman AB, Pettey W, Effiong A, Suo Y, Velasquez T, Nelson RE. Predictors of homeless service utilization and stable housing status among Veterans receiving services from a nationwide homelessness prevention and rapid rehousing program. Eval Program Plann 2023; 97:102223. [PMID: 36587433 DOI: 10.1016/j.evalprogplan.2022.102223] [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: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Homelessness prevention and rapid rehousing (RRH) programs are increasingly important components of the homeless assistance system in the United States. Yet, there are key gaps in knowledge about the dynamics of the utilization of these programs, with scant attention paid to examining the duration of homelessness prevention and RRH service episodes or to patterns of repeated use of these programs over time. To address these gaps, we use data from the U.S. Department of Veterans Affairs' (VA) Supportive Services for Veteran Families (SSVF) program-the largest program in the country providing homelessness prevention and RRH services-to assess the relationship between individual and program-level factors and exits to stable housing, length of service episodes, and patterns of repeated service use over time. We analyze data for a primary cohort of 570,798 of Veterans who received SSVF services during Fiscal Years (FY) 2012-2021, and for separate cohorts of Veterans who received SSVF prevention and RRH services, respectively, during FY 2016-2021. We find that participants' income, indicators of their health status, their use of other VA homeless programs, and rurality are consistent predictors of our outcomes. These findings have implications for how to allocate homelessness prevention and RRH resources in the most efficient manner to help households maintain or obtain stable housing.
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Affiliation(s)
- Thomas Byrne
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, United States; Boston University School of Social Work, United States; US Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, United States.
| | - Ann Elizabeth Montgomery
- US Department of Veterans Affairs, Birmingham VA Health Care System, United States; University of Alabama at Birmingham, School of Public Health, United States
| | - Alec B Chapman
- IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States; Division of Epidemiology, University of Utah School of Medicine, United States; Department of Population Health Sciences, University of Utah School of Medicine, United States
| | - Warren Pettey
- IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States; Division of Epidemiology, University of Utah School of Medicine, United States
| | - Atim Effiong
- IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States; Division of Epidemiology, University of Utah School of Medicine, United States
| | - Ying Suo
- IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States; Division of Epidemiology, University of Utah School of Medicine, United States
| | - Tania Velasquez
- IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States
| | - Richard E Nelson
- US Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, United States; IDEAS 2.0 COIN, VA Salt Lake City Health Care System, United States; Division of Epidemiology, University of Utah School of Medicine, United States
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Wilke ABB, Damian D, Litvinova M, Byrne T, Zardini A, Poletti P, Merler S, Mutebi JP, Townsend J, Ajelli M. Spatiotemporal distribution of vector mosquito species and areas at risk for arbovirus transmission in Maricopa County, Arizona. Acta Trop 2023; 240:106833. [PMID: 36736524 DOI: 10.1016/j.actatropica.2023.106833] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Mosquito-borne diseases are a major global public health concern and mosquito surveillance systems are essential for the implementation of effective mosquito control strategies. The objective of our study is to determine the spatiotemporal distribution of vector mosquito species in Maricopa County, AZ from 2011 to 2021, and to identify the hotspot areas for West Nile virus (WNV) and St. Louis Encephalitis virus (SLEV) transmission in 2021. The Maricopa County Mosquito Control surveillance system utilizes BG-Sentinel and EVS-CDC traps throughout the entire urban and suburban areas of the county. We estimated specific mosquito species relative abundance per unit area using the Kernel density estimator in ArcGIS 10.2. We calculated the distance between all traps in the surveillance system and created a 4 km buffer radius around each trap to calculate the extent to which each trap deviated from the mean number of Culex quinquefasciatus and Culex tarsalis collected in 2021. Our results show that vector mosquito species are widely distributed and abundant in the urban areas of Maricopa County. A total of 691,170Cx. quinquefasciatus, 542,733 Cx. tarsalis, and 292,305 Aedes aegypti were collected from 2011 to 2022. The relative abundance of Ae. aegypti was highly seasonal peaking in the third and fourth quarters of the year. Culex quinquefasciatus, on the other hand, was abundant throughout the year with several regions consistently yielding high numbers of mosquitoes. Culex tarsalis was abundant but it only reached high numbers in well-defined areas near irrigated landscapes. We also detected high levels of heterogeneity in the risk of WNV and SLEV transmission to humans disregarding traps geographical proximity. The well-defined species-specific spatiotemporal and geographical patterns found in this study can be used to inform vector control operations.
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Affiliation(s)
- André B B Wilke
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Dan Damian
- Maricopa County Environmental Services, Department Vector Control Division, Phoenix, AZ, USA
| | - Maria Litvinova
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; Boston University School of Social Work, Boston, MA, USA
| | - Agnese Zardini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - John-Paul Mutebi
- Arboviral Diseases Branch (ADB), Division of Vector-Borne Diseases (DVBD), Centers for Disease Control and Prevention (CDC), Fort Collins, CO, USA
| | - John Townsend
- Maricopa County Environmental Services, Department Vector Control Division, Phoenix, AZ, USA
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA.
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18
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Nguyen V, Liu Y, Mumford R, Flanagan B, Patel P, Braithwaite I, Shrotri M, Byrne T, Beale S, Aryee A, Fong WLE, Fragaszy E, Geismar C, Navaratnam AMD, Hardelid P, Kovar J, Pope A, Cheng T, Hayward A, Aldridge R. Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study. JMIR Public Health Surveill 2023; 9:e38072. [PMID: 36884272 PMCID: PMC9997704 DOI: 10.2196/38072] [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: 03/17/2022] [Revised: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. OBJECTIVE We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. METHODS Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. RESULTS We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI -50.08 to -31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI -19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. CONCLUSIONS Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period.
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Affiliation(s)
- Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Yunzhe Liu
- SpaceTimeLab, Department of Civil, Environmental and Geomatic Engineering, University College London, London, United Kingdom
| | - Richard Mumford
- Technical Research Department, Esri, Edinburgh, United Kingdom
| | | | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Anna Aryee
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Pia Hardelid
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Addy Pope
- Technical Research Department, Esri, Edinburgh, United Kingdom
| | - Tao Cheng
- SpaceTimeLab, Department of Civil, Environmental and Geomatic Engineering, University College London, London, United Kingdom
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Robert Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
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Blonigen D, Hyde J, McInnes DK, Yoon J, Byrne T, Ngo T, Smelson D. Integrating data analytics, peer support, and whole health coaching to improve the health outcomes of homeless veterans: Study protocol for an effectiveness-implementation trial. Contemp Clin Trials 2023; 125:107065. [PMID: 36572239 DOI: 10.1016/j.cct.2022.107065] [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: 09/26/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Homelessness is a strong determinant of acute care service utilization (inpatient hospitalization, emergency department visits) among US adults. Data analytics, peer support, and patient-centered approaches can collectively offer high-quality care for homeless patients who frequently utilize acute care ("super utilizers"). However, few outpatient programs have integrated these components and tested their effectiveness for this patient population. OBJECTIVE To test the effectiveness and implementation potential of a novel intervention that integrates data analytics with peers trained in whole health coaching ("Peer Whole Health") to reduce use of acute care among homeless adults. METHODS Using a randomized controlled trial design at two US Veterans Health Administration Medical Centers, we plan to enroll 220 veterans in primary care on VHA's Homeless Registry who are flagged on a super-utilizer clinical dashboard. Participants will complete a baseline interview, be randomized to Enhanced Usual Care (EUC; primary care and data analytics) or EUC plus 18 sessions of Peer Whole Health over 6 months, and be re-interviewed at 3, 6, and 9 months. Qualitative interviews with primary care staff and patients will identify facilitators and barriers to more widespread implementation of the intervention. DISCUSSION The primary hypothesis is that those who receive the intervention will have fewer total days of all-cause hospitalization. If confirmed, the findings can provide healthcare systems that serve homeless super-utilizers with a high-value approach to care that can be integrated into primary care services and reduce overall costs for these patients. CLINICAL TRIAL REGISTRATION The study is registered with ClinicalTrials.gov (NCT05176977).
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Affiliation(s)
- Daniel Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Justeen Hyde
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - D Keith McInnes
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jean Yoon
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas Byrne
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA
| | - Tu Ngo
- VA Bedford HealthCare System, Bedford, MA, USA
| | - David Smelson
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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20
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Serisier A, Beale S, Boukari Y, Hoskins S, Nguyen V, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Yavlinsky A, Hayward A, Aldridge RW. A case-crossover study of the effect of vaccination on SARS-CoV-2 transmission relevant behaviours during a period of national lockdown in England and Wales. Vaccine 2023; 41:511-518. [PMID: 36496282 PMCID: PMC9721283 DOI: 10.1016/j.vaccine.2022.11.073] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies of COVID-19 vaccine effectiveness show increases in COVID-19 cases within 14 days of a first dose, potentially reflecting post-vaccination behaviour changes associated with SARS-CoV-2 transmission before vaccine protection. However, direct evidence for a relationship between vaccination and behaviour is lacking. We aimed to examine the association between vaccination status and self-reported non-household contacts and non-essential activities during a national lockdown in England and Wales. METHODS Participants (n = 1154) who had received the first dose of a COVID-19 vaccine reported non-household contacts and non-essential activities from February to March 2021 in monthly surveys during a national lockdown in England and Wales. We used a case-crossover study design and conditional logistic regression to examine the association between vaccination status (pre-vaccination vs 14 days post-vaccination) and self-reported contacts and activities within individuals. Stratified subgroup analyses examined potential effect heterogeneity by sociodemographic characteristics such as sex, household income or age group. RESULTS 457/1154 (39.60 %) participants reported non-household contacts post-vaccination compared with 371/1154 (32.15 %) participants pre-vaccination. 100/1154 (8.67 %) participants reported use of non-essential shops or services post-vaccination compared with 74/1154 (6.41 %) participants pre-vaccination. Post-vaccination status was associated with increased odds of reporting non-household contacts (OR 1.65, 95 % CI 1.31-2.06, p < 0.001) and use of non-essential shops or services (OR 1.50, 95 % CI 1.03-2.17, p = 0.032). This effect varied between men and women and different age groups. CONCLUSION Participants had higher odds of reporting non-household contacts and use of non-essential shops or services within 14 days of their first COVID-19 vaccine compared to pre-vaccination. Public health emphasis on maintaining protective behaviours during this post-vaccination time period when individuals have yet to develop full protection from vaccination could reduce risk of SARS-CoV-2 infection.
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Affiliation(s)
- Aimee Serisier
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Sarah Beale
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK.
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Vincent Nguyen
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
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21
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Flike K, Byrne T. Systematic review of access to healthcare and social services among US women Veterans experiencing homelessness. Womens Health (Lond) 2023; 19:17455057231189550. [PMID: 37522527 PMCID: PMC10392165 DOI: 10.1177/17455057231189550] [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: 02/13/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Studies suggest female Veterans are under-identified as homeless in the VA healthcare system, which may impact their ability to access necessary services. In addition, the increasing number of female Veterans experiencing homelessness requires a better understanding of their access to necessary healthcare and social care. OBJECTIVES The purpose of this systematic review was to examine the barriers and facilitators for access to healthcare and social care among women Veterans experiencing homelessness. DESIGN A mixed methods systematic review was conducted and includes quantitative and qualitative primary research studies. DATA SOURCES AND METHODS Seven databases were searched for quantitative or qualitative research studies. Studies which addressed access or use of healthcare or social services, which were focused on female Veterans or allowed for comparison between male and female Veterans were included. Data were synthesized using a convergent integrated approach. RESULTS Thirty-five studies met inclusion criteria; 27 quantitative, 6 qualitative and 2 mixed methods studies. Three main themes resulted: (1) the comparison of access and use of healthcare and social services between women and men; (2) female specific barriers to access or use of social and health services; (3) female specific facilitators to access or use of social and health services. CONCLUSIONS Results showed although women Veterans had similar or better outcomes with permanent housing programming compared to men, gaps remain in the provision of emergency and short-term housing accommodations. In addition, many studies found that homeless women Veterans were unaware of the healthcare and social services available through the VA. Programs and policies need to ensure they are maximizing their reach to women Veterans experiencing homelessness by providing outreach and education, so they understand the benefits available when they discharge from the military and to understand the unique healthcare and social needs of women Veterans.
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Affiliation(s)
- Kimberlee Flike
- Center for Health Care Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
| | - Thomas Byrne
- Center for Health Care Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
- School of Social Work, Boston University, Boston, MA, USA
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22
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Bruzios KE, Shaffer PM, Byrne T, Pinals DA, Trojano M, Pressman K, Smelson D. Examining Perceived Coercion in Drug Treatment Courts. Int J Offender Ther Comp Criminol 2023; 67:53-65. [PMID: 35670193 DOI: 10.1177/0306624x221102838] [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: 06/15/2023]
Abstract
While perceptions of voluntary consent have been studied among participants in Mental Health Courts (MHC), little is known about coercion among participants in Drug Treatment Courts (DTC), the most common type of specialty court. The purpose of the present study was to examine perceptions of coercion at enrollment among participants (N = 85) in two Massachusetts DTCs. Results indicated that, on average, participants reported low levels of perceived coercion (M = 1.67, SD = 1.23), which suggests that most individuals did not perceive their decision to enroll in DTC to be coercive. However, further research is needed to delineate whether clinical or procedural variations exist within DTCs, if levels of perceived coercion predict DTC participant outcomes, and if subpopulations experience higher or lower levels of coercion.
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Affiliation(s)
- Kathryn E Bruzios
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Paige M Shaffer
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Thomas Byrne
- VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of School of Social Work, MA, USA
| | - Debra A Pinals
- University of Massachusetts Medical School, Worcester, USA
| | - Max Trojano
- Pennsylvania State University College of Medicine, Hershey, USA
| | | | - David Smelson
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
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23
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Beale S, Burns R, Braithwaite I, Byrne T, Lam Erica Fong W, Fragaszy E, Geismar C, Hoskins S, Kovar J, Navaratnam AMD, Nguyen V, Patel P, Yavlinsky A, Van Tongeren M, Aldridge RW, Hayward A. Occupation, Worker Vulnerability, and COVID-19 Vaccination Uptake: Analysis of the Virus Watch prospective cohort study. Vaccine 2022; 40:7646-7652. [PMID: 36372668 PMCID: PMC9637514 DOI: 10.1016/j.vaccine.2022.10.080] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Occupational disparities in COVID-19 vaccine uptake can impact the effectiveness of vaccination programmes and introduce particular risk for vulnerable workers and those with high workplace exposure. This study aimed to investigate COVID-19 vaccine uptake by occupation, including for vulnerable groups and by occupational exposure status. METHODS We used data from employed or self-employed adults who provided occupational information as part of the Virus Watch prospective cohort study (n = 19,595) and linked this to study-obtained information about vulnerability-relevant characteristics (age, medical conditions, obesity status) and work-related COVID-19 exposure based on the Job Exposure Matrix. Participant vaccination status for the first, second, and third dose of any COVID-19 vaccine was obtained based on linkage to national records and study records. We calculated proportions and Sison-Glaz multinomial 95% confidence intervals for vaccine uptake by occupation overall, by vulnerability-relevant characteristics, and by job exposure. FINDINGS Vaccination uptake across occupations ranged from 89-96% for the first dose, 87-94% for the second dose, and 75-86% for the third dose, with transport, trade, service and sales workers persistently demonstrating the lowest uptake. Vulnerable workers tended to demonstrate fewer between-occupational differences in uptake than non-vulnerable workers, although clinically vulnerable transport workers (76%-89% across doses) had lower uptake than several other occupational groups (maximum across doses 86%-96%). Workers with low SARS-CoV-2 exposure risk had higher vaccine uptake (86%-96% across doses) than those with elevated or high risk (81-94% across doses). INTERPRETATION Differential vaccination uptake by occupation, particularly amongst vulnerable and highly-exposed workers, is likely to worsen occupational and related socioeconomic inequalities in infection outcomes. Further investigation into occupational and non-occupational factors influencing differential uptake is required to inform relevant interventions for future COVID-19 booster rollouts and similar vaccination programmes.
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Affiliation(s)
- Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK.
| | - Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
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24
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Hoskins S, Beale S, Nguyen V, Boukari Y, Yavlinsky A, Kovar J, Byrne T, Fragaszy E, Fong WLE, Geismar C, Patel P, Navaratnam AMD, van Tongeren M, Johnson AM, Aldridge RW, Hayward A. Relative contribution of essential and non-essential activities to SARS-CoV-2 transmission following the lifting of public health restrictions in England and Wales. Epidemiol Infect 2022; 151:e3. [PMID: 36475452 PMCID: PMC9990391 DOI: 10.1017/s0950268822001832] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We aimed to understand which non-household activities increased infection odds and contributed greatest to SARS-CoV-2 infections following the lifting of public health restrictions in England and Wales. PROCEDURES We undertook multivariable logistic regressions assessing the contribution to infections of activities reported by adult Virus Watch Community Cohort Study participants. We calculated adjusted weighted population attributable fractions (aPAF) estimating which activity contributed greatest to infections. FINDINGS Among 11 413 participants (493 infections), infection was associated with: leaving home for work (aOR 1.35 (1.11-1.64), aPAF 17%), public transport (aOR 1.27 (1.04-1.57), aPAF 12%), shopping once (aOR 1.83 (1.36-2.45)) vs. more than three times a week, indoor leisure (aOR 1.24 (1.02-1.51), aPAF 10%) and indoor hospitality (aOR 1.21 (0.98-1.48), aPAF 7%). We found no association for outdoor hospitality (1.14 (0.94-1.39), aPAF 5%) or outdoor leisure (1.14 (0.82-1.59), aPAF 1%). CONCLUSION Essential activities (work and public transport) carried the greatest risk and were the dominant contributors to infections. Non-essential indoor activities (hospitality and leisure) increased risk but contributed less. Outdoor activities carried no statistical risk and contributed to fewer infections. As countries aim to 'live with COVID', mitigating transmission in essential and indoor venues becomes increasingly relevant.
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Affiliation(s)
- Susan Hoskins
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Annalan M. D. Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
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Tsai J, Byrne T, Hill LL, Flatley B, Harelik N, Deal M. Identifying Graduation Rates and Practices in the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing Program. Community Ment Health J 2022; 59:808-811. [PMID: 36417137 DOI: 10.1007/s10597-022-01057-y] [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: 07/28/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
Graduation from permanent supported housing program (PSH) is an important part of individuals' recovery and rehabilitation, yet little research has examined this process. We examined graduation rates, practices and policies in the U.S. Department of Veterans Affairs-Housing and Urban Development Supportive Housing (HUD-VASH) program, the largest PSH program in the United States. We used HUD-VASH administrative data from Fiscal Years 2016-2020 to summarize graduation rates from the program. Using a template analysis approach to open-ended online surveys from 65 HUD-VASH program managers, we identified key themes related to graduation practices. Graduations accounted for 21% of all HUD-VASH exits across all years. Graduation practices and policies varied across HUD-VASH programs, and staff expressed interest in having additional data to support graduation decisions. There may be value in developing standards for graduation criteria that is shared with clients and providers in supported housing programs in order to titrate care appropriately and support client independence.
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Affiliation(s)
- Jack Tsai
- Homeless Programs Office, U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Washington D.C, USA. .,School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, 77030, Houston, TX, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Thomas Byrne
- Homeless Programs Office, U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Washington D.C, USA.,School of Social Work, Boston University, Boston, MA, USA
| | - Lindsay L Hill
- Homeless Programs Office, Business Intelligence, U.S. Department of Veterans Affairs, Washington D.C, USA
| | - Bessie Flatley
- Homeless Programs Office, Business Intelligence, U.S. Department of Veterans Affairs, Washington D.C, USA
| | - Nicole Harelik
- Homeless Programs Office, Business Intelligence, U.S. Department of Veterans Affairs, Washington D.C, USA
| | - Meghan Deal
- Homeless Programs Office, National Center on Homelessness among Veterans, Housing and Urban Development-Veterans Affairs Supportive Housing Office, U.S. Department of Veterans Affairs, Washington D.C, USA
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Hyde J, Byrne T, Petrakis BA, Yakovchenko V, Kim B, Fincke G, Bolton R, Visher C, Blue-Howells J, Drainoni ML, McInnes DK. Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group. Health Justice 2022; 10:33. [PMID: 36348203 PMCID: PMC9644600 DOI: 10.1186/s40352-022-00195-5] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group. RESULTS There were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period. CONCLUSIONS Augmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.
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Affiliation(s)
- Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
| | - Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Bo Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, USA
| | - Graeme Fincke
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Rendelle Bolton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Christy Visher
- Center for Drug & Health Studies, Department of Sociology and Criminal Justice, University of Delaware, Wilmington, DE, USA
| | - Jessica Blue-Howells
- VA Healthcare for Re-Entry Veterans, U.S. Department of Veteran Affairs, Washington, USA
| | - Mari-Lynn Drainoni
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
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27
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Flike K, Hayman LL, Byrne T, Song Q, Aronowitz T. The impact of patient-centred care on the relationship between access to care and subjective health outcomes amongst people experiencing homelessness: A mediation analysis. Health Soc Care Community 2022; 30:e5755-e5764. [PMID: 36093584 DOI: 10.1111/hsc.14007] [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: 02/28/2022] [Revised: 08/10/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient-centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014-15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler-6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (β = 0.492, p < 0.001; β = 0.311, p < 0.001) and negatively associated with psychological distress (β = -2.53, p < 0.001; β = -1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = -0.21, 95% CI [-0.37, -0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = -0.14, 95% CI [-0.25, -0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient-centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes.
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Affiliation(s)
- Kimberlee Flike
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, Bedford, Massachusetts, USA
| | - Laura L Hayman
- Robert and Donna Manning College Nursing & Health Sciences, University of Massachusetts, Boston, Massachusetts, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Qian Song
- McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, Massachusetts, USA
| | - Teri Aronowitz
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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Cusack M, Montgomery AE, Harris T, Roncarati J, Brecht T, Antonellis C, Byrne T, Tsai J, True G. Providers' reflections on infrastructure and improvements to promote access to care for Veterans experiencing housing instability in rural areas of the United States: A qualitative study. Health Soc Care Community 2022; 30:e6356-e6365. [PMID: 36250724 DOI: 10.1111/hsc.14077] [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: 03/30/2022] [Revised: 08/15/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Veterans in rural areas of the United States face barriers to accessing healthcare and other services, which are intensified for those experiencing housing instability. Recent legislative acts have the potential to address obstacles faced by rural patients in the U.S. This study explores how infrastructure-including features related to the physical and digital environment-impacts the ability of rural Veterans experiencing housing instability to access healthcare and related services from the perspective of homeless service providers within the Veterans Health Administration (VHA). We conducted semi-structured telephone interviews (n = 22) with providers in high/low performing and/or resourced communities across the U.S. in May and June 2021 and analysed transcripts using template analysis. Themes described by providers highlight how infrastructure limitations in rural areas can exacerbate health disparities for Veterans experiencing housing instability, the impact of COVID-19 on service access, and recommendations to enhance service delivery. Providers suggested that VHA reconfigure where and how staff work, identify additional resources for transportation and/or alternative transportation models, and increase Veterans' access to technology and broadband Internet. Federal infrastructure investments should address challenges faced by Veterans experiencing housing instability in rural areas and the concerns of providers connecting them with care.
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Affiliation(s)
- Meagan Cusack
- VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Social Policy & Practice, Philadelphia, Pennsylvania, USA
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Taylor Harris
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles Healthcare System, West Los Angeles, California, USA
| | - Jill Roncarati
- VA Center for Healthcare Outcomes and Implementation Research, Bedford, Massachusetts, USA
| | - Tatiana Brecht
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Christel Antonellis
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
| | - Thomas Byrne
- VA Center for Healthcare Outcomes and Implementation Research, Bedford, Massachusetts, USA
- Boston University School of Social Work, Boston, Massachusetts, USA
| | - Jack Tsai
- VA National Center on Homelessness among Veterans, Washington, District of Columbia, USA
- University of Texas School of Public Health, Dallas, Texas, USA
- Yale School of Medicine, West Haven, Connecticut, USA
| | - Gala True
- VA South Central Mental Illness Research and Education Center, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
- Tulane University School of Medicine, New Orleans, Louisiana, USA
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29
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Nelson RE, Montgomery AE, Suo Y, Cook J, Pettey W, Evans W, Greene T, Gelberg L, Kertesz S, Tsai J, Byrne T. The Impact of Temporary Housing Assistance Expenditures on Subcategories of Health Care Cost for U.S. Veterans Facing Housing Instability. J Health Care Poor Underserved 2022; 33:1821-1843. [PMID: 36341665 DOI: 10.1353/hpu.2022.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to estimate the impact of temporary financial assistance (TFA) for housing-related expenses from the U.S. Department of Veterans Affairs on costs for a variety of health care services. We conducted a retrospective cohort study of Veterans who entered the Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the effect of TFA on health care costs using a multivariable difference-in-difference approach. Outcomes were direct medical costs of health care encounters (i.e., emergency department, outpatient mental health, inpatient mental health, outpatient substance use disorder treatment, and residential behavioral health) in the VA system. Temporary financial assistance was associated with a decrease in ED (-$11, p<.003), outpatient mental health (-$28, p<.001), outpatient substance use disorder treatment (-$25, p<.001), inpatient mental health (-$258, p<.001), and residential behavioral health (-$181, p<.001) costs per quarter for Veterans in the rapid re-housing component of SSVF. These results can inform policy debates regarding proper solutions to housing instability.
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30
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Moloney K, Byrne T, Mathews S, Foran M, Conroy B, Molamphy A, Murphy N, Dillon A, Doyle K, Cunningham C, Romero-Ortuno R. 82 THE IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVITY OF A RAPID-ACCESS GERIATRIC DAY HOSPITAL SERVICE. Age Ageing 2022. [PMCID: PMC9620317 DOI: 10.1093/ageing/afac218.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In the 1970s, Jack Flanagan developed the first Geriatric Day Hospital (GDH) in Ireland. Since, the GDH model of care has evolved to accommodate for the growing demands of our ageing population. Before the COVID-19 pandemic, the operational scope of our GDH was extended to allow for the rapid medical and multidisciplinary assessment and follow-up of older patients. During the pandemic, the GDH did not suspend operations and remained open as a COVID-negative ambulatory pathway. We evaluated the activity of this GDH service. Methods Retrospective Service Evaluation Approval was granted by our Research & Innovation Office (Reference: 7419). Pseudonymised data corresponding to all GDH attendances between January 2017 and December 2021 were retrieved from the hospital electronic records. Yearly trends in proportions were tested with the Chi-square for trend statistic. Trends in monthly attendances were assessed via Statistical Process Control (SPC) charts with three-sigma limits. Statistical significance was set at p<0.05. Results There were 27,278 attendances of patients aged 65 and over to the GDH over the 5-year period (6,362, 5,978, 6,115, 4,306, and 4,517, respectively). Mean age was 82 every year. Of the 7,813 new episodes, yearly proportions referred directly by primary care teams were 10.4%, 29.5%, 38.6%, 24.5%, and 16.3% (p<0.001). SPC charts showed that Apr-May 2020 and Jan-Feb 2021 had significantly lower numbers of review attendances (50-59 and 146-142, respectively, average 324 p/m). However, new appointments did not significantly decline (average 130 p/m). Of the 7,813 new episodes, 2,595 (33.2%) were seen by Physiotherapy, and 1,860 (23.8%) by Occupational Therapy. Conclusion Our GDH saw a sustained number of new attendances and demonstrated increased community availability during the unprecedented COVID-19 crisis, especially during the first wave of the pandemic when hospital access was most affected. A rapid access GDH model can facilitate integrated care at times of crisis to promote ageing in place.
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Affiliation(s)
- K Moloney
- St. James's Hospital , Dublin, Ireland
| | - T Byrne
- St. James's Hospital , Dublin, Ireland
| | - S Mathews
- St. James's Hospital , Dublin, Ireland
| | - M Foran
- St. James's Hospital , Dublin, Ireland
| | - B Conroy
- St. James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St. James's Hospital , Dublin, Ireland
| | - A Dillon
- St. James's Hospital , Dublin, Ireland
| | - K Doyle
- St. James's Hospital , Dublin, Ireland
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31
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Kershaw K, Martelly L, Stevens C, McInnes DK, Silverman A, Byrne T, Aycinena D, Sabin LL, Garvin LA, Vimalananda VG, Hass R. Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study. Digit Health 2022; 8:20552076221129729. [PMID: 36238754 PMCID: PMC9551340 DOI: 10.1177/20552076221129729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess the feasibility and effectiveness of text messaging to increase
outpatient care engagement and medication adherence in an urban homeless
population in Boston. Methods Between July 2017 and April 2018, 62 patients from a clinic serving a
homeless population were sent automated text messages for four months.
Messages were either appointment reminders and medication adherence
suggestions (intervention group) or general health promotion messages
(control group). Medical records were reviewed to evaluate appointment
keeping, emergency room (ER) use, and hospitalizations. Pre- and
post-surveys were administered to measure self-reported medication
adherence. Results No significant differences were found in inpatient or outpatient care between
the intervention and control groups, though differences in no-show rates and
medication adherence approached significance. Appointment no-show rates were
21.0% vs. 30.6% (p = 0.08) for intervention and control,
respectively, and rates of completed appointments were 65.8% vs. 56.7%
(p = 0.12). Mean ER visits were 3.86 vs 2.33
(p = 0.16) for intervention and control groups, and
mean inpatient admissions were 0.6 versus 1.24 (p = 0.42).
Self-reported medication adherence increased from 8.27 to 9.84 in
intervention participants, compared to an increase from 8.27 to 8.68 in
control participants (p = 0.07), on a 1–11 scale. Conclusions Text messaging showed the potential to improve patient engagement in care and
medication adherence in an urban homeless population (findings approaching
but not achieving statistical significance). Work is needed to enhance the
effectiveness of text-messaging interventions, which may involve increasing
ease of use for mobile phones and texting apps, and addressing high rates of
phone theft and loss.
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Affiliation(s)
- Karyn Kershaw
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Department of Health Communication and Promotion,
Boston
University School of Public Health, Boston,
MA, USA
| | - Lisa Martelly
- Department of Epidemiology and Biostatistics,
Boston
University School of Public Health, Boston,
MA, USA
| | - Cassidy Stevens
- Social Services
Department, Massachusetts General Hospital,
Boston, MA, USA
| | - D. Keith McInnes
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,D Keith McInnes, VA Bedford Healthcare
System, Bedford, MA 01730, USA.
| | - Allie Silverman
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Heller School for Social Policy and Management, Brandeis University,
Waltham, MA, USA
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Boston
University School of Social Work, Boston,
MA, USA
| | - Diana Aycinena
- Boston Health
Care for the Homeless Program, Boston, MA,
USA
| | - Lora L. Sabin
- Department of Global Health, Boston University School of Public
Health, Boston, MA, USA
| | - Lynn A. Garvin
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Center for Healthcare Organization and Implementation Research, VA
Boston Healthcare System, Boston, MA, USA
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Section of Endocrinology, Diabetes and Metabolism,
Boston
University School of Medicine, Boston, MA,
USA
| | - Robert Hass
- Boston Health
Care for the Homeless Program, Boston, MA,
USA
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McGarry A, Ni Nualláin A, Byrne T, O'Brien J, Rice C, Breathnach O, Grogan W, McAleer C, McQuillan R, McNally, Cowie E. 1277P The role of palliative care in patients with glioblastoma multiforme: A single centre review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Aldridge RW, Yavlinsky A, Nguyen V, Eyre MT, Shrotri M, Navaratnam AMD, Beale S, Braithwaite I, Byrne T, Kovar J, Fragaszy E, Fong WLE, Geismar C, Patel P, Rodger A, Johnson AM, Hayward A. SARS-CoV-2 antibodies and breakthrough infections in the Virus Watch cohort. Nat Commun 2022; 13:4869. [PMID: 35982056 PMCID: PMC9387883 DOI: 10.1038/s41467-022-32265-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/22/2022] [Indexed: 12/27/2022] Open
Abstract
A range of studies globally demonstrate that the effectiveness of SARS-CoV-2 vaccines wane over time, but the total effect of anti-S antibody levels on risk of SARS-CoV-2 infection and whether this varies by vaccine type is not well understood. Here we show that anti-S levels peak three to four weeks following the second dose of vaccine and the geometric mean of the samples is nine fold higher for BNT162b2 than ChAdOx1. Increasing anti-S levels are associated with a reduced risk of SARS-CoV-2 infection (Hazard Ratio 0.85; 95%CIs: 0.79-0.92). We do not find evidence that this antibody relationship with risk of infection varies by second dose vaccine type (BNT162b2 vs. ChAdOx1). In keeping with our anti-S antibody data, we find that people vaccinated with ChAdOx1 had 1.64 times the odds (95% confidence interval 1.45-1.85) of a breakthrough infection compared to BNT162b2. We anticipate our findings to be useful in the estimation of the protective effect of anti-S levels on risk of infection due to Delta. Our findings provide evidence about the relationship between antibody levels and protection for different vaccines and will support decisions on optimising the timing of booster vaccinations and identifying individuals who should be prioritised for booster vaccination, including those who are older, clinically extremely vulnerable, or received ChAdOx1 as their primary course. Our finding that risk of infection by anti-S level does not interact with vaccine type, but that individuals vaccinated with ChAdOx1 were at higher risk of infection, provides additional support for the use of using anti-S levels for estimating vaccine efficacy.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Max T Eyre
- Centre of Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | - Andrew Hayward
- Centre of Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
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Hoskins S, Beale S, Nguyen V, Fragaszy E, Navaratnam AM, Smith C, French C, Kovar J, Byrne T, Fong WLE, Geismar C, Patel P, Yavlinksy A, Johnson AM, Aldridge RW, Hayward A. Settings for non-household transmission of SARS-CoV-2 during the second lockdown in England and Wales - analysis of the Virus Watch household community cohort study. Wellcome Open Res 2022; 7:199. [PMID: 36874571 PMCID: PMC9975411 DOI: 10.12688/wellcomeopenres.17981.1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: "Lockdowns" to control serious respiratory virus pandemics were widely used during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited information to understand the settings in which most transmission occurs during lockdowns, to support refinement of similar policies for future pandemics. Methods: Among Virus Watch household cohort participants we identified those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outside the household. Using survey activity data, we undertook multivariable logistic regressions assessing the contribution of activities on non-household infection risk. We calculated adjusted population attributable fractions (APAF) to estimate which activity accounted for the greatest proportion of non-household infections during the pandemic's second wave. Results: Among 10,858 adults, 18% of cases were likely due to household transmission. Among 10,475 participants (household-acquired cases excluded), including 874 non-household-acquired infections, infection was associated with: leaving home for work or education (AOR 1.20 (1.02 - 1.42), APAF 6.9%); public transport (more than once per week AOR 1.82 (1.49 - 2.23), public transport APAF 12.42%); and shopping (more than once per week AOR 1.69 (1.29 - 2.21), shopping APAF 34.56%). Other non-household activities were rare and not significantly associated with infection. Conclusions: During lockdown, going to work and using public or shared transport independently increased infection risk, however only a minority did these activities. Most participants visited shops, accounting for one-third of non-household transmission. Transmission in restricted hospitality and leisure settings was minimal suggesting these restrictions were effective. If future respiratory infection pandemics emerge these findings highlight the value of working from home, using forms of transport that minimise exposure to others, minimising exposure to shops and restricting non-essential activities.
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Affiliation(s)
- Susan Hoskins
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, Greater London, WC1E 7HT, UK
| | - Annalan M.D. Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Colette Smith
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Clare French
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Uinversity of Bristol, Bristol, BS8 2BN, UK
| | - Jana Kovar
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Alexei Yavlinksy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
| | - Andrew Hayward
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
| | - Virus Watch Collaborative
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK
- Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, Greater London, WC1E 7HT, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Uinversity of Bristol, Bristol, BS8 2BN, UK
- Institute for Global Health, University College London, London, WC1N 1EH, UK
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Byrne T, Hoang M, Montgomery AE, Johns E, Shinn M, Mijanovich T, Culhane D, Doran KM. Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients. JAMA Netw Open 2022; 5:e2226691. [PMID: 35969399 PMCID: PMC9379745 DOI: 10.1001/jamanetworkopen.2022.26691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite increasing interest in assessing patient social needs in health care settings, there has been little research examining the performance of housing-related screening questions. OBJECTIVE To examine the performance of 2 single-item screening questions assessing emergency department (ED) patients' self-perceived risk of future homelessness. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted among a randomly selected sample of adult ED patients from 2016 to 2017 in a public hospital ED in New York City. Data were analyzed from September 2019 through October 2021. EXPOSURES Responses on patient surveys conducted at the baseline ED visit for 2 single-item screening questions on self-perceived risk for future housing instability and homelessness were collected. One question asked patients if they were worried about having stable housing in the next 2 months, and the other question asked them to rate the likelihood that they would enter a homeless shelter in the next 6 months. OUTCOMES Homeless shelter entry 2, 6, and 12 months after an ED visit, assessed using shelter administrative data in the study city, which was linked with participant baseline survey responses. RESULTS There were 1919 study participants (976 [51.0%] men and 931 [48.6%] women among 1915 individuals with gender data; 700 individuals aged 31-50 years [36.5%] among 1918 individuals with age data; 1126 Hispanic or Latinx individuals [59.0%], 368 non-Hispanic Black individuals [19.3%], and 225 non-Hispanic White individuals [11.8%] among 1908 individuals with race and ethnicity data). Within 2, 6, and 12 months of the ED visit, 45 patients (2.3%), 66 patients (3.4%), and 95 patients (5.0%) had entered shelter, respectively. For both single-item screening questions, participants who answered affirmatively had significantly higher likelihood of future shelter entry at each time point examined (eg, at 2 months: 31 participants responding yes [6.5%] vs 14 participants responding no [1.0%] to the question concerning being worried about having stable housing in the next 2 months). Sensitivity of the screening questions ranged from 0.27 to 0.69, specificity from 0.76 to 0.97, positive predictive value from 0.07 to 0.27, and area under the receiver operating characteristic curve from 0.62 to 0.72. CONCLUSIONS AND RELEVANCE This study found that 2 single-item screening questions assessing ED patient self-perceived risk of future housing instability and homelessness had adequate to good performance in identifying risk for future shelter entry. Such single-item screening questions should be further tested before broad adoption.
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Affiliation(s)
- Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts
| | - Mindy Hoang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ann Elizabeth Montgomery
- School of Public Health, University of Alabama at Birmingham, Birmingham
- Birmingham Veterans Affairs Health Care System, Birmingham, Alabama
| | - Eileen Johns
- New York City Center for Innovation through Data Intelligence, New York, New York
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, New York University Steinhardt School, New York, New York
| | - Dennis Culhane
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Kelly M. Doran
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
- Department of Population Health, New York University School of Medicine, New York, New York
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Yavlinsky A, Beale S, Nguyen V, Shrotri M, Byrne T, Geismar C, Fragaszy E, Hoskins S, Fong WLE, Navaratnam AMD, Braithwaite I, Patel P, Kovar J, Hayward A, Aldridge RW. Anti-spike antibody trajectories in individuals previously immunised with BNT162b2 or ChAdOx1 following a BNT162b2 booster dose. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17914.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The two most common SARS-CoV-2 vaccines in the UK, BNT162b2 (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca), employ different immunogenic mechanisms. Compared to BNT162b2, two-dose immunisation with ChAdOx1 induces substantially lower peak anti-spike antibody (anti-S) levels and is associated with a higher risk of breakthrough infections. To provide preliminary indication of how a third booster BNT162b2 dose impacts anti-S levels, we performed a cross-sectional analysis using capillary blood samples from vaccinated adults participating in Virus Watch, a prospective community cohort study in England and Wales. Methods: Blood samples were analysed using Roche Elecsys Anti-SARS-CoV-2 S immunoassay. We analysed anti-S levels by week since the third dose for vaccines administered on or after 1 September 2021 and stratified the results by second-dose vaccine type (ChAdOx1 or BNT162b2), age, sex and clinical vulnerability. Results: Anti-S levels peaked at two weeks post-booster for BNT162b2 (22,185 U/mL; 95%CI: 21,406-22,990) and ChAdOx1 second-dose recipients (19,203 U/mL; 95%CI: 18,094-20,377). These were higher than the corresponding peak antibody levels post-second dose for BNT162b2 (12,386 U/mL; 95%CI: 9,801-15,653, week 2) and ChAdOx1 (1,192 U/mL; 95%CI: 818-1735, week 3). No differences emerged by second dose vaccine type, age, sex or clinical vulnerability. Anti-S levels declined post-booster for BNT162b2 (half-life=44 days) and ChAdOx1 second dose recipients (half-life=40 days). These rates of decline were steeper than those post-second dose for BNT162b2 (half-life=54 days) and ChAdOx1 (half-life=80 days). Conclusions: Our findings suggest that peak anti-S levels are higher post-booster than post-second dose, but levels are projected to be similar after six months for BNT162b2 recipients. Higher peak anti-S levels post-booster may partially explain the increased effectiveness of booster vaccination compared to two-dose vaccination against symptomatic infection with the Omicron variant. Faster waning trajectories post-third dose may have implications for the timing of future booster campaigns or four-dose vaccination regimens for the clinically vulnerable.
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Rubenstein E, Bock E, Brochu P, Byrne T. Quantifying the intersection of disability and homelessness in Massachusetts public schools in 2018-2019. Child Care Health Dev 2022; 48:569-577. [PMID: 35018667 DOI: 10.1111/cch.12961] [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: 06/14/2021] [Revised: 11/08/2021] [Accepted: 01/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Homelessness has a major impact on the educational and health trajectories of children. Youth with disabilities may be especially vulnerable to experiencing homelessness, but little epidemiological work has been done to characterize dual disparity. Our goal was to describe the relationship between homelessness and disability among students (age 3-21) receiving public education in Massachusetts in 2018-2019. We evaluated the proportion of students with and without disabilities experiencing homelessness by county and school district. METHODS We used publicly available data from the United States and Massachusetts Department's of Education. These data used the McKinney Vento Homelessness Assistance Act definition of homelessness which is a lack of fixed, adequate, and regular housing, and disability was determined by the presence of an individualized education program or individualized family service plan. We calculated percentages of students with and without disabilities experiencing homelessness at the state, county, and district level and calculated and mapped risk of homelessness comparing students and without disability. We also determined the occurrence of disability among those experiencing homelessness. RESULTS In Massachusetts public schools, 3.5% of students with disabilities experienced homelessness compared with 2.4% of students without disabilities (relative risk 1.50, 95% CI: 1.47, 1.53). A greater proportion of students with disabilities experienced homelessness compared with students without disabilities in all counties. In sum, 24.8% of students experiencing homelessness had a reported disability. CONCLUSIONS In Massachusetts public schools, a greater proportion of students with disabilities experience homelessness compared with students without disabilities, and disability is common among students experiencing homelessness. We hypothesize potential mechanisms, such as the financial cost of disability, that may lead to this finding. Findings support the need for additional funding and interventions for school districts and communities to better serve vulnerable students with disabilities experiencing homelessness.
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Affiliation(s)
- Eric Rubenstein
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Emily Bock
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Paige Brochu
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts, USA
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Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol 2022; 90:413-426. [PMID: 35404638 PMCID: PMC9426716 DOI: 10.1037/ccp0000721] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Moral reconation therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. METHOD In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). RESULTS Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p = .63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose-that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Daniel M. Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Thomas Byrne
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Paige M. Shaffer
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Brenna Giordano
- Clinical Psychology PhD Program, Palo Alto University, Palo Alto, CA USA
| | - Jennifer S. Smith
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Christine Timko
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Joel Rosenthal
- Veterans Justice Programs, Veterans Health Administration, Washington DC USA
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
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Beale S, Hoskins S, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam AM, Nguyen V, Patel P, Yavlinsky A, Johnson AM, Van Tongeren M, Aldridge RW, Hayward A. Workplace contact patterns in England during the COVID-19 pandemic: Analysis of the Virus Watch prospective cohort study. Lancet Reg Health Eur 2022; 16:100352. [PMID: 35475035 PMCID: PMC9023315 DOI: 10.1016/j.lanepe.2022.100352] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Background Workplaces are an important potential source of SARS-CoV-2 exposure; however, investigation into workplace contact patterns is lacking. This study aimed to investigate how workplace attendance and features of contact varied between occupations across the COVID-19 pandemic in England. Methods Data were obtained from electronic contact diaries (November 2020-November 2021) submitted by employed/self-employed prospective cohort study participants (n=4,616). We used mixed models to investigate the effects of occupation and time for: workplace attendance, number of people sharing workspace, time spent sharing workspace, number of close contacts, and usage of face coverings. Findings Workplace attendance and contact patterns varied across occupations and time. The predicted probability of intense space sharing during the day was highest for healthcare (78% [95% CI: 75-81%]) and education workers (64% [59%-69%]), who also had the highest probabilities for larger numbers of close contacts (36% [32%-40%] and 38% [33%-43%] respectively). Education workers also demonstrated relatively low predicted probability (51% [44%-57%]) of wearing a face covering during close contact. Across all occupational groups, workspace sharing and close contact increased and usage of face coverings decreased during phases of less stringent restrictions. Interpretation Major variations in workplace contact patterns and mask use likely contribute to differential COVID-19 risk. Patterns of variation by occupation and restriction phase may inform interventions for future waves of COVID-19 or other respiratory epidemics. Across occupations, increasing workplace contact and reduced face covering usage is concerning given ongoing high levels of community transmission and emergence of variants. Funding Medical Research Council; HM Government; Wellcome Trust.
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Affiliation(s)
- Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Annalan M.D. Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Virus Watch Collaborative
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Institute for Global Health, University College London, London WC1N 1EH, UK
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
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40
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Beale S, Patel P, Rodger A, Braithwaite I, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam A, Nguyen V, Shrotri M, Aryee A, Aldridge R, Hayward A. Occupation, work-related contact and SARS-CoV-2 anti-nucleocapsid serological status: findings from the Virus Watch prospective cohort study. Occup Environ Med 2022; 79:oemed-2021-107920. [PMID: 35450951 PMCID: PMC9072780 DOI: 10.1136/oemed-2021-107920] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Risk of SARS-CoV-2 infection varies across occupations; however, investigation into factors underlying differential risk is limited. We aimed to estimate the total effect of occupation on SARS-CoV-2 serological status, whether this is mediated by workplace close contact, and how exposure to poorly ventilated workplaces varied across occupations. METHODS We used data from a subcohort (n=3775) of adults in the UK-based Virus Watch cohort study who were tested for SARS-CoV-2 anti-nucleocapsid antibodies (indicating natural infection). We used logistic decomposition to investigate the relationship between occupation, contact and seropositivity, and logistic regression to investigate exposure to poorly ventilated workplaces. RESULTS Seropositivity was 17.1% among workers with daily close contact vs 10.0% for those with no work-related close contact. Compared with other professional occupations, healthcare, indoor trade/process/plant, leisure/personal service, and transport/mobile machine workers had elevated adjusted total odds of seropositivity (1.80 (1.03 to 3.14) - 2.46 (1.82 to 3.33)). Work-related contact accounted for a variable part of increased odds across occupations (1.04 (1.01 to 1.08) - 1.23 (1.09 to 1.40)). Occupations with raised odds of infection after accounting for work-related contact also had greater exposure to poorly ventilated workplaces. CONCLUSIONS Work-related close contact appears to contribute to occupational variation in seropositivity. Reducing contact in workplaces is an important COVID-19 control measure.
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Affiliation(s)
- Sarah Beale
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Parth Patel
- UCL Institute of Health Informatics, University College London, London, UK
| | - Alison Rodger
- UCL Institute of Health Informatics, University College London, London, UK
| | - Isobel Braithwaite
- Extreme Events and Health Protection Team, Centre for Radiation, Chemicals and Environmental Hazards, Public Health England, London, UK
| | - Thomas Byrne
- UCL Institute of Health Informatics, University College London, London, UK
| | | | - Ellen Fragaszy
- UCL Institute of Health Informatics, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Cyril Geismar
- UCL Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- UCL Institute of Health Informatics, University College London, London, UK
| | - Annalan Navaratnam
- UCL Institute of Health Informatics, University College London, London, UK
| | - Vincent Nguyen
- UCL Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
| | - Anna Aryee
- UCL Institute of Health Informatics, University College London, London, UK
| | - Robert Aldridge
- UCL Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
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McInnes DK, Troszak LK, Fincke BG, Shwartz M, Midboe AM, Gifford AL, Dunlap S, Byrne T. Is the Availability of Direct-Acting Antivirals Associated with Increased Access to Hepatitis C Treatment for Homeless and Unstably Housed Veterans? J Gen Intern Med 2022; 37:1038-1044. [PMID: 34173193 PMCID: PMC8971232 DOI: 10.1007/s11606-021-06933-z] [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: 01/06/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Hepatitis C virus (HCV) treatment has experienced a rapid transformation in the USA. New direct-acting antiviral (DAA) medications make treatment easier, less toxic, and more successful (90% or greater viral cure) than prior, interferon-based HCV medications. We sought to determine whether DAAs may have improved access to HCV treatment for hard-to-reach populations such as the homeless. METHODS In a retrospective study of VA electronic medical record data, a cohort was created of 63,586 veterans with a positive HCV RNA or genotype test taken at any point from January 1, 2012, through December 31, 2016. Patient data were examined for up to 5 years using a discrete time survival model to assess the relationship between their housing status and receipt of HCV medications in 6-month time periods in both the interferon and DAA eras. RESULTS In the interferon era, the probability of HCV treatment in a given 6-month window among housed veterans, at 6.2% (95% CI: 5.3-7.1%) was significantly higher than among veterans who were homeless or unstably housed; for example, among currently homeless veterans, the probability of treatment initiation, in a given 6-month window, was 2.6% (95% CI: 1.9-3.3%). With the arrival of DAAs, each housing category had an increased probability of treatment initiation. For housed veterans, the probability was 8.6% (95% CI: 8.3-8.9%) while for currently homeless veterans, it was 6.3% (95% CI: 5.7-6.9%). CONCLUSIONS We found a clear indication that the likelihood of treatment initiation was greater for all veterans in the DAA era as compared to the interferon era. However, disparities in treatment initiation rates between housed and homeless veterans that were observed in the interferon era persisted in the DAA era.
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Affiliation(s)
- D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA. .,Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, Boston, USA.
| | - Lara K Troszak
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Stanford University School of Medicine, CA, Stanford, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, Boston, USA
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Stanford University School of Medicine, CA, Stanford, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Departments of Medicine, and Health Law, Policy, and Management, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Boston University School of Social Work, Boston, MA, USA
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Byrne T, Cashy J, Metraux S, Blosnich JR, Cusack M, Culhane DP, McInnes DK, Culhane E, Montgomery AE. Association Between Registered Sex Offender Status and Risk of Housing Instability and Homelessness among Veterans. J Interpers Violence 2022; 37:NP5818-NP5829. [PMID: 32960141 DOI: 10.1177/0886260520959646] [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: 06/11/2023]
Abstract
Research is limited about whether and to what extent registered sex offenders (RSOs) face an increased risk of housing instability. The intersection of RSO and housing instability is particularly salient for veterans as there are disproportionately higher rates of veterans among both RSOs and homeless populations. This study assessed the relationship between RSO status and risk of housing instability and homelessness among military veterans. We matched a list of 373,774 RSOs obtained from publicly available sex offender registries in 19 states with a cohort of 5.9 million veterans who responded to a brief screening for housing instability administered throughout the Veterans Health Administration between 2012 and 2016. Logistic regression estimated adjusted odds of any housing instability and homelessness among veterans identified as RSOs. Veterans identified as RSOs had 1.81 (95% confidence interval [CI] 1.46-2.25) and 2.97 (95% CI 1.67-5.17) times greater odds of reporting any housing instability and homelessness, respectively, than non-RSOs. Findings represent some of the strongest evidence to date for the high risk of housing instability and homelessness among RSOs, suggesting a clear gap in policy and programmatic responses to their unique housing needs. Evidence-based alternative approaches to residence restriction laws may reduce recidivism and protect public safety.
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Affiliation(s)
- Thomas Byrne
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University School of Social Work, Boston MA, USA
| | - John Cashy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA
| | - Stephen Metraux
- Biden School of Public Policy & Administration, University of Delaware, Newark, DE, USA
| | - John R Blosnich
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Meagan Cusack
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Dennis P Culhane
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA
- School of Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
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Inoue M, Kim M, Inoue T, Tait M, Byrne T, Nitschké M, Murer P, Cha H, Subramanian A, De Silva N, Chiaverotti T, McDonald DM. Oncolytic vaccinia virus injected intravenously sensitizes pancreatic neuroendocrine tumors and metastases to immune checkpoint blockade. Mol Ther Oncolytics 2022; 24:299-318. [PMID: 35118189 PMCID: PMC8783073 DOI: 10.1016/j.omto.2021.12.016] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
This study determined the influence of intravenous (i.v.) oncolytic vaccinia virus mpJX-594 (mpJX) on antitumor activity of anti-programmed death receptor-1 antibody (aPD1) in functional and metastatic pancreatic neuroendocrine tumors (PanNETs). One i.v. dose of mpJX, engineered for mice with the same plasmid design as clinical virus Pexa-Vec, was administered alone or with repeated dosing of aPD1 (mpJX+aPD1) to two contrasting genetic models of PanNET: one developing benign insulin-secreting tumors (RIP1-Tag2;C57BL/6J mice) and the other developing liver metastases (RIP1-Tag2;AB6F1 mice). Experiments revealed that aPD1 had synergistic actions with mpJX on CD8+ T cell and natural killer (NK) cell influx, apoptosis, and suppression of proliferation in PanNETs. After mpJX+aPD1, the 53-fold increase in apoptosis (5 days) and 85% reduction in proliferation (20 days) exceeded the sum of mpJX and aPD1 given separately. mpJX+aPD1 also stabilized blood insulin and glucose in mice with functional PanNETs, regressed liver metastases in mice with aggressive PanNETs, and prolonged survival of both. The findings revealed that mpJX+aPD1 converted “cold” PanNETs into immunogenic tumors with widespread cytotoxic T cell influx, tumor cell killing, and suppression of proliferation. Reduction of tumor insulin secretion from functional PanNETs prolonged survival, and anti-metastatic actions on aggressive PanNETs reduced the metastatic burden to less than before treatment. The findings support the efficacy of the vaccinia virus with aPD1 for functional and metastatic PanNETs.
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Affiliation(s)
- Mitsuko Inoue
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Minah Kim
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Tomoyoshi Inoue
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Madeline Tait
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Thomas Byrne
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Maximilian Nitschké
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Patrizia Murer
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Howard Cha
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Aishwarya Subramanian
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
| | - Naomi De Silva
- SillaJen Biotherapeutics Inc., San Francisco, CA 94111, USA
| | | | - Donald M McDonald
- UCSF Helen Diller Family Comprehensive Cancer Center, Cardiovascular Research Institute and Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, Room S1349, San Francisco, CA 94143-0452, USA
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Smelson DA, Yakovchenko V, Byrne T, McCullough MB, Smith JL, Bruzios KE, Gabrielian S. Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial. PLoS One 2022; 17:e0265396. [PMID: 35298514 PMCID: PMC8929696 DOI: 10.1371/journal.pone.0265396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare systems face difficulty implementing evidence-based practices, particularly multicomponent interventions. Additional challenges occur in settings serving vulnerable populations such as homeless Veterans, given the population’s acuity, multiple service needs, and organizational barriers. Implementation Facilitation (IF) is a strategy to support the uptake of evidence-based practices. This study’s aim was to simultaneously examine IF on the uptake of Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking-Veterans Edition (MISSION-Vet), an evidence-based multicomponent treatment engagement intervention for homeless Veterans with co-occurring mental health and substance abuse, and clinical outcomes among Veterans receiving MISSION-Vet. Methods This multi-site hybrid III modified stepped-wedge trial involved seven programs at two Veterans Affairs Medical Centers comparing Implementation as Usual (IU; training and educational materials) to IF (IU + internal and external facilitation). Results A total of 110 facilitation events averaging 27 minutes were conducted, of which 85% were virtual. Staff (case managers and peer specialists; n = 108) were trained in MISSION-Vet and completed organizational readiness assessments (n = 77). Although both sites reported being willing to innovate and a desire to improve outcomes, implementation climate significantly differed. Following IU, no staff at either site conducted MISSION-Vet. Following IF, there was a significant MISSION-Vet implementation difference between sites (53% vs. 14%, p = .002). Among the 93 Veterans that received any MISSION-Vet services, they received an average of six sessions. Significant positive associations were found between number of MISSION-Vet sessions and outpatient treatment engagement measured by the number of outpatient visits attended. Conclusions While staff were interested in improving patient outcomes, MISSION-Vet was not implemented with IU. IF supported MISSION-Vet uptake and increased outpatient service utilization, but MISSION-Vet still proved difficult to implement particularly in the larger healthcare system. Future studies might tailor implementation strategies to organizational readiness. Trial registration ClinicalTrials.gov, NCT02942979.
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Affiliation(s)
- David A. Smelson
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
| | - Vera Yakovchenko
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
| | - Thomas Byrne
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- School of Social Work, Boston University, Boston, Massachusetts, United States of America
| | - Megan B. McCullough
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Jeffrey L. Smith
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States of America
| | - Kathryn E. Bruzios
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Sonya Gabrielian
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, United States of America
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
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Fragaszy E, Shrotri M, Geismar C, Aryee A, Beale S, Braithwaite I, Byrne T, Eyre MT, Fong WLE, Gibbs J, Hardelid P, Kovar J, Lampos V, Nastouli E, Navaratnam AM, Nguyen V, Patel P, Aldridge RW, Hayward A. Symptom profiles and accuracy of clinical case definitions for COVID-19 in a community cohort: results from the Virus Watch study. Wellcome Open Res 2022; 7:84. [PMID: 37745779 PMCID: PMC10514573 DOI: 10.12688/wellcomeopenres.17479.1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 09/23/2023] Open
Abstract
Background: Understanding symptomatology and accuracy of clinical case definitions for community COVID-19 cases is important for Test, Trace and Isolate (TTI) and future targeting of early antiviral treatment. Methods: Community cohort participants prospectively recorded daily symptoms and swab results (mainly undertaken through the UK TTI system). We compared symptom frequency, severity, timing, and duration in test positive and negative illnesses. We compared the test performance of the current UK TTI case definition (cough, high temperature, or loss of or altered sense of smell or taste) with a wider definition adding muscle aches, chills, headache, or loss of appetite. Results: Among 9706 swabbed illnesses, including 973 SARS-CoV-2 positives, symptoms were more common, severe and longer lasting in swab positive than negative illnesses. Cough, headache, fatigue, and muscle aches were the most common symptoms in positive illnesses but also common in negative illnesses. Conversely, high temperature, loss or altered sense of smell or taste and loss of appetite were less frequent in positive illnesses, but comparatively even less frequent in negative illnesses. The current UK definition had 81% sensitivity and 47% specificity versus 93% and 27% respectively for the broader definition. 1.7-fold more illnesses met the broader case definition than the current definition. Conclusions: Symptoms alone cannot reliably distinguish COVID-19 from other respiratory illnesses. Adding additional symptoms to case definitions could identify more infections, but with a large increase in the number needing testing and the number of unwell individuals and contacts self-isolating whilst awaiting results.
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Affiliation(s)
- Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anna Aryee
- Centre of Health Informatics, Computing and Statistics, Lancaster University, Lancaster, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Max T. Eyre
- Centre of Health Informatics, Computing and Statistics, Lancaster University, Lancaster, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching Department, University College London, London, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vasileios Lampos
- Department of Computer Science, University College London, London, UK
| | - Eleni Nastouli
- Francis Crick Institute, London, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Annalan M.D. Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Virus Watch Collaborative
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
- Centre of Health Informatics, Computing and Statistics, Lancaster University, Lancaster, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
- Institute for Global Health, University College London, London, UK
- Population, Policy and Practice Research and Teaching Department, University College London, London, UK
- Department of Computer Science, University College London, London, UK
- Francis Crick Institute, London, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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46
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Anzinger JJ, Mears CD, Ades AE, Francis K, Phillips Y, Leys YE, Spyer MJ, Brown D, de Filippis AMB, Nastouli E, Byrne T, Bailey H, Palmer P, Bryan L, Webster-Kerr K, Giaquinto C, Thorne C, Christie CDC. Antenatal Seroprevalence of Zika and Chikungunya Viruses, Kingston Metropolitan Area, Jamaica, 2017–2019. Emerg Infect Dis 2022; 28:473-475. [PMID: 35076369 PMCID: PMC8798668 DOI: 10.3201/eid2802.211849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To determine the extent of exposure to Zika virus (ZIKV) and chikungunya virus (CHIKV) in Jamaica, we collected serum from 584 pregnant women during 2017–2019. We found that 15.6% had antibodies against ZIKV and 83.6% against CHIKV. These results indicate potential recirculation of ZIKV but not CHIKV in the near future.
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Geismar C, Fragaszy E, Nguyen V, Fong WLE, Shrotri M, Beale S, Rodger A, Lampos V, Byrne T, Kovar J, Navaratnam AMD, Patel P, Aldridge RW, Hayward A. Household serial interval of COVID-19 and the effect of Variant B.1.1.7: analyses from prospective community cohort study (Virus Watch). Wellcome Open Res 2022; 6:224. [PMID: 34796276 PMCID: PMC8564743 DOI: 10.12688/wellcomeopenres.16974.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction: Increased transmissibility of B.1.1.7 variant of concern (VOC) in the UK may explain its rapid emergence and global spread. We analysed data from putative household infector - infectee pairs in the Virus Watch Community cohort study to assess the serial interval of COVID-19 and whether this was affected by emergence of the B.1.1.7 variant. Methods: The Virus Watch study is an online, prospective, community cohort study following up entire households in England and Wales during the COVID-19 pandemic. Putative household infector-infectee pairs were identified where more than one person in the household had a positive swab matched to an illness episode. Data on whether or not individual infections were caused by the B.1.1.7 variant were not available. We therefore developed a classification system based on the percentage of cases estimated to be due to B.1.1.7 in national surveillance data for different English regions and study weeks. Results: Out of 24,887 illnesses reported, 915 tested positive for SARS-CoV-2 and 186 likely ‘infector-infectee’ pairs in 186 households amongst 372 individuals were identified. The mean COVID-19 serial interval was 3.18 (95%CI: 2.55-3.81, sd=4.36) days. There was no significant difference (p=0.267) between the mean serial interval for VOC hotspots (mean = 3.64 days, (95%CI: 2.55 – 4.73)) days and non-VOC hotspots, (mean = 2.72 days, (95%CI: 1.48 – 3.96)). Conclusions: Our estimates of the average serial interval of COVID-19 are broadly similar to estimates from previous studies and we find no evidence that B.1.1.7 is associated with a change in serial intervals. Alternative explanations such as increased viral load, longer period of viral shedding or improved receptor binding may instead explain the increased transmissibility and rapid spread and should undergo further investigation.
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Affiliation(s)
- Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Vincent Nguyen
- Institute of Epidemiology and Health Care, University College London, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Sarah Beale
- Institute of Epidemiology and Health Care, University College London, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Vasileios Lampos
- Department of Computer Science, University College London, London, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Annalan M D Navaratnam
- Institute of Epidemiology and Health Care, University College London, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
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Abstract
The accurate identification of persons at risk of exiting permanent supportive housing could help maximize client success and minimize attrition and premature exits from such housing. Thus, in the present study, we developed and tested multivariable prediction models of negative and positive exits from the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program using logistic regression and random forests. We compared the performance of these models with clinical predictions made by HUD-VASH program case managers. We selected a cohort of all 92,196 Veterans who entered HUD-VASH nationwide between October 1, 2014 and September 30, 2019, 70% of whom were randomly selected to serve as the development cohort and the remaining 30% of whom served as the validation cohort. Negative and positive exits were measured until September 30, 2019. A subset of 1,264 Veterans was used to compare performance of models with clinical judgment. Predictor variables included sociodemographic characteristics, health and behavioral health diagnoses, homeless/housing history, and VA service utilization history. Performance of models and clinical judgment were assessed using an array of metrics including area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and positive predictive value. The logistic regression and random forest models had similar, modest performance in predicting negative and positive exits. These models were substantially more sensitive, yet far less specific in predicting exits than clinician ratings. Study findings highlight the challenges and tradeoffs in using actuarial models or case manager predictions to target interventions to Veterans at risk of exiting HUD-VASH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Thomas Byrne
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
- Boston University School of Social Work, Boston, MA
| | - Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans
- School of Public Health, University of Texas Health Science Center, Houston, TX
- Department of Psychiatry, Yale University, New Haven, CT
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49
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Aldridge RW, Pineo H, Fragaszy E, Eyre MT, Kovar J, Nguyen V, Beale S, Byrne T, Aryee A, Smith C, Devakumar D, Taylor J, Katikireddi SV, Fong WLE, Geismar C, Patel P, Shrotri M, Braithwaite I, Patni N, Navaratnam AMD, Johnson A, Hayward A. Household overcrowding and risk of SARS-CoV-2: analysis of the Virus Watch prospective community cohort study in England and Wales. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17308.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Household overcrowding is associated with increased risk of infectious diseases across contexts and countries. Limited data exist linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and SARS-CoV-2. Methods: The Virus Watch study is a household community cohort of acute respiratory infections in England and Wales. We calculated overcrowding using the measure of persons per room for each household. We considered two primary outcomes: PCR-confirmed positive SARS-CoV-2 antigen tests and laboratory-confirmed SARS-CoV-2 antibodies. We used mixed-effects logistic regression models that accounted for household structure to estimate the association between household overcrowding and SARS-CoV-2 infection. Results: 26,367 participants were included in our analyses. The proportion of participants with a positive SARS-CoV-2 PCR result was highest in the overcrowded group (9.0%; 99/1,100) and lowest in the under-occupied group (4.2%; 980/23,196). In a mixed-effects logistic regression model, we found strong evidence of an increased odds of a positive PCR SARS-CoV-2 antigen result (odds ratio 2.45; 95% CI:1.43–4.19; p-value=0.001) and increased odds of a positive SARS-CoV-2 antibody result in individuals living in overcrowded houses (3.32; 95% CI:1.54–7.15; p-value<0.001) compared with people living in under-occupied houses. Conclusion: Public health interventions to prevent and stop the spread of SARS-CoV-2 should consider the risk of infection for people living in overcrowded households and pay greater attention to reducing household transmission.
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50
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Byrne T, Patel P, Shrotri M, Beale S, Michie S, Butt J, Hawkins N, Hardelid P, Rodger A, Aryee A, Braithwaite I, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam AMD, Nguyen V, Hayward A, Aldridge RW. Trends, patterns and psychological influences on COVID-19 vaccination intention: Findings from a large prospective community cohort study in England and Wales (Virus Watch). Vaccine 2021; 39:7108-7116. [PMID: 34728095 PMCID: PMC8498741 DOI: 10.1016/j.vaccine.2021.09.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vaccination intention is key to the success of any vaccination programme, alongside vaccine availability and access. Public intention to take a COVID-19 vaccine is high in England and Wales compared to other countries, but vaccination rate disparities between ethnic, social and age groups has led to concern. METHODS Online survey of prospective household community cohort study participants across England and Wales (Virus Watch). Vaccination intention was measured by individual participant responses to 'Would you accept a COVID-19 vaccine if offered?', collected in December 2020 and February 2021. Responses to a 13-item questionnaire collected in January 2021 were analysed using factor analysis to investigate psychological influences on vaccination intention. RESULTS Survey response rate was 56% (20,785/36,998) in December 2020 and 53% (20,590/38,727) in February 2021, with 14,880 adults reporting across both time points. In December 2020, 1,469 (10%) participants responded 'No' or 'Unsure'. Of these people, 1,266 (86%) changed their mind and responded 'Yes' or 'Already had a COVID-19 vaccine' by February 2021. Vaccination intention increased across all ethnic groups and levels of social deprivation. Age was most strongly associated with vaccination intention, with 16-24-year-olds more likely to respond "Unsure" or "No" versus "Yes" than 65-74-year-olds in December 2020 (OR: 4.63, 95 %CI: 3.42, 6.27 & OR 7.17 95 %CI: 4.26, 12.07 respectively) and February 2021 (OR: 27.92 95 %CI: 13.79, 56.51 & OR 17.16 95 %CI: 4.12, 71.55). The association between ethnicity and vaccination intention weakened, but did not disappear, over time. Both vaccine- and illness-related psychological factors were shown to influence vaccination intention. CONCLUSIONS Four in five adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind in February 2021 and planned to accept, or had already accepted, a vaccine.
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Affiliation(s)
- Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK.
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK.
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jabeer Butt
- Race Equality Foundation, 27 Greenwood Pl, London NW5 1LB, UK
| | | | - Pia Hardelid
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK
| | - Alison Rodger
- Institute for Global Health, University College London, 30 Guilford St, London WC1N 1EH, UK; Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Anna Aryee
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College, 222 Euston Rd, London NW1 2DA, UK.
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